Buccal Midazolam Seizure Dose — MFDS Part 1 MCQ

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ModeratePharmacologyBuccal Midazolam Seizure DoseMFDS Part 1

A 35-year-old patient develops a generalised convulsive seizure during dental treatment. Despite initial supportive management, the seizure continues for 5 minutes. There is no patient-specific emergency treatment plan. What single dose of midazolam should be administered by the buccal route?

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Correct answer: E — 10 mg

The correct answer is E: 10 mg. A generalised convulsive seizure continuing for 5 minutes is a prolonged seizure requiring emergency treatment. In an adult without a patient-specific plan, the recommended single buccal midazolam dose is 10 mg. The medicine is administered into the space between the cheek and gum while airway, breathing and circulation are supported and emergency assistance is arranged. Doses of 2.5 mg, 5 mg and 7.5 mg are age-banded paediatric doses and are inadequate as the standard adult dose. A 20 mg initial dose is excessive and increases the risk of respiratory and cardiovascular depression. Further dosing should follow the relevant emergency protocol or specialist medical advice rather than being given automatically.

Reference: Electronic Medicines Compendium, BUCCOLAM 10 mg oromucosal solution: Summary of Product Characteristics, sections 4.1–4.2, updated 17 October 2024. https://www.medicines.org.uk/emc/product/7460/smpc