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Midazolam is sometimes used for the acute management of seizures.
A benefit of midazolam is that in children it can be given in the cheek or in the nose for acute seizures, including status epilepticus.
Midazolam is effective for status epilepticus that has not improved following other treatments or
causing metabolic acidosis from the propylene glycol vehicle (which is not required due to its solubility in water), which occurs with other benzodiazepines.
Drawbacks include a high degree of breakthrough seizures—due to the short half-life of midazolam
—in over 50% of people treated, as well as treatment failure in 14–18% of people with refractory status epilepticus.
With prolonged use, tolerance and tachyphylaxis can occur and the elimination half-life may increase, up to days.
There is evidence buccal and intranasal midazolam is easier to administer and more effective than rectally administered diazepam in the emergency control of seizures.
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Injectable midazolam in 1 and 5 mg/ml strengths
People experiencing amnesia as a side effect of midazolam are generally unaware their memory is impaired, unless they had previously known it as a side effect.
It is unclear whether full recovery occurs after longer periods of abstinence. Benzodiazepines can cause or worsen depression.
Paradoxical excitement occasionally occurs with benzodiazepines, including a worsening of seizures.
Children and elderly individuals or those with a history of excessive alcohol use and individuals with a history of aggressive behavior or anger are at increased risk of paradoxical effects.
Paradoxical reactions are particularly associated with intravenous administration.
After nighttime administration of midazolam, residual ‘hangover’ effects, such as sleepiness and impaired psychomotor and cognitive functions, may persist into the next day.
This may impair the ability of users to drive safely and may increase the risk of falls and hip fractures.
Sedation, respiratory depression and hypotension due to a reduction in systematic vascular resistance, and an increase in heart rate can occur.
If intravenous midazolam is given too quickly, hypotension may occur.
and may lead to an increase in the length of ventilatory support needed.
a well-documented complication with benzodiazepines.
When this occurs, the individual may experience anxiety, involuntary movements,
aggressive or violent behavior, uncontrollable crying or verbalization, and other similar effects.
This seems to be related to the altered state of consciousness or disinhibition produced by the drug.
In extreme situations,
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flumazenil can be administered to inhibit or reverse the effects of midazolam. Antipsychotic medications, such as haloperidol, have also been used for this purpose.
In healthy humans, 0.15 mg/kg of midazolam may cause respiratory depression, which is postulated to be a central nervous system (CNS) effect.
the concomitant use with CNS acting drugs, mainly analgesic opiates, may increase the possibility of hypotension,
respiratory depression, respiratory arrest, and death, even at therapeutic doses.
Potential drug interactions involving at least one CNS depressant were observed for 84% of midazolam users