Midolam 15 mg Tablet

Short-acting benzodiazepine for:

• Sedation before and during procedures (endoscopy, minor surgery, dental work) — conscious sedation
• Premedication and induction of anaesthesia; sedation in intensive care
• Emergency treatment of prolonged convulsive seizures (buccal/oromucosal or intranasal, or IM)
• Short-term treatment of severe insomnia (tablets, where approved)

Used by trained health professionals with monitoring, except prescribed buccal seizure rescue.

• Procedural sedation (adults): 2–2.5 mg IV slowly, then 1 mg increments; elderly 0.5–1 mg (usual total 3.5–7.5 mg; elderly up to 3.5 mg).
• Premedication: 0.07–0.1 mg/kg IM, or oral solution in children 0.25–0.5 mg/kg (max 20 mg).

Prolonged seizure (buccal), single dose:

• 3–11 months: 2.5 mg; 1–4 years: 5 mg; 5–9 years: 7.5 mg; 10 years–adult: 10 mg.
• Call an ambulance if the seizure continues 10 minutes after the dose.

Tablets (insomnia): 7.5–15 mg at bedtime for a short period only.

• Severe breathing problems or respiratory depression (unless ventilated)
• Severe sleep apnoea
• Myasthenia gravis
• Acute narrow-angle glaucoma
• Allergy to benzodiazepines
• Severe liver failure (oral)

Common: drowsiness, amnesia for the procedure, dizziness, headache, nausea, hiccups.

Serious: respiratory depression and apnoea, low blood pressure, slow heart rate (especially with opioids, in elderly or with fast IV injection); paradoxical agitation (children, elderly); dependence with repeated use.

• IV/IM use only where resuscitation equipment and oxygen are available.
• Elderly, heart/lung disease, liver or kidney impairment, obesity: lower doses.
• After sedation, do not drive or make important decisions for 24 hours; an adult should accompany the patient.
• Avoid alcohol.

Avoid in early pregnancy and repeated use near delivery (floppy baby, breathing problems, withdrawal). Single doses are compatible with breastfeeding; wait about 4 hours after a procedural dose if possible.

• Opioids, alcohol, other sedatives, antipsychotics (deep sedation, breathing depression — potentially fatal)
• Ketoconazole, itraconazole, clarithromycin, erythromycin, ritonavir, diltiazem, verapamil, grapefruit (greatly raise levels; avoid oral midazolam with strong inhibitors)
• Rifampicin, carbamazepine, phenytoin (reduce effect)

Deep sedation, confusion, breathing depression, coma, low blood pressure. Emergency: airway support; flumazenil can reverse.

Store below 30°C, protected from light. Do not freeze.