Adults

Dosage varies widely based on indication, patient's age, physical status, and concomitant medications. For procedural sedation: IV initial dose 0.5-2 mg titrated slowly. For induction of anesthesia: IV 0.15-0.35 mg/kg. For status epilepticus: IV 0.2 mg/kg loading dose, then 0.1-0.2 mg/kg/hour infusion.

Elderly

Reduced doses are recommended due to increased sensitivity and slower elimination. For procedural sedation: IV initial dose 0.5-1 mg, titrated slowly. Max initial dose for healthy elderly: 3.5 mg.

Renal_impairment

No specific dose adjustment for mild to moderate renal impairment. For severe renal impairment/ESRD, caution is advised; dosage reduction may be necessary due to accumulation of active metabolites.

Onset

IV: 1.5-5 minutes; IM: 5-15 minutes

Excretion

Primarily excreted renally as glucuronide-conjugated metabolites.

Half life

1.8-6.4 hours (terminal half-life)

Absorption

Rapidly and completely absorbed following IM administration; bioavailability for IM is >90%. IV administration achieves rapid onset.

Metabolism

Extensively metabolized in the liver and small intestine via CYP3A4 to active (1-hydroxymidazolam) and inactive metabolites.

Opioids (e.g., Fentanyl, Morphine)

Increased risk of profound sedation, respiratory depression, coma, and death.

CYP3A4 Inducers (e.g., Rifampin, Phenytoin, Carbamazepine)

Decreased plasma concentration and reduced effects of Midazolam.

CNS Depressants (e.g., Alcohol, Barbiturates, Antihistamines, Antidepressants)

Potentiated CNS depressant effects.

CYP3A4 Inhibitors (e.g., Ketoconazole, Itraconazole, Erythromycin, Grapefruit juice)

Increased plasma concentration and prolonged effects of Midazolam.