midazolam

midazolam

Indication

  • Treatment of refractory seizures after other therapies such as PHENobarbital, levETIRAcetam or phenytoin have failed
  • Sedation

Dosage Guidelines

Seizures: 0.15 mg/kg IV direct followed by 2 micrograms/kg/minute IV continuous infusion. If seizures continue, give 0.15 mg/kg bolus and increase infusion rate by 2 microgram/kg/min q5 minutes as needed to a maximum of 24 microgram/kg/min.

If no seizures for 48 hours, taper by 1 microgram/kg/min q15 minutes. If seizure recurs during taper, give 0.15 mg/kg IV direct and resume prior infusion rate for 48 hours

Sedation:

  • Loading dose: 0.05-0.1 mg/kg/dose IV direct over 5 minutes
  • Maintenace dose: 0.16-1 microgram/kg/min IV via continuous infusion
  • Procedural sedation: 0.05-1 mg/kg/dose IV direct/IM or 0.1-0.2 mg/kg/dose intranasal (administer approximately half total volume in each nostril)

Administration

  • IM
  • IV direct over 5 minutes
  • Intranasal
  • IV continuous infusion
  • For patients 2 kg or less:

Use midazolam 0.2 mg/mL

To make 50 mL of midazolam [0.2 mg/mL] [10 mg/50mL]:

Add 10 mL (10 mg) of midazolam [1 mg/mL] to 40 mL of solution

  • For patients over 2 kg to 4 kg:

Use midazolam 0.6 mg/mL

To make 50 mL of midazolam [0.6 mg/mL] [30 mg/50mL]:

Add 30 mL (30 mg) of midazolam [1 mg/mL] to 20 mL of solution

  • For patients over 4 kg to 10 kg:

Use midazolam 1 mg/mL

To make 50 mL of midazolam [1 mg/mL] [50 mg/50mL]:

50 mL (50 mg) of midazolam [1 mg/mL] (straight drug)

Adverse Effects

  • Hypotension, bradycardia, respiratory depression, oxygen desaturation, apnea
  • Rhythmic myoclonic jerk

Comments

  • Use with caution in preterm infants
  • Doses should be tapered gradually with prolonged use.  Benzodiazepine withdrawal may occur with abrupt discontinuation.
  • Monitor blood pressure, ECG

Remember that midazolam provides sedation, NOT analgesia.

Supplied As

  • 1 mg/mL (2 mL and 5 mL vials)
  • Supplied by Pharmacy as standard concentrations:
    • 2 kg or less: 0.2 mg/mL, supplied as 10 mg in 50 mL solution
    • Over 2 kg to 4 kg: 0.6 mg/mL, supplied as 30 mg in 50 mL solution
    • Over 4 kg to 10 kg: 1 mg/mL, supplied as 50 mg/mL (straight drug)
  • At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

LexiComp Sick Kids and LexiComp Pediatric and Neonatal