In patients with acute renal failure, total body clearance is lower and the elimination half-life, while considering midazolam duration of action becomes longer than in patients with normal kidney function.
In patients with impaired kidney function, the excretion of 1-hydroxymethyl midazolam glucuronide, the major metabolite of midazolam, is impaired.
In healthy children aged 1 year and older, the pharmacokinetic properties of midazolam are similar to those in adults. Weight-normalized clearance is similar to or higher than adult and elimination half-life and midazolam duration of action is similar to or shorter than adult.
As with adults, absolute bioavailability of IM midazolam is greater than 80%. In seriously ill neonates and children, the half-life midazolam duration of action is substantially prolonged and the clearance reduced compared to healthy adults or other groups of children.
It cannot be determined if these differences are due to age, immature organ function or immature metabolic pathways, underlying illness or debility.