Midazolam

Lore & Background

It is on the World Health Organization's List of Essential Medicines and is available as a generic medication. In many countries, it is a controlled substance. Midazolam can be given by mouth, intravenously, by injection into a muscle, by spraying into the nose, or through the cheek. When given intravenously, it typically begins working within five minutes; when injected into a muscle, it can take fifteen minutes to begin working; when taken orally, it can take 10–20 minutes to begin working.

Reader's Guide

Midazolam is significant as a widely used benzodiazepine for procedural sedation, seizure management, and end-of-life care. Its rapid onset and short elimination half-life make it popular in intensive care units, though lorazepam is preferred for long-term sedation and propofol offers quicker recovery. The drug carries risks including respiratory depression, hypotension, tolerance, withdrawal syndrome, and paradoxical reactions, especially in children and the elderly. It is contraindicated in certain populations and requires caution during pregnancy and breastfeeding. Its inclusion on the WHO Essential Medicines List underscores its global medical importance, despite being a controlled substance in many countries.

Did You Know?

• Midazolam does not cause unconsciousness, only sedation.
• It can be administered through the cheek or nose for acute seizures in children.
• Paradoxical effects, such as increased activity, can occur especially in children and older people.