{"id":4198,"date":"2025-03-31T18:12:00","date_gmt":"2025-03-31T18:12:00","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/midazolam-txt\/"},"modified":"2025-03-31T18:12:00","modified_gmt":"2025-03-31T18:12:00","slug":"midazolam-txt","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/midazolam-txt\/","title":{"rendered":"Midazolam.txt"},"content":{"rendered":"

CLINICAL USE <\/H3>
\nBenzodiazepine:Sedation with amnesia in conjunction with local anaesthesia, premedication, induction

DOSE IN NORMAL RENAL FUNCTION <\/H3>See SPC for dosing guidelines

PHARMACOKINETICS <\/H3>
  • Molecular weight &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :325.8 (362.2 as hydrochloride)<\/li>\n
  • %Protein binding &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :96\u201398<\/li>\n
  • %Excreted unchanged in urine &nbsp &nbsp : <1<\/li>\n

  • Volume of distribution (L\/kg) &nbsp &nbsp &nbsp :0.7\u20131.2<\/li>\n

  • half-life \u2013 normal\/ESRD (hrs)&nbsp &nbsp &nbsp :2\u20137\/Unchanged

    DOSE IN RENAL IMPAIRMENT <\/H3>

    GFR (mL\/MIN)<\/H4>
  • 20 to 50 &nbsp &nbsp : Dose as in normal renal function
  • 10 to 20 &nbsp &nbsp : Dose as in normal renal function
  • <10 &nbsp &nbsp &nbsp &nbsp &nbsp : Use sparingly and titrate according to response. Only bolus doses, not continuous infusion

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES <\/H3>
  • CAPD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp:Unlikely to be dialysed. Dose as in GFR <10 mL\/min <\/p>\n
  • HD &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp &nbsp :Not dialysed. Dose as in GFR <10 mL\/min
  • HDF\/high flux &nbsp :Unknown dialysability. Dose as in GFR <10 mL\/min
  • CAV\/VVHD &nbsp &nbsp &nbsp:Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS <\/H3>Potentially hazardous interactions with other drugs\n
  • Antibacterials: concentration increased by erythromycin, clarithromycin, telithromycin and quinupristin\/dalfopristin (profound sedation); metabolism possibly accelerated by rifampicin\n
  • Antifungals: concentration increased by itraconazole, ketoconazole, posaconazole and fluconazole (prolonged sedative effect)\n
  • Antipsychotics: increased sedative effects; increased risk of hypotension, bradycardia and respiratory depression when parenteral benzodiazepines are given with IM olanzapine\n
  • Antivirals: atazanavir, efavirenz, nelfinavir, saquinavir, ritonavir, amprenavir and indinavir increase risk of prolonged sedation with midazolam, avoid with atazanavir\n
  • Ciclosporin: in vitro studies suggested that ciclosporin could inhibit the metabolism of midazolam. However, blood ciclosporin concentrations in patients given ciclosporin to prevent graft rejection were considered too low to result in an interactionSodium oxybate: enhanced effects of sodium oxybate \u2013 avoid

    ADMINISTRATION <\/H3>

    Reconstition<\/H4>_

    Route <\/H4>IV, IM

    Rate of Administration <\/H4>1\u201310 mL\/hour according to response

    Comments<\/H4>Can be used undiluted Compatible with glucose 5%, sodium chloride 0.9%

    OTHER INFORMATION <\/H4>Protein binding of midazolam is decreased in ERF; hence more unbound drug is available to produce CNS effects, so a decrease in dose is recommendedCSM has received reports of respiratory depression, sometimes associated with severe hypotension, following intravenous administrationCaution when used for sedation in severe renal impairment especially when used with opiates and\/or neuromuscular blocking agents \u2013 monitor sedation and titrate to responseIncreased CNS sensitivity in patients with renal impairmentOne study reports midazolam as having a sieving coefficient = 0.06 and unlikely to be removed by haemofiltration.
    \n","protected":false},"excerpt":{"rendered":"

    CLINICAL USE Benzodiazepine:Sedation with amnesia in conjunction with local anaesthesia,<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-4198","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4198","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=4198"}],"version-history":[{"count":0,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/4198\/revisions"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=4198"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=4198"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=4198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}