midazolam maleate at a glance
Medicine class
Short-acting benzodiazepine anticonvulsant
Licensed role
Rescue treatment for prolonged acute convulsive seizures
Route
Oromucosal: placed between the cheek and gum using the supplied oral syringe
After use
A carer should remain with and supervise the person until they have recovered
What is midazolam maleate used for?
The selected product is licensed for:
Treatment of prolonged acute convulsive seizures in adults, adolescents, children and infants aged 3 months and over with diagnosed epilepsy. Treatment at 3–6 months must take place in hospital, where respiratory monitoring and resuscitation equipment are available.
How does midazolam maleate work?
Midazolam enhances the calming action of GABA at GABA-A receptors in the brain. This reduces excessive neuronal activity, helping to stop convulsive seizures; it can also cause sleepiness, reduced alertness and slower breathing.
midazolam maleate preparations and strengths
Oromucosal preparation
Route: Oromucosal
Strengths: 2.5 mg, 5 mg, 7.5 mg, 10 mg
How to take midazolam maleate
This rescue treatment should be given only by someone who understands the person's seizure plan and has been shown how to use it.
Use the supplied needle-free oral syringe and check the label, expiry date, packaging and solution before use.
Place the syringe tip into the space between the cheek and gum, avoiding the throat, and gently release the solution. It may be divided between both sides of the mouth.
Do not force the mouth open or place fingers between the teeth during a seizure.
Keep the person under supervision afterwards and give the used syringe to attending healthcare professionals.
midazolam maleate side effects
Common or expected effects
- Sleepiness or sedation
- Reduced alertness
- Dizziness, headache or poor coordination
- Nausea or vomiting
- Fatigue
Get urgent medical advice
- Slow, shallow or stopped breathing
- Severe reduction in consciousness or failure to recover as expected
- Severe allergic reaction, including facial or throat swelling
- Very slow heartbeat, low blood pressure or collapse
- Severe agitation, aggression or other paradoxical behavioural reactions
midazolam maleate in pregnancy
Pregnancy data are limited. Midazolam may be used when clearly necessary, but the prescriber should consider maternal and fetal risks, particularly later in pregnancy or around labour because newborn sedation, poor feeding, low muscle tone and respiratory depression have been reported.
midazolam maleate while breastfeeding
Only very small amounts of midazolam enter breast milk, and breastfeeding may not need to stop after isolated use. Monitor the infant for unusual drowsiness, slow breathing, poor feeding and appropriate weight gain; seek specialist advice for premature or unwell infants.
midazolam maleate interactions
Midazolam is metabolised mainly by CYP3A4 and has additive effects with other central nervous system depressants.
Opioids
The combination can markedly increase sedation and respiratory depression, potentially causing coma or death.
Alcohol and other sedating medicines
Alcohol, other benzodiazepines, sedating antihistamines, antipsychotics and anaesthetic or hypnotic medicines can intensify sedation and breathing suppression.
Strong CYP3A4 inhibitors
Azole antifungals, macrolide antibiotics and some HIV protease inhibitors can increase and prolong midazolam's effects.
Common questions about midazolam maleate
Answers are fully visible for fast scanning and source review.
What is midazolam maleate used for?
The selected Epistatus product is used as emergency rescue treatment for prolonged acute convulsive seizures in people with diagnosed epilepsy.
How is it given during a seizure?
The solution is released from the supplied oral syringe into the space between the cheek and gum by a trained caregiver following the person's seizure plan.
What happens if it is swallowed?
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.