Benzodiazepine

Midazolam (IV/IM)

Brand names: Midazolam (generic), Buccolam (buccal), Epistatus (buccal)

Midazolam is a short-acting benzodiazepine used for procedural sedation, premedication, anaesthesia, intensive-care sedation, and (by the buccal route) for prolonged or repeated seizures.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

US labelling (FDA)

Reference — US labelling, may differ from UK

DOSAGE AND ADMINISTRATION Note: CONTAINS BENZYL ALCOHOL (see WARNINGS and PRECAUTIONS , Pediatric Use ) Midazolam hydrochloride injection is a potent sedative agent that requires slow administration and individualization of dosage. Clinical experience has shown midazolam hydrochloride to be 3 to 4 times as potent per mg as diazepam. BECAUSE SERIOUS AND LIFE-THREATENING CARDIORESPIRATORY ADVERSE EVENTS HAVE BEEN REPORTED, PROVISION FOR MONITORING, DETECTION AND CORRECTION OF THESE REACTIONS MUST BE MADE FOR EVERY PATIENT T0 WHOM MIDAZOLAM HYDROCHLORIDE INJECTION IS ADMINISTERED, REGARDLESS OF AGE OR HEALTH STATUS. Excessive single doses or rapid intravenous administration may result in …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-12-05. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Clinical monograph

How it works

It enhances GABA at the GABA-A receptor, producing rapid sedation, amnesia, anxiolysis and anticonvulsant effects.

Prescribing in practice

Respiratory depression and hypotension can occur, particularly with rapid intravenous injection, in older patients, and with opioids — titrate slowly with resuscitation facilities and flumazenil available.
Reduce the dose in older or frail patients and in hepatic impairment.
Buccal midazolam is a first-line community treatment for prolonged seizures.

Monitoring

Monitor conscious level, oxygen saturation, respiratory rate and blood pressure during sedation.

Counselling the patient

You may not remember the procedure afterwards.
Do not drive or operate machinery and avoid alcohol for the rest of the day after sedation.

Evidence & guidelines

Standard for procedural sedation and premedication, and a first-line community treatment (buccal) for prolonged or repeated seizures.

Reference: RASS/SAT protocols; MENDS Trial (Pandharipande et al, JAMA 2007); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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