Dr. C P Ravi Kumar
Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore
What is Midazolam?
Midazolam is classified as a benzodiazepine. Midazolam is commonly used in medical settings for sedation, Seizures, anxiety reduction, and as a part of anaesthesia regimens.
It is a medication frequently used in emergency situations to rapidly control seizures. Recently, a nasal spray form has been developed, enabling parents or caregivers to use it outside of the hospital setting when a seizure occurs.
What is Midazolam used for?
- Status epilepticus
- Intermittent seizure
- Procedural sedation
- General anesthesia
- Insomnia
How is Midazolam available?
- Nasal Spray
- Injection
- Syrup
How does Midazolam act (mechanism of action)?
In order to provide its calming effects, midazolam increases the activity of a brain chemical known as GABA. This helps to reduce anxiety, induce sleepiness, and relax muscles. You will experience a sense of relaxation or sedation as a result of the slowing down of brain activity.
MIDAZOLAM VS DIAZEPAM
Midazolam and diazepam are both medications from the same drug family, but they serve slightly different purposes. Midazolam works very quickly and is mainly used in hospitals to calm patients before surgery or to stop seizures right away. Its effects don’t last long, so it’s ideal for short-term use. Diazepam, on the other hand, takes a bit longer to start working but stays in the body much longer. It’s often used to treat anxiety, muscle spasms, seizures, or alcohol withdrawal symptoms and can be taken at home with a prescription. Essentially, midazolam is for fast, short-term use, while diazepam is better for longer-lasting relief.
How much time does Midazolam take to act?
Intravenous (IV) administration of midazolam usually begins to function within 1 to 5 minutes, whereas oral administration can take approximately 10 to 15 minutes.
The exact onset can depend on how it’s administered and individual factors, but its effects are usually felt quickly.
Why is Midazolam important for you/your child’s treatment?
Think of Midazolam like a shield protecting your child from seizures. But it only works when used every day. If you stop giving it suddenly, it’s like dropping the shield—and seizures can come back or get worse. It doesn’t cure epilepsy, but it helps manage it. So keep using it regularly, as your doctor told you.
What to do when my child has seizure? How to use spray?
- Help the child stay calm.
- Make your child as comfortable as possible
- Don’t put anything in your child’s mouth
- Don’t try to restrain your child
Steps to use Midazolam Nasal Spray
- Remove the cap of nasal spray bottles after giving it a gentle shake.
- Grip the bottle by placing your thumb underneath for stability, while your index and middle fingers rest on each side of the nozzle.
- If this is your first time utilising the spray, spray three test sprays into the air, keeping the nozzle pointed away from the patient.
- If the patient is lying down, gently raise their head slightly. Position the spray bottle close to their nose.
- Place the nozzle in one nostril and apply even, firm pressure to the pump. The patient does not need to breathe in during this process.
- Avoid tilting the head back, as this helps prevent the solution from being swallowed.
- Follow the dosage instructions according to the prescription and spray the recommended number of sprays into each nostril.
- For easier understanding, please refer to the instructional video.
What is the ideal time to take Midazolam?
The ideal time to take Midazolam can vary based on the specific condition it is being used to treat. Since its use can be complex and individualized, it is important to consult with your healthcare provider for personalized advice. They will consider factors such as your health condition, dosage, and other medications you’re taking to determine the best time for you to take Midazolam safely.
How many sprays in EACH nostril?
Your doctor will advise based on child’s weight, follow his or her instructions.
What if I miss a dose?
For sleep or anxiety: Unless it’s due for the next dose, take it as soon as you recall.
For seizures: Don’t try to make up a missed dose, and seek medical help if needed.
Always check with your doctor if you’re unsure.
Would there be any negative effects on my child from this medication?
Every medication has both benefits and possible risks. Serious side effects are uncommon, but knowing the warning signs helps ensure timely medical attention if needed. Contact your doctor right away if you experience any symptoms of a severe reaction.
SIDE EFFECTS:
Nose spray:
- Feeling sleepy
- Nose or throat irritation
- Runny nose
- Headache
Other side effects
- Breathing problems: Slow or difficult breathing, especially in adults.
- Heart issues: Irregular heartbeat, low blood pressure, or fainting.
- Nervous system: Confusion or memory problems, Drowsiness or dizziness
- Stomach: Nausea or vomiting
- Dependence: Risk of addiction with long-term use.
- Unusual behaviour: Agitation, hallucinations, or suicidal thoughts (rare).
If you experience any of the more serious side effects (like trouble breathing, severe allergic reactions, or suicidal thoughts), seek immediate medical attention. Talk to your doctor about any side effects that annoy you or don’t go away.
Does Midazolam cause weight gain?
Midazolam is not commonly associated with significant weight gain as a side effect. There are other co-morbid factors which may contribute to weight gain, for example disability limiting physical activity.
Can Midazolam be taken with other common medications?
It is important to be cautious when taking other medications with Midazolam because it can interact with many drugs. While some drugs may decrease the efficiency of midazolam or raise the possibility of adverse effects, others may enhance its effects. Common drugs that may interact with Midazolam include: Antidepressants, Pain medications, Antifungal or antibiotic medications (like ketoconazole or clarithromycin), Anticonvulsants (like phenytoin or carbamazepine)
What food to avoid while taking Midazolam?
- Grapefruit and grapefruit juice: Grapefruit can interact with many medications, including Midazolam. It may increase the levels of the drug in your system, which could increase the risk of side effects like drowsiness or breathing problems.
- Heavy or fatty meals: Midazolam's absorption may be slowed down by large or high-fat meals, which could reduce its effectiveness.
- Alcohol: Alcohol should be avoided when taking Midazolam, as it can intensify the sedative effects and increase the risk of dangerous side effects like extreme drowsiness or difficulty breathing.
It is always a good idea to check with your doctor or pharmacist for any additional dietary restrictions based on your personal health and the other medications you may be taking.
PREGNANCY AND LACTATION:
Pregnancy: Midazolam is generally not recommended during pregnancy, especially in the first trimester, unless absolutely necessary. Kindly get the consultation from your doctor before getting conceived.
Lactation (Breastfeeding): If you’re breastfeeding, it’s recommended to avoid breastfeeding for at least 24 hours after taking Midazolam, depending on the dosage and duration of use.
Contra indications of Midazolam
- Allergy to benzodiazepines.
- Severe respiratory problems (e.g., severe asthma, sleep apnea) or difficulty breathing.
- Severe liver problems (e.g., liver failure).
- Myasthenia Gravis
- Acute narrow-angle glaucoma.
- Concurrent use with certain medications like strong opioid painkillers, which can cause serious side effects.
Always consult your doctor before using Midazolam to ensure it’s safe for your specific health condition.
Can I stop taking Midazolam?
You should not stop taking Midazolam suddenly without consulting your doctor, as it may cause withdrawal symptoms or other issues. Your doctor will guide you on the best way to gradually reduce the dosage if necessary.
Where should you store Midazolam?
- Midazolam should be stored in a cool, dry place, away from direct light and moisture. Keep it out of reach of children.
- If it's liquid, make sure it's sealed tightly and stored according to the packaging's directions.
MONITORING PARAMETERS:
- CBC
- Mental status
- Liver and kidney function test
- Level of sedation
- Vital signs
Dependence or Withdrawal (if used long-term): For people using Midazolam for extended periods, doctors may monitor for signs of dependence or withdrawal symptoms.
How to cope with side effects of Midazolam?
- Drowsiness or Fatigue: Rest as needed and avoid tasks requiring alertness, such as driving or operating heavy machinery, until the effects wear off. Drink water to stay hydrated, as dehydration can worsen fatigue.
- Dizziness or Lightheadedness: Rise slowly from sitting or lying positions to prevent falls.
- Nausea or Vomiting: Eat light, bland foods (e.g., crackers or toast). You can take ginger tea or eat peppermint as anti-nausea medicines.
- Memory Problems: Accept temporary memory lapses as a side effect; avoid important decision-making until fully alert.
- Slurred Speech or Difficulty Coordinating Movements: Rest in a safe environment until the medication wears off.
General Tips
Follow Dosage Instructions: Taking more than prescribed increases the risk of severe side effects.
Inform Your Doctor: Share any pre-existing conditions or current medications to prevent harmful interactions.
Stay Hydrated: Drinking fluids can alleviate mild side effects like dry mouth and fatigue.
Avoid Alcohol and Recreational Drugs: These can intensify side effects or lead to dangerous complications.
Monitor for Allergic Reactions: Seek immediate medical help if you experience symptoms like rash, swelling, or difficulty breathing.
SUMMARY:
Midazolam belonging to the class of benzodiazepine typically acts faster and is used for its sedative, anxiolytic, muscle relaxant, and anticonvulsant properties in emergency settings. It acts quickly, providing rapid sedation, but its effects are short-lived. It can also be used in emergency situations (e.g., for seizures). Dizziness, sleepiness, and dependency risk are among the side effects. It should be used under supervision, especially in patients with breathing or liver problems.
Let us know if this information was useful!
REFERENCE:
Author:
- Dr. Likitha B S, Pharm. D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr Praveen Kumar, B. Pharm, Pharm D(PB), Lead Clinical Pharmacologist, REGIONAL HEAD KIMS Hospitals, Bengaluru
- Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU
