Indications: sedation with amnesia; sedation in intensive care; premedication, induction of anaesthesia; status epilepticus.

Cautions: cardiac disease; respiratory disease; myasthenia gravis; children (particularly if cardiovascular impairment); history of drug or alcohol abuse; reduce dose in elderly and debilitated; avoid prolonged use (and abrupt withdrawal thereafter); concentration of midazolam in children under 15 kg not to exceed 1 mg/ml; hepatic impairment; renal impairment

Contra-indication: marked neuromuscular respiratory weakness including unstable myasthenia gravis; severe respiratory depression; acute pulmonary insufficiency

Side Effects: gastro-intestinal disturbances, increased appetite, jaundice; hypotension, cardiac arrest, heart rate changes, anaphylaxis, thrombosis; laryngospasm, bronchospasm, respiratory depression and respiratory arrest (particularly with high doses or on rapid injection); drowsiness, confusion, ataxia, amnesia, headache, euphoria, hallucinations, fatigue, dizziness, vertigo, involuntary movements, paradoxical excitement and aggression (especially in children and elderly), dysarthria; urinary retention, incontinence, changes in libido; blood disorders; muscle weakness; visual disturbances; salivation changes; skin reactions; on intravenous injection, pain, thrombophlebitis.

Central nervous system (CNS) depressants or alcohol— The CNS depressant and other effects of alcohol, other medicines, or midazolam may be increased; also, the effects of midazolam may last longer Saquinavir—Saquinavir may interfere with the removal of midazolam from the body, which could lead to serious side effects

Dose: Sedation, by slow intravenous injection, 70-100 mcg/kg 30-60 minutes before surgery. Usual dose 5 mg (2.5 mg in elderly patients) Induction, by slow intravenous injection, 200-300 mcg/kg (elderly patients 100-200 mcg/kg).

Pregnancy: Midazolam is not recommended for use during pregnancy because it may cause birth defects; use of midazolam during pregnancy, especially during the last few days, may cause drowsiness, slow heartbeat, shortness of breath, or troubled breathing in the newborn infant. In addition, receiving midazolam just before or during labor may cause weakness in the newborn infant. Breast feeding: Midazolam passes into human breast milk