Midazolam (Paediatric)

How it works

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

Prescribing in practice

• The most important paediatric concern is the risk of respiratory depression and apnoea, so it must be given where airway support and resuscitation are available and the child observed closely after administration.
• Effects are potentiated by other CNS depressants and opioids, and clearance is reduced in hepatic impairment, increasing the risk of oversedation.
• The buccal/oromucosal liquid used for seizures and the injectable form differ in strength and route; doses are weight-based and should be confirmed against a children's formulary, with rescue plans documented for carers.

Monitoring

Monitor respiratory rate, oxygen saturation, conscious level and cardiovascular status during and after administration.

Counselling the patient

• For seizure rescue, carers should be trained when and how to give the buccal liquid and when to call emergency services.
• The medicine can cause drowsiness and slowed breathing, so close observation is needed afterwards.
• Use only the product and strength prescribed for the child.

Evidence & guidelines

Buccal midazolam is recommended by NICE as a first-line option for treating prolonged or repeated seizures in children in the community.