Diazepam to Midazolam Conversion — SCE Palliative Medicine MCQ

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ModerateSyringe Driver & Drug CompatibilityDiazepam to Midazolam ConversionSCE Palliative Medicine

A hospice patient requires conversion from oral diazepam 10 mg three times daily to subcutaneous midazolam via continuous subcutaneous infusion (CSCI) for anxiolysis in the dying phase. What is the approximate conversion ratio?

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Correct answer: E — SC midazolam approximately 10–15 mg over 24 hours

Option E is correct. The Scottish Palliative Care Guidelines specify that midazolam is approximately three times more potent than diazepam when used as a sedative (relevant to anxiolysis at end of life). Thus, 30 mg oral diazepam per day is roughly equivalent to 10–15 mg SC midazolam per 24 hours. Option D overestimates the conversion (using an incorrect ratio), while option A ignores the greater potency of midazolam. Option B is incorrect as established conversions exist between benzodiazepines, and option C underestimates the appropriate midazolam dose. The reference directly matches current UK specialty practice. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: Scottish Palliative Care Guidelines, 'Midazolam in palliative care', Right Decisions, NHS Scotland. https://rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/scottish-palliative-care-guidelines/medicines/medicines-information/midazolam-in-palliative-care