Midazolam injectable
Midazolam guidance for first-line treatment of convulsive status epilepticus by buccal, intranasal, or IM routes.
Therapeutic action
Short-acting antiseizure (anticonvulsant), muscle relaxant, sedative-hypnotic, anxiolytic.
Indications
First-line treatment of convulsive status epilepticus.
Forms and strengths, route of administration
- 5 mg in 5 ml ampoule (1 mg/ml) and 50 mg in 10 ml ampoule (5 mg/ml) for buccal or intranasal administration or IM injection.
- For buccal or intranasal administration, preferably use the 50 mg in 10 ml ampoule (5 mg/ml).
- For IM injection, use only the 5 mg in 5 ml ampoule (1 mg/ml).
Dose and duration
During and after administration, have ventilation equipment and solutions for fluid replacement ready for use.
For seizures, preferably use the buccal or intranasal route, especially in children.
If seizures do not stop 5 minutes after the first dose, readminister the same dose regardless of route. Do not administer more than 2 doses in total.
Child 1 month to 11 years
- Buccal or intranasal route: one dose of 0.2 to 0.3 mg/kg, equal to 0.04 to 0.06 ml/kg of the 5 mg/ml solution or 0.2 to 0.3 ml/kg of the 1 mg/ml solution, maximum 10 mg.
- IM injection: one dose of 0.15 to 0.2 mg/kg, equal to 0.15 to 0.2 ml/kg of the 1 mg/ml solution, maximum 10 mg.
| Age | Weight | 5 mg/ml buccal/intranasal | 1 mg/ml buccal/intranasal | 1 mg/ml IM injection |
|---|---|---|---|---|
| 1 to < 4 months | 3 to < 6 kg | 0.25 ml | 1 ml | 0.6 ml |
| 4 to < 12 months | 6 to < 10 kg | 0.4 ml | 1.8 ml (max. 2 ml) | 1.2 ml |
| 1 to < 3 years | 10 to < 15 kg | 0.6 ml | - | 2 ml |
| 3 to < 5 years | 15 to < 20 kg | 1 ml | - | 3 ml |
| 5 to < 9 years | 20 to < 30 kg | 1.2 ml | - | 4 ml |
| 9 to < 12 years | 30 to < 40 kg | 2 ml | - | 6 ml |
Child 12 years and over and adult
- Buccal or intranasal route: one dose of 10 mg, equal to 2 ml of the 5 mg/ml solution.
- IM injection: one dose of 10 mg, equal to 10 ml of the 1 mg/ml solution.
Buccal and intranasal administration technique
- Buccal route: lay the patient on the side, withdraw the required dose with a 1 ml or 2 ml syringe, remove the needle, insert the tip into the space between gum and cheek, and administer slowly.
- Intranasal route: lay the patient on the back or side, withdraw the required dose with a 1 ml or 2 ml syringe, add 0.1 ml to account for remaining liquid in the atomising device, remove the needle, attach the intranasal atomisation device, and spray briskly into the nostril. The dose can be split between both nostrils to reduce irritation.
Contra-indications, adverse effects, precautions
- Do not administer to patients with severe respiratory insufficiency or severe hepatic impairment.
- Administer with caution to older patients and patients with renal or hepatic impairment.
- May cause pain at injection site, nasal irritation if used intranasally, hypotension, muscle weakness, ataxia, hypotonia, drowsiness, lethargy, confusional state, respiratory depression, and coma in overdose.
- Avoid or monitor combination with opioid analgesics, antipsychotics, first-generation antihistamines, antidepressants, other antiseizure medications, enzyme inducers, omeprazole, macrolides, ritonavir, isoniazid, fluconazole, itraconazole, and phenytoin.
- Pregnancy and breast-feeding: avoid, except if vital.
- Midazolam is subject to international controls: follow national regulations.
- Midazolam is also used as premedication before surgical procedures, for sedation in medical procedures and intensive care, and for induction of general anaesthesia.
- Do not mix with other drugs in the same syringe.
Source
MSF Essential drugs practical guidelines (January 2026)
This page reproduces the structured reference information for this batch while leaving out the Storage and Remarks sections.
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