midazolam at a glance
Medicine class
Short-acting benzodiazepine sedative.
Usual roles
Procedural sedation, premedication before anaesthesia, induction of anaesthesia in selected patients and intensive-care sedation.
After sedation
Memory, judgement and coordination may remain impaired. Follow written restrictions from the treating unit and arrange an escort home when instructed.
What is midazolam used for?
Selected products are licensed for:
Oral sedation and anxiety reduction in children aged 6 months to 14 years before diagnostic, surgical, therapeutic or endoscopic procedures.
Oral premedication in children aged 6 months to 14 years before general anaesthesia.
Intravenous sedation before and during minor medical, dental and surgical procedures.
Continuous intravenous sedation in intensive care.
Intramuscular premedication before surgery.
Intravenous induction of anaesthesia in selected high-risk or older patients where cardiovascular stability is important.
How does midazolam work?
Midazolam strengthens the inhibitory effects of gamma-aminobutyric acid (GABA) in the brain. This reduces neuronal activity, causing sedation, anxiety relief, muscle relaxation, anticonvulsant effects and temporary difficulty forming new memories. Its effects are relatively short because it is rapidly metabolised.
midazolam preparations and strengths
Oral solution
Route: Oral
Strengths: 5 mg/mL
Injection
Route: Parenteral
Strengths: 5 mg/1 mL
How to take midazolam
Use midazolam only as directed by the clinical team. The selected oral solution is swallowed using the supplied oral syringe. Injection is given by trained healthcare professionals where breathing and circulation can be monitored.
Follow the procedure team’s fasting instructions.
The oral solution may be given into the side of the mouth or mixed with apple juice or diluted blackcurrant cordial. Swallow the entire prepared drink.
Do not use oral solution that is cloudy or contains particles.
Leave only when the clinical team agrees. Follow written advice about driving, alcohol, machinery and important decisions, and use the arranged escort.
midazolam side effects
Common or expected effects
- Drowsiness, reduced alertness or prolonged sedation
- Temporary memory loss
- Dizziness, poor coordination or unsteadiness
- Nausea or vomiting
- Headache
- Unexpected agitation, restlessness or other paradoxical behaviour
Get urgent medical advice
- Slow, shallow or stopped breathing
- Severe difficulty waking or loss of consciousness
- Markedly low blood pressure, slow heartbeat or collapse
- Severe allergic reaction, including facial or throat swelling
- Severe agitation, aggression, hallucinations or involuntary movements
midazolam in pregnancy
Evidence in pregnancy is limited. Midazolam should be used only when clinical benefit justifies it. Near the end of pregnancy, newborn breathing, muscle tone, temperature and feeding may be affected. Tell the anaesthetic or procedure team if you are pregnant or might be pregnant.
midazolam while breastfeeding
Only small amounts enter breast milk. Breastfeeding can usually resume after short procedural use once the mother has recovered sufficiently, while observing the infant for unusual drowsiness, slow breathing or poor feeding. Product instructions differ; follow advice for the specific preparation, particularly for premature or unwell infants.
midazolam interactions
Tell the clinical team about all prescribed, non-prescribed and herbal products. Important interactions include:
Opioids, including morphine, fentanyl, oxycodone and methadone
Additive sedation and respiratory depression can lead to coma or death, requiring close monitoring when combined use is unavoidable.
Alcohol and other central nervous system depressants
These can markedly increase drowsiness, impaired coordination and respiratory depression.
Common questions about midazolam
Answers are fully visible for fast scanning and source review.
Will midazolam put me completely to sleep?
Not always. Procedural sedation often leaves a person drowsy but responsive. It can also be used as part of deeper sedation or induction of general anaesthesia in monitored settings.
Why can midazolam cause memory loss?
It can temporarily prevent new memories from forming while effects are strongest. This is called anterograde amnesia and may continue into early recovery.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.