4/1/2019 Versed (midazolam) dosing, indications, interactions, adverse effects, and more

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midazolam (Rx)
Brand and Other Names: Versed
Classes: Antianxiety Agents;
Anxiolytics, Benzodiazepines

Dosing & Uses

Dosage Forms & Strengths

2mg/mL

injectable solution: Schedule IV

1mg/mL
5mg/mL

Preoperative Sedation/Anxiolysis With Anterograde Amnesia

IM

70-80 mcg/kg (dose range ~5 mg) 30-60 minutes before surgery (reduce 50% for chronically
ill or geriatric patients)

IV

Initial: Usually 0.5-1 mg given over 2 minutes (not to exceed 2.5 mg/dose); wait 2-3 minutes
to evaluate sedative effect after each dose adjustment; total dose >5 mg usually not
necessary to reach desired sedation; use 30% less midazolam if patient premedicated with
narcotics or other CNS depressants
Debilitated or chronically ill patients: 1.5 mg IV initially; may repeat with 1 mg/dose IV q2-3
min PRN; not to exceed cumulative dose of 3.5 mg; peak effect may be delayed in elderly, so
increments should be smaller and rate of injection slower
Maintenance: 25% of initial effective dose PRN by slow titration; reduce 30% if premedicated
with opiate (50% in elderly/chronically ill)

Anesthesia
Induction

<55 years without premedication: 300-350 mcg/kg IV injection over 20-30 seconds; wait 2-3
minutes to evaluate sedative effect after each dose adjustment; may use increments of 25%
of initial dose PRN to complete induction; may use up to 0.6 mg/kg total dose in resistant
cases, but such dosing may prolong recovery
>55 years without premedication and with no systemic disease, in a patient who is not weak:
300 mcg/kg over 20-30 seconds initially; wait 2-3 minutes to evaluate sedative effect after
each dose adjustment
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4/1/2019 Versed (midazolam) dosing, indications, interactions, adverse effects, and more

>55 years without premedication but presence of systemic disease or weak patient: 200-250
mcg/kg over 20-30 seconds usually enough; 0.15 mg/kg enough in some cases; wait 2-3
minutes to evaluate sedative effect after each dose adjustment
>55 years with premedication: 150-350 mcg/kg IV injection over 20-30 seconds; wait 2-3
minutes to evaluate sedative effect after each dose adjustment; a dose of 250 mcg/kg usually
enough to achieve desired effect

Maintenance

May administer increments of 25% of induction dose PRN when there are signs that
anesthetic effects are lightening

Sedation of Intubated/Ventilated Patients

Maintenance: Initial, 20-100 mcg/kg/hr infusion; titrate up or down 25-50% PRN

Dosing Considerations

Because it is water soluble, takes approximately 3 times longer than diazepam to peak EEG
effects; thus, clinician must wait 2-3 minutes to fully evaluate sedative effects before initiating
procedure or repeating dose

Has twice the affinity for benzodiazepine receptors that diazepam has

May be administered IM if unable to obtain vascular access

Anesthesia: Typical adult induction and maintenance doses may need to be decreased in some
elderly patients by 20-50%, because the elderly overall are more susceptible to CNS depressants
than is the general population

Status Epilepticus (Off-label)

Administer 10 mg IM once or 0.2 mg/kg IM once; not to exceed 10 mg IM

Refractory Status Epilepticus (Off-label)

Alternatively, 0.2 mg/kg bolus followed by continuous infusion of 0.05-2 mg/kg/hr; titrate to
cessation of electrographic seizures or burst of suppression; if breakthrough of status epilepticus
occurs while on continuous infusion, administer bolus of 0.1-0.2 mg/kg and increase infusion rate
by 0.05-0.1 mg/kg/hr (0.83-1.66 mcg/kg/min q3-4hr; may withdraw infusion after at least 24-48 hr
of electrographic control; withdraw gradually to prevent recurrent status epilepticus

Status Epilepticus (Orphan)

Orphan designation for treatment of status epilepticus

Sponsor

Meridian Medical Technologies, Inc., A Pfizer Company; 6350 Stevens Forest Road;
Columbia, Maryland 21046

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4/1/2019 Versed (midazolam) dosing, indications, interactions, adverse effects, and more

Organophophorous Poisoning (Orphan)

Orphan designation for treatment of seizures induced by organophosphorous insecticide poisoning

Sponsor

Meridian Medical Technologies, Inc., A Pfizer Company; 6350 Stevens Forest Road;
Columbia, Maryland 21046

Seizure Clusters (Orphan)

Rescue treatment of seizures in patients on stable AED regimens who require control of
intermittent bouts of increased seizure activity (eg, acute repetitive seizures, seizure clusters)

Administered by intranasal route

Orphan indication sponsors

Upsher-Smith Laboratories, Inc. 6701 Evenstad Drive Maple Grove, MN 55369-6026

Status Epilepticus (Orphan)

Orphan designation for treatment of status epilepticus

Sponsors

Meridian Medical Technologies, Inc., A Pfizer Company; 6350 Stevens Forest Road;
Columbia, Maryland 21046
Crossject SA; 6 Rue Pauline Kergomard Dijon France

Geriatric Dosing

Preoperative sedation/anxiolysis with anterograde amnesia

IM: 2-3 mg (~20-50 mcg/kg) 30-60 minutes before surgery; some elderly patients may
respond to as little as 1 mg; onset is 15 minutes (peaking at 30-60 min)
IV (>60 years): 1-1.5 mg initially; not to exceed >1.5 mg in 2 min period; may repeat with 1
mg/dose q2-3min PRN; not to exceed cumulative dose of 3.5 mg; peak effect may be
delayed in elderly, so increments should be smaller and rate of injection slower
IV maintenance: 25% of initial effective dose PRN by slow titration

Dosing considerations

Anesthesia: Typical adult induction and maintenance doses may need to be decreased in
some elderly patients by 20-50%, because the elderly overall are more susceptible to CNS
depressants than is the general population

Dosage Forms & Strengths

2mg/mL

injectable solution: Schedule IV

1mg/mL
5mg/mL
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4/1/2019 Versed (midazolam) dosing, indications, interactions, adverse effects, and more

Sedation

500-750 mcg/kg PO once diluted by juice 20-30 minutes prior to procedure; not to exceed 20 mg

100-150 mcg/kg IM; up to 500 mcg/kg used; not to exceed 10 mg

IV

<6 months: Initial, 50 mcg/kg IV over 2-3 minutes; titrate with small increments to clinical
effect; monitor closely
6 months-6 years: Initial, 50-100 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may
require up to 600 mcg/kg total dose; not to exceed 6 mg total dose
6-12 years: Initial, 25-50 mcg/kg IV over 2-3 minutes; repeat q2-3min PRN; may require up to
400 mcg/kg; not to exceed 10 mg total dose

Anesthesia (Non-neonatal)

Loading dose: 50-150 mcg/kg IV over 2-3 minutes PRN to achieve desired effect

Continuous infusion: 1-2 mcg/kg/min IV infusion

Anesthesia (Neonatal)

IV loading dose should not be used in neonates

Continuous infusion: 0.5 mcg/kg/min IV infusion

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