Midazolam

Midazolam is one of the most famous sedatives. The prescription drug belongs to the group of benzodiazepines.

What is midazolam?

Midazolam is a hypnotic or sedative that belongs to the group of short-acting benzodiazepines. The name 'midazolam' is derived from 'imidazole', a heretocyclic organic compound.

Midazolam is still a relatively new sedative. While benzodiazepines of earlier generations had a long-lasting effectiveness, midazolam stands for a safe mode of action, the duration of which is only about four hours. The reason for this is its breakdown within the body, which proceeds faster than its predecessors.

The sedative has been used in Europe since the early 1980s. It is often used as a short-acting preparation for treating restlessness.

Pharmacological effect

There are different neurotransmitters within the human nervous system. These are messenger substances with an inhibiting or activating effect. In humans, there is a good balance between the neurotransmitters that lead to targeted actions in external circumstances such as fear, stress or calm.

The messenger substance GABA (gamma-aminobutyric acid) has a braking effect on the nervous system after it has been bound to the corresponding receptors. Taking midazolam can increase the effects of GABA. This in turn results in a relaxation of the muscles and a pronounced calming effect. In addition, the agent promotes sleep in the patient and relieves anxiety and cramps.

Because midazolam is rapidly broken down in the body, its duration of action is limited. If the drug is injected into a blood vessel or muscle, the patient will experience brief memory loss. This prevents the patient from remembering things that happened while midazolam was at its highest.

After taking midazolam, which is usually taken orally, the drug enters the intestine after a short time. From there it passes into the blood. Once the active ingredient has spread throughout the body, it is broken down in the liver. The breakdown products of the agent get out of the body through the kidneys.

Medical application & use

Midazolam is used in both adults and children to put them to sleep for a short time. In addition, the agent relieves pain and restrains the patient prior to surgery for therapeutic or diagnostic purposes. Midazolam is also suitable as a sedative in the intensive care unit.

In the context of anesthesia, midazolam is used to prepare and initiate anesthesia in the case of combination anesthesia. In children, the active ingredient is not used to induce anesthesia, but is used as an anesthetic. The use of midazolam in babies and children for the treatment of acute and prolonged cramps is considered useful. Furthermore, the sedative is administered for a short-term treatment of sleep disorders.

Midazolam is mostly taken in the form of tablets. Alternatively, the agent can be injected directly into the bloodstream and administered rectally. The normal dose is between 7.5 and 15 milligrams of midazolam. Due to its short effect, it is recommended to take the product about 30 minutes before the desired sedative effect. For example, tablets are given just before bedtime.

In order to avoid withdrawal symptoms from the use of midazolam, it is advisable to gradually discontinue the sedative after a long period of therapy.

Since midazolam is a prescription drug, treatment with the drug is controlled by the doctor. This prescribes the preparation to the patient, who receives it by presenting a prescription at the pharmacy.

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Risks & side effects

Some patients may experience undesirable side effects from taking midazolam. In most cases, these are allergic reactions, hypersensitivity, arousal, confusion, muscle tremors, hallucinations, aggression and hostility.

In addition, dizziness, temporary memory loss, headache, unsteady gait, low blood pressure, slow heartbeat, withdrawal spasms, inflammation of the veins, dilated blood vessels, hiccups, itching, hives, constipation, nausea, vomiting, tiredness, reddened skin, dry mouth and dysfunction are conceivable .

In the worst case, it can lead to respiratory or cardiac arrest. In babies, cramps are a possibility.

Midazolam should not be given if the patient is hypersensitive to the drug or other benzodiazepines. Further contraindications are acute pauses in breathing, severe respiratory disorders and the nerve disease myasthenia gravis. The same applies to people who have severe liver function impairment.

Strict control is required with midazolam therapy if the patient is older than 60 years or if their general health is poor. Caution should also be exercised with people who have had a history of alcohol or drug abuse. You can quickly become addicted to taking midazolam.

The use of midazolam in pregnant and breastfeeding women is not recommended. Better alternatives are available for them.

The use of midazolam and other drugs can sometimes cause interactions. So the decomposition of the preparation is inhibited by fungal agents, which leads to a considerable increase in effectiveness. Itraconazole, fluconazole, posaconazole, voriconazole and ketoconazole are considered to be of particular concern. For the same reasons, the AIDS drug saquinavir, the calcium channel blockers diltiazem and verapamil, and the macrolide antibiotics clarithromycin and erythromycin should be avoided.