What Are the Most Common Midazolam Side Effects?

The main ingredient of this product is midazolam. Its chemical name is 8-chloro-6- (2-fluorophenyl) -1-methyl-4H-imidazole [1,5-a] [1,4] benzene ( And) Diazo.
Molecular formula: C ₁₈ H ₁₃ ClFN ₃ .
Molecular weight: 325.75

Versaide (midazolam injection), the indications are 1. Sedation before surgery. 2. Sober sedation before diagnosis or endoscopy. 3 Intraoperative sedation during induction of anesthesia, general anesthesia or epidural anesthesia.

Drug Name: Verside
Drug type: Prescription medicines, essential medicines, medicines for medical workers' injuries

Special medicine: Psychotropic drugs
Use classification: Benzodiazepines

Versace ingredients

Verset character

This product is colorless to light yellow clear liquid.

Forsythe indications

1. Sedation before surgery.
2. Sober sedation before diagnosis or endoscopy.
3 Intraoperative sedation during induction of anesthesia, general anesthesia or epidural anesthesia.

Versace Specifications

Ampoule: 1ml: 5mg
Vial: 5ml: 5mg

Dosage

Midazolam is a powerful sedative, the injection speed is slow, and the dosage is adjusted according to personal circumstances.
Midazolam can be used in combination with 5% glucose solution, 0.9% sodium chloride or Ringer's solution.
General Adult Dose 1. Preoperative sedation intramuscularly For adults under 60 years of age, it is recommended to administer a dose of 0.07-0.08 mg / kg one hour before surgery. The following patients should be individualized and adjusted for dose reduction: chronic obstructive pulmonary disease; older than 60 years; patients are using analgesics or other central nervous system inhibitors; other high-risk surgery patients. Midazolam should be injected deep into the large muscle group.
2. Intravenous administration of conscious sedation When used for conscious sedation, the dose must also be individualized and gradually adjusted. A single large or rapid intravenous injection should not be used. 1 mg / ml midazolam is recommended for conscious sedation. For slow injection, the two dosage forms of 1 mg / ml and 5 mg / ml can be diluted with 0.9% sodium chloride or 5% glucose solution.
Maintenance dose To maintain the desired sedative effect, the dose can be increased by 25% compared to the first dose, but the drip rate should be slow, especially in elderly patients with chronic diseases or extremely debilitating patients. This increased dose is limited to patients who have a clear need after a comprehensive clinical assessment.
1) Adults under 60 years of age are slowly administered until the desired effect is achieved, for example, the patient begins to have speech insufficiency. The dose should not exceed 2.5 mg for at least 2 minutes at the beginning, and wait for 2 minutes or longer to observe the effect. If further drips are needed, they should be increased in small doses until the desired sedative effect is achieved, and the total dose generally does not exceed 5 mg.
2) Patients older than 60 years old, debilitated or with chronic diseases The elderly and patients with chronic diseases or patients with pulmonary dysfunction have an increased risk of dyspnea or asphyxia, and in these patients, the peak effect of the drug It may be prolonged, so the dose should be increased gradually and the injection speed should be slower. Some patients have a response dose as small as 1 mg. The dose should not exceed 1.5 mg within at least 2 minutes. Wait for 2 minutes or longer to observe the effect. If necessary, dosing should not exceed 1 mg every two minutes, and then wait 2 minutes or more to evaluate the sedative effect. The total dose generally does not exceed 3.5 mg.
3. Sedation during anesthesia induction, general anesthesia or epidural anesthesia:
Patients who have not used medicine before administration For patients who have not used medicine before administration and the average age is below 55 years old, the induction dose is 0.3-0.35mg / kg, injected within 20-30 seconds, and wait for about 2 minutes to observe the results. If necessary, it should be given in an increase of 25% of the initial amount until the full induction effect is achieved, and some highly tolerated patients often need to increase the dose to 0.6 mg / kg, but such a large dose will prolong the patient's recovery time.
Patients over 55 years old who do not take medication before administration often need a smaller dose of midazolam for induction of anesthesia. The recommended initial dose is 0.3 mg / kg. The initial dose for patients with severe systemic diseases or physical weakness is generally 0.2- 0.25mg / kg, and some patients can be as small as 0.15mg / kg.
Patients who have been administered before administration When the patient has received a sedative or analgesic drug, the recommended dose of midazolam is: 0.15-0.35 mg / kg.
Adults under 55 years old, the dose is 0.25mg / kg, and the injection is waited for 2 minutes within 20-30 seconds to observe the effect.
The first recommended dose for surgical patients over 55 years of age is 0.2 mg / kg.

Forsad adverse reactions

The most common reaction after midazolam application is instability of vital signs. Asphyxia may occur after intravenous injection. Local reactions at the injection site include pain, redness, or phlebitis. Other uncommon side effects include hiccups, nausea, vomiting, headaches, lethargy, bronchospasm, progressive memory loss, sudden delirium, and prolonged accidents due to anesthesia.

Forsad Taboo

Midazolam is contraindicated in patients known to be allergic to benzodiazepines, benzodiazepine is contraindicated in patients with acute angle-closure glaucoma, and when used in open-angle glaucoma, patients should receive appropriate treatment.

Versace notes

General matters:
With the sedative or anesthetic effects of midazolam, there may be a decrease in motor mental function. This phenomenon may last for different periods of time due to the different drugs and total doses. When midazolam is used in outpatients, it should consider the side effects that may occur in people who need to be particularly awake at work (such as drivers or other skilled work). Do not perform machine operation or drive a motor vehicle until midazolam has sedative effects such as: lethargy and memory loss; or wait one day (or wait longer) after anesthesia or surgery.
caveat:
For high-risk surgery or elderly patients, lower doses should be used regardless of whether they were administered before administration. Patients with chronic obstructive pulmonary disease have abnormal sensitivity to midazolam with respiratory depression. Renal dysfunction and first dose in elderly patients should be reduced.
Each time you use midazolam, you should adjust the dosage according to the different conditions of each person. Before taking the medicine, you should prepare oxygen, rescue equipment, and emergency personnel who can keep the patient's airway open. In order to find the patient's dyspnea in time and take appropriate first-aid measures, otherwise it may cause hypoxemia and cardiac arrest. The vital signs of the patient should be closely observed during the resuscitation period. When midazolam is used for conscious sedation, be careful not to administer rapid or single high-dose intravenous injection.
The combination of midazolam with barbitur, alcohol, or other central nervous system inhibitory drugs can increase the risk of poor or difficult breathing in patients, and can also prolong the duration of the drug's action.

Fersed medication for pregnant and lactating women

It should not be used in the first trimester of pregnancy unless the physician considers it absolutely necessary.
Midazolam is secreted in human milk and is not recommended for lactating women.

Forsythia children's medication

There are no studies on the relationship between age and pharmacological effects of midazolam in children under 18 years of age. There is no documented problem with medications for children. Newborns should not use midazolam.

Verseder

Elderly patients often have age-related renal dysfunction and should be used in reduced doses.

Versaide drug interactions

Application of morphine, pethidine, and fentanyl to enhance the sedative effect of intravenous midazolam before administration. The dosage of midazolam must be adjusted according to the dose before administration. After midazolam intramuscular injection, the dose of thiopental for induction of anesthesia should be appropriately reduced.
Midazolam has potential when used concurrently with beta-blockers, channel antagonists, diuretics, ACE inhibitors, levodopa, magnesium sulfate, nitrates, and other antihypertensive drugs. The antihypertensive effect.
Intravenous midazolam reduces the minimum alveolar concentration of halothane for general anesthesia.
The inhibitory effect of cimetidine on the cytochrome P450 enzyme system may lead to a decrease in the metabolism of midazolam in the liver, thus delaying the elimination of midazolam and increasing the serum concentration.

Forsythia overdose

At present, there is not enough data on the overdose of midazolam in humans, but it is speculated that the clinical manifestations of overdose are the same as those of other benzodiazepines, such as: sedation, drowsiness, blurred consciousness, decreased coordination ability, decreased reflex effect, and coma. And other vital signs.
Overdose management < br The changes in breathing, pulse and blood pressure should be closely monitored, appropriate supportive therapies should be taken to keep the patient's breathing unobstructed, proper assisted breathing should be given, and intravenous infusion should be started. If hypotension occurs, treatment should include intravenous fluid replacement, and vasopressors should be used with caution based on clinical conditions.
Flumazenil is a special benzodiazepine receptor antagonist. It can completely or partially alleviate the sedative effects of benzodiazepines. It can be used to confirm or suspect benzodiazepine overdose.
[Drug abuse and dependence]
After 5-10 weeks of administration to monkeys, mild to moderate drug dependence will occur. Available data suggest that midazolam has the same abuse and potential dependence as diazepam.

Forsyth Pharmacology and Toxicology

Pharmacological effects:
Midazolam has antianxiety, hypnosis, anticonvulsant, muscle relaxation, and anterograde amnesia. Although the mechanism of action of midazolam is not very clear, it is similar to other benzodiazepines, that is, it interferes with the reabsorption of the inhibitory neuron -aminobutyric acid (GABA), leading to GABA accumulation. . Midazolam has a strong affinity with benzodiazepine receptors (about twice as stable), and the mechanism and action point of midazolam's forgetfulness are not completely clear.
Toxicology research:
Carcinogenicity and mutation: Long-term administration at a dose of 80mg / kg / day, it was found that liver tumors occurred in female rats, and the chance of benign thyroid cystic cell tumors in male rats increased significantly. At a dose of 9mg / kg (normal human body) 25 times the dosage), the incidence of the above tumors did not increase. Ames test, Chinese hamster lung cell test, human lymphocyte or mouse micronucleus test found that midazolam has no mutagenic effect.
Pregnancy and reproductive toxicity experiments: 10 times the human dose of 0.35 mg / kg was administered, and no evidence of fertility decline was found in pendazolamide.

Forsaide Pharmacokinetics

Midazolam was absorbed rapidly after intramuscular injection, and the bioavailability was greater than 90%. The effect reached its peak within 15-60 minutes after intramuscular injection. Midazolam is widely distributed in the body, including cerebrospinal fluid and brain tissue. It is widely bound to plasma proteins with a protein binding rate of 97%. Midazolam is rapidly metabolized to 1-hydroxymethyl midazolam and 4-hydroxymidazolam. The pharmacological effects of these metabolites are negligible compared to the drug form. Midazolam is mainly glucoside The conjugate is excreted from the kidney and less than 0.03% of the intravenous dose is excreted as it is. The elimination half-life is approximately 2.5 hours.

Fuseid Storage

Shaded and sealed.
Keep out of reach of children. The remaining medication must be discarded after use.

Versace Packaging

Ampoule: 10 sticks / box.
Small bottle: 5 bottles / box.

Verset validity

24 months.

Verside Manufacturing

Lambeth Labs Limited