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Midazolam review
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The drug Midazolam is classified as an ultra short-acting derivative of benzodiazepine. It contains potent amnestic, anxiolytic, anticonvulsant, hypnotic, sedative and muscle relaxing properties. The drug is both water soluble and fat soluble in a physiologic pH solution. It is also freely soluble in both alcohol and acetone.
Midazolam, marketed under various brand names such as Dormicum, Hypnovel, Midacum, and Versed comes in forms of intravenous and intramuscular solutions. It is also marketed as an oral solution.
Intravenous midazolam is used for procedural sedation, usually accompanied by an opioid such as fentanyl. It may also be used for the induction of general anesthesia, and for sedating ventilated patients in critical care units.
Various pharmaceutical companies market midazolam in different packages and dosages. Roche pharmaceuticals market midazolam as Dormicum in white, oval tablets having dosages of 7.5mg. Novell Pharmaceutical markets the drug as Miloz, available in 3 ml and 5ml ampoules.
The most commonly reported side effects that the drug caused were fluctuations in the patients’ vital signs. Such fluctuations included irregular heartbeats, and difficulty in breathing. There has also been found to be variations in blood pressure and pulse rate.
Administration of the drug at night also caused some effects such as extreme sleepiness and impaired movement and cognitive functioning that pervaded until the following days or so. Rarely have patients been reported to experience confusion and amnesia as the drug’s side effects.
The drug midazolam is contraindicated for patients with a known hypersensitivity to the drug or its known components. It is also contraindicated in patients with acute narrow angle glaucoma, hypotension, head injuries, known alcohol and drug abuse and shock. Patients with known mental and/or psychotic disorders must be given caution when using the drug.
As the main action of the drug is to depress the central nervous system, the dosage of the drug to be given to patients must be adjusted depending on the amount of concomitant drugs used in conjunction with midazolam.
Caution must be exercised if the drug will be given to people who will be performing tasks requiring physical activity and mental alertness as the drug affects physical energy and mental awareness. Similarly, caution is to be exercised in patients taking midazolam with erythromycin as this drug may decrease the plasma clearance of midazolam.
Midazolam has been found out to cause rapid tolerance, and benzodiazepine dependence. It has also been found out that discontinued use of the drug brings about sever withdrawal syndrome, which may include rebound insomnia. Caution is to be advised when a patient opts out of treatment; the doctor must always be consulted to create a therapy to minimize withdrawal effects.
Midazolam has been found out to cause various serious cardio-respiratory effects, which may include apnea, oxygen desaturation, respiratory or cardiac arrest, airway obstruction and respiratory depression. Hypoventilation may also be experienced in these cases. The concomitant uses of barbiturates, alcohol and some other dugs have been found to increase the risk of such effects. Therefore, caution must be exercised when a patient is concomitantly using these drugs with midazolam.
The drug has been found out to pose a risk to the unborn when taken during the third trimester, as it may cause withdrawal syndrome in the child with symptoms such as hypotonia, cyanosis, and impaired metabolic responses. Therefore, the use of the drug in pregnant women should always be consulted with the doctor. Nursing mothers, or women planning to breastfeed must first consult their doctor prior to the usage of the drug. The potential benefits of the drug must always be weighed against its risks to the nursing mother and infant.
Midazolam has the following structural formula:
• Molecular formula of midazolam is C18H13ClFN3
Brand name(s): Dormicum, Midazolamum, Versed
Review published on: 12 September 2009
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