Midazolam administration

Reactions such as agitation, involuntary movements, hyperactivity and combativeness are usually reported during midazolam administration .

Should such reactions occur, the response to each dose of midazolam and all other drugs, including local anesthetics, should be evaluated before proceeding with the midazolam administration of the drug.

For induction of general anaesthesia in healthy patients, the initial dose should be administered over 20 to 30 seconds for optimal effect.

About 2 minutes must pass to see the effect of the dose. Extreme care should be taken to avoid intra-arterial injection or extravasations.

Nasal midazolam administration is uncomfortable for most children. Midazolam must always be used with caution when administered with narcotics because of the potential for respiratory depression.

One important interaction is that erythromycin, calcium channel blockers, protease inhibitors, and even grapefruit juice produce a clinically important delay in midazolam metabolism because of inhibition of cytochrome P450.

In this circumstance either midazolam administration should be avoided or the dose reduced by 50%.

One further concern is that with nasal administration there is the theoretical possibility of central nervous system (CNS) toxicity as a result of drug entering the CNS along neural connections (olfactory nerves).

Because neurotoxicity has never been examined and most children cry with nasal midazolam administration, I believe that this route should generally be avoided.

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