midazolam hydrochloride at a glance
Medicine class
Short-acting benzodiazepine
Main roles
Emergency seizure control, procedural sedation, anaesthesia and intensive-care sedation
Oromucosal administration
Placed slowly between the cheek and gum using the supplied needle-free oral syringe
Important practical effect
May cause marked drowsiness, amnesia and impaired coordination; driving and machinery must wait until full recovery
What is midazolam hydrochloride used for?
Selected products are licensed for:
Oromucosal rescue treatment of prolonged, acute convulsive seizures in diagnosed epilepsy, from infancy through adulthood; use in very young infants requires a monitored hospital setting.
Conscious sedation before and during diagnostic or therapeutic procedures.
Premedication, induction or a sedative component of anaesthesia, depending on age and product.
Sedation in intensive-care units.
How does midazolam hydrochloride work?
Midazolam positively modulates GABA-A receptors, strengthening the effect of GABA, the brain’s main inhibitory neurotransmitter. This rapidly produces sedation and anxiolysis and can suppress convulsive activity; rapid redistribution and metabolism contribute to its relatively short action.
midazolam hydrochloride preparations and strengths
Oromucosal preparation
Route: Oromucosal
Strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg
Injection
Route: Parenteral
Strengths: 1 mg/1 mL, 1 mg/mL, 2 mg/mL, 5 mg/mL
How to take midazolam hydrochloride
Use only the formulation and route prescribed. Oromucosal solution should be administered by a trained carer according to the person’s seizure plan; remove and safely discard the syringe cap, then place the solution slowly between the cheek and gum. Do not attach a needle or intravenous tubing, and do not use an oral syringe for injection. Injectable midazolam must be prepared and administered by appropriately trained healthcare professionals with respiratory and cardiovascular support available.
Keep an oromucosal syringe in its protective tube until needed.
Avoid directing solution towards the throat because of aspiration risk.
After procedural midazolam, leave only when the treating team considers it safe and with an accompanying adult.
midazolam hydrochloride side effects
Common or expected effects
- Drowsiness or sedation
- Reduced alertness or level of consciousness
- Nausea and vomiting
Get urgent medical advice
- Slow, shallow or stopped breathing
- Severe or prolonged unresponsiveness
- Marked agitation, aggression, hallucinations or other paradoxical behaviour
- Low blood pressure, very slow heartbeat or cardiac arrest
- Anaphylaxis or angioedema, including facial or throat swelling
midazolam hydrochloride in pregnancy
Pregnancy safety data are limited. Midazolam may be considered when clearly necessary, but exposure late in pregnancy or around delivery can affect the newborn’s muscle tone, feeding, temperature and breathing. The anaesthetist, epilepsy team or prescriber should assess the clinical need and neonatal monitoring requirements.
midazolam hydrochloride while breastfeeding
Only small amounts of midazolam enter breast milk, and short-term use is considered unlikely to pose a significant risk. Use with caution and monitor the infant for unusual drowsiness, slow breathing, poor feeding or inadequate weight gain. Product-specific advice can differ, so follow the treating clinician’s instructions about when to resume feeding.
midazolam hydrochloride interactions
Tell the treating team about all prescribed, non-prescribed and herbal products. Important interactions include:
Opioids
Additive sedation can cause severe respiratory depression, coma or death, requiring close monitoring when combined use is unavoidable.
Alcohol and other central nervous system depressants
Can markedly increase sedation, impaired alertness and respiratory depression; alcohol should be avoided.
Azole antifungals, macrolide antibiotics and some antiviral protease inhibitors
CYP3A inhibition may make midazolam’s effects stronger and longer-lasting, delaying recovery and increasing respiratory risk.
Common questions about midazolam hydrochloride
Answers are fully visible for fast scanning and source review.
Is midazolam hydrochloride a sedative or an anti-seizure treatment?
It has both effects. It produces rapid sedation and amnesia and also has anticonvulsant activity used in oromucosal rescue treatment for prolonged convulsive seizures.
How is Buccolam midazolam given?
The solution is inserted slowly into the space between the cheek and gum using the supplied needle-free oral syringe. It should be given by a trained carer according to the individual seizure plan.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.