Midazolam

ATC: N05CD08
DDD: 15 mg oral and parenteral
ICD-10: G47, G41

Dose:
NL: oral 7.5 - 15 mg at night
UK: buccal: 10 mg, repeated after 10 minutes (unlicensed)
Parenteral: according to dosage schedules for various forms of sedation
Contra-indications: hepatic and renal failure, myasthenia gravis
Interactions: through CYP3A4
Max level (oral) after 30 to 90 minutes

Half life:
Adults 2 - 3½ hours
Child aged 3-10: 1 - 1½ hours
Neonates: 6 - 12 hours
Metabolites: 0.8 - 1 hour
Elderly: 3 times longer
Long-term sedation in ITU: up to 6 x longer

NL: Dormicum 7.5 and 15 mg tablets
Injection: 1 mg/ml, 5 and 50 ml
2 mg/ml, 50 ml
5 mg/ml, 1, 3 and 10 ml
Nasal spray (not licensed) 2.5mg and 0.5mg per dose

UK:  CD3
oromucosal solution 5mg/ml, 0.5, 1ml, 1.5 and 2 ml prefilled syringes
injection: 1 mg/ml, 2ml, 5 ml, 50 ml; 2 mg/ml, 5 ml; 5 mg/ml 2ml and 10 ml
Hypnovel: 5 mg/ml, 2ml

	Midazolam - parenteral
Indication	UK	NL
Conscious sedation	IV 2-2.5 mg increase in steps of 1 mg to total of 3.5-5 mg, max 7.5 mg Elderly: 0.5-1mg, steps 0.5-1mg, max 3.5 mg	IV 2-2.5 mg increase in steps of 1 mg to total of 3.5-5 mg, max 7.5 mg Elderly: 0.5-1mg, steps 0.5-1mg, max 3.5 mg
Sedative in combined anaesthesia	IV 30-100 mcg/kg repeated as necessary of 30-100 mcg/kg/h by continuous infusion	IV 30-100 mcg/kg repeated as necessary of 30-100 mcg/kg/h by continuous infusion
Premedication	IM 70-100 mcg/kg (elderly 25-50 mcg/kg) IV 1-2 mg (elderly 0.5 mg(	IM 70-100 mcg/kg (elderly 25-50 mcg/kg) IV 1-2 mg (elderly 0.5 mg(
Induction	150-200 mcg/kg (elderly 50-150 mcg/kg) in divided doses of max 5 mg every 2 minutes, max 600 mcg/kg	150-200 mcg/kg (elderly 50-150 mcg/kg) in divided doses of max 5 mg every 2 minutes, max 600 mcg/kg
Sedation in ITU	30-300 mcg/kg  in steps of 1-2.5 mg every 2 minutes, then 30-200 mcg/kg/h	30-300 mcg/kg  in steps of 1-2.5 mg every 2 minutes, then 30-200 mcg/kg/h