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How Effective Is Midazolam for Sedation?

By Maggie J. Hall
Updated Feb 12, 2024
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The commonly used formulation known as midazolam effectively induces sedation. The effects produced by the medication are generally determined by the route of administration and dosage levels. The potent depressant effects on the central nervous system enable midazolam’s use as a general anesthetic. Besides using midazolam for sedation, health care professionals prescribe the medication for the treatment of anxiety and seizure control.

Midazolam belongs to the group of medications known as benzodiazepines, and researchers theorize that administering midazolam for sedation depresses the central nervous system by enhancing the action of the neurotransmitter gamma-aminobutyric acid (GABA). GABA produces a calming effect by binding to receptor sites that release excitatory neurotransmitters. Scientists also believe that the drug enhances GABA’s binding ability and inhibits the breakdown and reuptake of the chemical, increasing the concentration of GABA and its effects.

Anti-anxiety, sedation, and anesthesia are some of the uses of midazolam. Physicians may provide midazolam as a calming or sleep inducing agent prior to administering anesthesia or performing medical procedures. Surgeons also commonly use the formulation alone as a short-acting general anesthetic. Physicians may administer the benzodiazepine orally in syrup form, intramuscularly (IM) or intravenously (IV). In Australia and Great Britain health care professionals often prescribe the compound in prepackaged plastic ampules as emergency oral pediatric anti-seizure medication. Physicians also administer the medication IM or IV for seizure control in adult patients.

As an anti-anxiety medication, physicians typically administer the drug in a single dose ranging from 0.25 to 1 milligram (mg) for every kilogram (kg) of body weight, up to 20 mg. The sedative effects of the medication generally last anywhere from two to seven hours. Anesthesiologists generally use a midazolam dose of 0.15 mg/kg when administering the medication through an IV. Administered via an IM injection, the fast acting benzodiazepine produces effects in as little as 15 minutes. The response time quickens with IV administration to 3 to 5 minutes.

Common adverse effects of midazolam include nausea and vomiting, and individuals who are sensitive to benzodiazepines should not use the medication. Pediatric patients, who exhibit allergic reactions after consuming cherries, should not use the syrup formulation. The risks of using midazolam for sedation include the possibility of inducing respiratory depression and of lowering the blood pressure. Federal drug regulating agencies advise that ensuring the safety of midazolam requires administration in clinical or hospital settings where emergency medical personnel and equipment are available for resuscitation.

Using medications that inhibit the CYP3A4 enzyme that is required to metabolize benzodiazepines increases the blood levels and the effects of midazolam. On the other hand, medications that initiate the release of the enzyme, decrease the blood levels and the effectiveness of the benzodiazepine. Combining the drug with other known central nervous system depressants can cause midazolam interactions that may include deep sedation accompanied by respiratory depression or failure.

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