Remimazolam

How it works

It is a positive allosteric modulator at GABA-A receptors producing sedation and hypnosis; its ester linkage is rapidly hydrolysed by tissue esterases to an inactive metabolite, giving a short, predictable recovery.

Prescribing in practice

• It causes dose-dependent respiratory and cardiovascular depression, so it should be used only with continuous monitoring and immediate access to airway and resuscitation support.
• Its sedative effect can be reversed with flumazenil, though the offset of remimazolam itself is rapid because of esterase metabolism.
• Effects are potentiated by concurrent opioids and other central nervous system depressants, requiring careful titration.

Monitoring

Monitor level of consciousness, respiration, oxygen saturation and haemodynamics continuously during and after administration.

Counselling the patient

• This sedative is given by trained staff with full monitoring in place.
• You may feel drowsy afterwards; do not drive or make important decisions until fully recovered and advised it is safe.

Evidence & guidelines

Its use for procedural sedation and general anaesthesia is supported by clinical trials and described in the SPC.