Intranasal Midazolam Dosing and Administration

Clinical Considerations and Precautions

Dose reduction of 20% or more is indicated for patients older than 60 years and those with ASA physical status III or greater, as recommended by the American Gastroenterological Association 1, 2
Patients with hepatic or renal impairment require dose adjustments due to reduced midazolam clearance, according to the American Gastroenterological Association 2, 3
When midazolam is used with an opioid, a synergistic interaction occurs that increases the risk of respiratory depression, necessitating a reduction in the midazolam dose, as noted by the American Gastroenterological Association 1, 3
The major side effect of midazolam is respiratory depression, which can occur up to 30 minutes after administration, as reported by the American Gastroenterological Association 2, 3

Avoids the risk of thrombophlebitis associated with intravenous diazepam, as noted by the American Gastroenterological Association 1, 3
Offers superior amnestic properties compared to diazepam, according to the American Gastroenterological Association 2, 3

Flumazenil should be available for reversal of benzodiazepine effects if needed, though be aware it may induce seizures in patients taking benzodiazepines for seizure control, as recommended by the American Academy of Pediatrics 4