Midazolam

Provider Level

RN/Paramedic

Class

Short-acting benzodiazepine, CNS depressant

Mechanism of Action

Binds to the benzodiazepine receptor on the GABA-A receptor complex, enhancing the inhibitory effect of GABA on the central nervous system, which results in sedation, amnesia, and anticonvulsant effects.

Indications

Active seizures (status epilepticus), sedation for medical procedures (e.g., synchronized cardioversion, transcutaneous pacing, intubation), management of severe agitation or combative behavior.

Contraindications

Hypersensitivity to midazolam or other benzodiazepines, acute narrow-angle glaucoma, shock, severe respiratory depression.

Routes

IM, IV, IO, Buccal

Onset / Duration

Onset: IV/IO 1-3 minutes; IM 15 minutes. Duration: 2-6 hours depending on route and patient metabolism.

Adverse Effects

Respiratory depression, apnea, hypotension, paradoxical agitation, nausea, vomiting.

Precautions & Interactions

Concomitant use with other CNS depressants (e.g., opioids, alcohol) significantly increases the risk of severe respiratory depression and hypotension. Continuous monitoring of respiratory rate, EtCO2, and oxygen saturation is required.

Special Considerations

Flumazenil and advanced airway equipment must be readily available. Reduce dose in elderly, pediatric, or debilitated patients. Authorized for RN/Paramedic levels.