Midazolam - Wikipedia Midazolam Midazolam Clinical data Pronunciation / mɪˈdæzəlæm / Trade names Dormicum, Hypnovel, Versed, others AHFS / Drugs.com Monograph MedlinePlus a609003 License data EU EMA : by INN Pregnancy category AU : C US : D ( Evidence of risk ) Routes of administration By mouth, intramuscular, intravenous, buccal, intranasal Drug class Benzodiazepine ATC code N05CD08 ( WHO ) Legal status Legal status AU : S4 ( Prescription only ) CA : Schedule IV DE : Prescription only ( Anlage III for higher doses ) NZ : Class C UK : Class C US : Schedule IV South Africa : S5 Pharmacokinetic data Bioavailability By mouth ( variable, around 40 % ) intramuscular 90 % + Protein binding 97 % Metabolism Liver 3A3, 3A4, 3A5 Onset of action Within 5 min ( IV ), 15 min ( IM ), 20 min ( oral ) Elimination half - life 1.5 -- 2.5 hours Duration of action 1 to 6 hrs Excretion Kidney Identifiers IUPAC name 8 - chloro - 6 - ( 2 - fluorophenyl ) - 1 - methyl - 4H - imidazo ( 1, 5 - a ) ( 1, 4 ) benzodiazepine CAS Number 59467 - 70 - 8 PubChem CID 4192 IUPHAR / BPS 3342 DrugBank DB00683 ChemSpider 4047 UNII R60L0SM5BC KEGG D00550 ChEMBL CHEMBL655 ECHA InfoCard 100.056. 140 Chemical and physical data Formula C H Cl FN Molar mass 325.78 3D model ( JSmol ) Interactive image SMILES ClC1 = CC = C2C ( C ( C3 = CC = CC = C3F ) = NCC4 = CN = C ( C ) N42 ) = C1 InChI InChI = 1S / C18H13ClFN3 / c1 - 11 - 21 - 9 - 13 - 10 - 22 - 18 ( 14 - 4 - 2 - 3 - 5 - 16 ( 14 ) 20 ) 15 - 8 - 12 ( 19 ) 6 - 7 - 17 ( 15 ) 23 ( 11 ) 13 / h2 - 9H, 10H2, 1H3 Key : DDLIGBOFAVUZHB - UHFFFAOYSA - N ( verify ) Midazolam, marketed under the trade name Versed, among others, is a medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ability to create new memories. It is also useful for the treatment of seizures. Midazolam can be given by mouth, intravenously, or injection into a muscle, by spraying into the nose, or through the cheek. When given intravenously, it typically begins working within five minutes ; when injected into a muscle, it can take fifteen minutes to begin working. Effects last for between one and six hours. Side effects can include a decrease in efforts to breathe, low blood pressure, and sleepiness. Tolerance to its effects and withdrawal syndrome may occur following long - term use. Paradoxical effects, such as increased activity, can occur especially in children and older people. There is evidence of risk when used during pregnancy but no evidence of harm with a single dose during breastfeeding. It belongs to the benzodiazepine class of drugs and works by increasing the activity of the GABA neurotransmitter in the brain. Midazolam first came into use in 1976. It is on the World Health Organization 's List of Essential Medicines, the most effective and safe medicines needed in a health system. Midazolam is available as a generic medication and is not very expensive. The wholesale cost in the developing world of a vial is about US $0.35. In many countries, it is a controlled substance. Contents 1 Medical uses 1.1 Seizures 1.2 Procedural sedation 1.3 Problems sleeping 1.4 Agitation 1.5 End of life care 2 Contraindications 3 Side effects 3.1 Pregnancy and breastfeeding 3.2 Elderly 3.3 Tolerance, dependence, and withdrawal 3.4 Overdose 3.5 Detection in body fluids 3.6 Interactions 4 Pharmacology 5 History 6 Society and culture 6.1 Cost 6.2 Availability 6.3 Legal status 6.4 Marketing authorization 6.5 Use in executions 7 References 8 External links Medical uses Seizures Midazolam is sometimes used for the acute management of seizures. Long - term use for the management of epilepsy is not recommended due to the significant risk of tolerance ( which renders midazolam and other benzodiazepines ineffective ) and the significant side effect of sedation. A benefit of midazolam is that in children it can be administered buccally or intranasally at home or at school for emergency control of acute seizures, including status epilepticus. Midazolam is effective for status epilepticus that has not improved following other treatments or when intravenous access can not be obtained, and has advantages of being water - soluble, having a rapid onset of action and not causing metabolic acidosis from the propylene glycol vehicle, 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. Tolerance develops rapidly to the anticonvulsant effect, and the dose may need to be increased by several times to maintain anticonvulsant therapeutic effects. 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. Procedural sedation Intravenous midazolam is indicated for procedural sedation ( often in combination with an opioid, such as fentanyl ), for preoperative sedation, for the induction of general anesthesia, and for sedation of people who are ventilated in critical care units. Midazolam is superior to diazepam in impairing memory of endoscopy procedures, but propofol has a quicker recovery time and a better memory - impairing effect. It is the most popular benzodiazepine in the intensive care unit ( ICU ) because of its short elimination half - life, combined with its water solubility and its suitability for continuous infusion. However, for long - term sedation, lorazepam is preferred due to its long duration of action, and propofol has advantages over midazolam when used in the ICU for sedation, such as shorter weaning time and earlier tracheal extubation. Midazolam is sometimes used in neonatal intensive care units. When used, additional caution is required in newborns ; midazolam should not be used for longer than 72 hours due to risks of tachyphylaxis, and the possibility of development of a benzodiazepine withdrawal syndrome, as well as neurological complications. Bolus injections should be avoided due to the increased risk of cardiovascular depression, as well as neurological complications. Midazolam is also sometimes used in newborns who are receiving mechanical ventilation, although morphine is preferred, owing to its better safety profile for this indication. Problems sleeping Oral midazolam is indicated for the short - term treatment of moderately severe insomnia in people who have not reacted adequately to other hypnotics, and who have persistent trouble in falling asleep. Because of midazolam 's extremely short duration, it is not used for people who have trouble staying asleep through the night ; moderate - to long - acting benzodiazepines, such as temazepam, nitrazepam, flunitrazepam, and lormetazepam, are used for those purposes. Midazolam and other benzodiazepines may cause a deterioration in sleep quality. Agitation Midazolam, in combination with an antipsychotic drug, is indicated for the acute management of schizophrenia when it is associated with aggressive or out - of - control behaviour. End of life care In the final stages of end - of - life care, midazolam is routinely used at low doses via subcutaneous injection to help with agitation, myoclonus, restlessness or anxiety in the last hours or days of life. At higher doses during the last weeks of life, midazolam is considered a first line agent in palliative continuous deep sedation therapy when it is necessary to alleviate intolerable suffering not responsive to other treatments, but the need for this is rare. Contraindications Benzodiazepines require special precaution if used in the elderly, during pregnancy, in children, in alcohol - or other drug - dependent individuals or those with comorbid psychiatric disorders. Additional caution is required in critically ill patients, as accumulation of midazolam and its active metabolites may occur. Kidney or liver impairments may slow down the elimination of midazolam leading to prolonged and enhanced effects. Contraindications include hypersensitivity, acute narrow - angle glaucoma, shock, hypotension, or head injury. Most are relative contraindications. Side effects See also : Long - term effects of benzodiazepines Injectable midazolam in 1 and 5 mg / ml strengths Side effects of midazolam in the elderly are listed above. 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. Long - term use of benzodiazepines has been associated with long - lasting deficits of memory, and show only partial recovery six months after stopping benzodiazepines. 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 alcohol abuse 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. A `` midazolam infusion syndrome '' may result from high doses, and is characterised by delayed arousal hours to days after discontinuation of midazolam, and may lead to an increase in the length of ventilatory support needed. In susceptible individuals, midazolam has been known to cause a paradoxical reaction, 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. Paradoxical behavior is often not recalled by the patient due to the amnesia - producing properties of the drug. In extreme situations, flumazenil can be administered to inhibit or reverse the effects of midazolam. Antipsychotic medications, such as haloperidol, have also been used for this purpose. Midazolam is known to cause respiratory depression. In healthy humans, 0.15 mg / kg of midazolam may cause respiratory depression, which is postulated to be a central nervous system ( CNS ) effect. When midazolam is administered in combination with fentanyl, the incidence of hypoxemia or apnea becomes more likely. Although the incidence of respiratory depression / arrest is low ( 0.1 -- 0.5 % ) when midazolam is administered alone at normal doses, 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 who were subsequently required to receive the benzodiazepine antagonist flumazenil. Therefore, efforts directed toward monitoring drug interactions and preventing injuries from midazolam administration are expected to have a substantial impact on the safe use of this drug. Pregnancy and breastfeeding Midazolam, when taken during the third trimester of pregnancy, may cause risk to the neonate, including benzodiazepine withdrawal syndrome, with possible symptoms including hypotonia, apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. Symptoms of hypotonia and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. Other neonatal withdrawal symptoms include hyperexcitability, tremor, and gastrointestinal upset ( diarrhea or vomiting ). Breastfeeding by mothers using midazolam is not recommended. Elderly Additional caution is required in the elderly, as they are more sensitive to the pharmacological effects of benzodiazepines, metabolise them more slowly, and are more prone to adverse effects, including drowsiness, amnesia ( especially anterograde amnesia ), ataxia, hangover effects, confusion, and falls. Tolerance, dependence, and withdrawal A benzodiazepine dependence occurs in about one - third of individuals who are treated with benzodiazepines for longer than 4 weeks, which typically results in tolerance and benzodiazepine withdrawal syndrome when the dose is reduced too rapidly. Midazolam infusions may induce tolerance and a withdrawal syndrome in a matter of days. The risk factors for dependence include dependent personality, use of a benzodiazepine that is short - acting, high potency and long - term use of benzodiazepines. Withdrawal symptoms from midazolam can range from insomnia and anxiety to seizures and psychosis. Withdrawal symptoms can sometimes resemble a person 's underlying condition. Gradual reduction of midazolam after regular use can minimise withdrawal and rebound effects. Tolerance and the resultant withdrawal syndrome may be due to receptor down - regulation and GABA receptor alterations in gene expression, which causes long - term changes in the function of the GABAergic neuronal system. Chronic users of benzodiazepine medication who are given midazolam experience reduced therapeutic effects of midazolam, due to tolerance to benzodiazepines. Prolonged infusions with midazolam results in the development of tolerance ; if midazolam is given for a few days or more a withdrawal syndrome can occur. Therefore, preventing a withdrawal syndrome requires that a prolonged infusion be gradually withdrawn, and sometimes, continued tapering of dose with an oral long - acting benzodiazepine such as clorazepate dipotassium. When signs of tolerance to midazolam occur during intensive care unit sedation the addition of an opioid or propofol is recommended. Withdrawal symptoms can include irritability, abnormal reflexes, tremors, clonus, hypertonicity, delirium and seizures, nausea, vomiting, diarrhea, tachycardia, hypertension, and tachypnea. In those with significant dependence, sudden discontinuation may result in withdrawal symptoms such as status epilepticus that may be fatal. Overdose See also : Benzodiazepine overdose A midazolam overdose is considered a medical emergency and generally requires the immediate attention of medical personnel. Benzodiazepine overdose in healthy individuals is rarely life - threatening with proper medical support ; however, the toxicity of benzodiazepines increases when they are combined with other CNS depressants such as alcohol, opioids, or tricyclic antidepressants. The toxicity of benzodiazepine overdose and risk of death is also increased in the elderly and those with obstructive pulmonary disease or when used intravenously. Treatment is supportive ; activated charcoal can be used within an hour of the overdose. The antidote for an overdose of midazolam ( or any other benzodiazepine ) is flumazenil. While effective in reversing the effects of benzodiazepines it is not used in most cases as it may trigger seizures in mixed overdoses and benzodiazepine dependent individuals. Symptoms of midazolam overdose can include : Ataxia Dysarthria Nystagmus Slurred speech Somnolence ( difficulty staying awake ) Mental confusion Hypotension Respiratory arrest Vasomotor collapse Impaired motor functions Impaired reflexes Impaired coordination Impaired balance Dizziness Coma Death Detection in body fluids Concentrations of midazolam or its major metabolite, 1 - hydroxymidazolam glucuronide, may be measured in plasma, serum, or whole blood to monitor for safety in those receiving the drug therapeutically, to confirm a diagnosis of poisoning in hospitalized patients, or to assist in a forensic investigation of a case of fatal overdosage. Patients with renal dysfunction may exhibit prolongation of elimination half - life for both the parent drug and its active metabolite, with accumulation of these two substances in the bloodstream and the appearance of adverse depressant effects. Interactions Protease inhibitors, nefazodone, sertraline, grapefruit, fluoxetine, erythromycin, diltiazem, clarithromycin inhibit the metabolism of midazolam, leading to a prolonged action. St John 's wort, rifapentine, rifampin, rifabutin, phenytoin enhance the metabolism of midazolam leading to a reduced action. Sedating antidepressants, antiepileptic drugs such as phenobarbital, phenytoin and carbamazepine, sedative antihistamines, opioids, antipsychotics and alcohol enhance the sedative effects of midazolam. Midazolam is metabolized almost completely by cytochrome P450 - 3A4. Atorvastatin administration along with midazolam results in a reduced elimination rate of midazolam. St John 's wort decreases the blood levels of midazolam. Grapefruit juice reduces intestinal 3A4 and results in less metabolism and higher plasma concentrations. Pharmacology Midazolam is a short - acting benzodiazepine in adults with an elimination half - life of 1.5 - 2.5 hours. In the elderly, as well as young children and adolescents, the elimination half - life is longer. Midazolam is metabolised into an active metabolite alpha1 - hydroxymidazolam. Age - related deficits, renal and liver status affect the pharmacokinetic factors of midazolam as well as its active metabolite. However, the active metabolite of midazolam is minor and contributes to only 10 percent of biological activity of midazolam. Midazolam is poorly absorbed orally, with only 50 percent of the drug reaching the bloodstream. Midazolam is metabolised by cytochrome P450 ( CYP ) enzymes and by glucuronide conjugation. The therapeutic as well as adverse effects of midazolam are due to its effects on the GABA receptors ; midazolam does not activate GABA receptors directly but, as with other benzodiazepines, it enhances the effect of the neurotransmitter GABA on the GABA receptors ( ↑ frequency of Cl − channel opening ) resulting in neural inhibition. Almost all of the properties can be explained by the actions of benzodiazepines on GABA receptors. This results in the following pharmacological properties being produced : sedation, induction of sleep, reduction in anxiety, anterograde amnesia, muscle relaxation and anticonvulsant effects. History Midazolam is among about 35 benzodiazepines currently used medically, and was synthesized in 1975 by Walser and Fryer at Hoffmann - LaRoche, Inc in the United States. Owing to its water solubility, it was found to be less likely to cause thrombophlebitis than similar drugs. The anticonvulsant properties of midazolam were studied in the late 1970s, but not until the 1990s did it emerge as an effective treatment for convulsive status epilepticus. As of 2010, it is the most commonly used benzodiazepine in anesthetic medicine. In acute medicine, midazolam has become more popular than other benzodiazepines, such as lorazepam and diazepam, because it is shorter lasting, is more potent, and causes less pain at the injection site. Midazolam is also becoming increasingly popular in veterinary medicine due to its water solubility. Society and culture Cost Midazolam is available as a generic medication and is not very expensive. The wholesale price of a vial is about US $0.35. Availability Midazolam is available in the United States as a syrup or as an injectable solution. Dormicum brand midazolam is marketed by Roche as white, oval, 7.5 - mg tablets in boxes of two or three blister strips of 10 tablets, and as blue, oval, 15 - mg tablets in boxes of two ( Dormonid 3x ) blister strips of 10 tablets. The tablets are imprinted with `` Roche '' on one side and the dose of the tablet on the other side. Dormicum is also available as 1 -, 3 -, and 10 - ml ampoules at a concentration of 5 mg / ml. Another manufacturer, Novell Pharmaceutical Laboratories, makes it available as Miloz in 3 - and 5 - ml ampoules. Midazolam is the only water - soluble benzodiazepine available. Another maker is Roxanne Laboratories ; the product in an oral solution, Midazolam HCl Syrup, 2 mg / ml clear, in a red to purplish - red syrup, cherry in flavor. It becomes soluble when the injectable solution is buffered to a pH of 2.9 -- 3.7. Midazolam is also available in liquid form. It can be administered intramuscularly, intravenously, intrathecally, intranasally, buccally, or orally. Legal status In the Netherlands, midazolam is a List II drug of the Opium Law. Midazolam is a Schedule IV drug under the Convention on Psychotropic Substances. In the United Kingdom, midazolam is a Schedule 3 / Class C controlled drug. In the United States, midazolam ( DEA number 2884 ) is on the Schedule IV list of the Controlled Substances Act as a non-narcotic agent with low potential for abuse. Marketing Authorization In 2011, the European Medicines Agency granted a marketing authorisation for a buccal application form of midazolam, sold under the trade name Buccolam. Buccolam was approved for the treatment of prolonged, acute, convulsive seizures in people from three months to less than 18 years of age. This was the first application of a paediatric - use marketing authorisation. Use in executions Oklahoma State Penitentiary, the site of the state of Oklahoma 's execution chamber The drug has been introduced for use in executions by lethal injection in certain jurisdictions in the United States in combination with other drugs. It was introduced to replace pentobarbital after the latter 's manufacturer disallowed that drug 's use for executions. Midazolam has been used as part of a three - drug cocktail, with vecuronium bromide and potassium chloride in Florida and Oklahoma prisons. Midazolam has also been used along with hydromorphone in a two - drug protocol in Ohio and Arizona. Ohio used midazolam in the execution of Dennis McGuire in January 2014 ; it took McGuire 24 minutes to die after the procedure started, and he gasped and appeared to be choking during that time, leading to questions about the dosing and timing of the drug administration, as well as the choice of drugs. In October 2016, the U.S. state of Ohio announced that it would resume executions in January 2017, using the midazolam - vecuronium bromide - potassium chloride cocktail, but this was blocked by a Federal judge. On 25 July 2017, Ronald Phillips was executed with a three - drug cocktail including midazolam after the Supreme Court refused to grant a stay. Prior to this, the last execution in Ohio had been that of Dennis McGuire. Murderer Gary Otte 's lawyers unsuccessfully challenged his Ohio execution, arguing that midazolam might not protect him from serious pain when the other drugs are administered. He died without incident in about 14 minutes on September 13, 2017. Midazolam acts as a sedative to render the condemned prisoner unconscious, at which time the vecuronium bromide and potassium chloride are administered, stopping the prisoner 's breathing and heart, respectively. Florida used midazolam to execute William Happ in October 2013. The usage of midazolam in executions has become controversial after condemned inmate Clayton Lockett apparently regained consciousness and started speaking midway through his execution when the state of Oklahoma attempted to execute him with an untested three - drug lethal injection cocktail using 100 mg of midazolam. Prison officials reportedly discussed taking him to a hospital before he was pronounced dead of a heart attack 40 minutes after the execution began. An observing doctor stated that Lockett 's vein had ruptured. It is not clear which drug or drugs caused his death or what quantities of vecuronium bromide and potassium chloride were released before the execution was cancelled. In Glossip v. Gross, attorneys for three Oklahoma inmates argued that midazolam could not achieve the level of unconsciousness required for surgery, meaning severe pain and suffering was likely. They argued that midazolam was cruel and unusual punishment and thus contrary to the Eighth Amendment to the United States Constitution. In June 2015, the U.S. Supreme Court ruled they failed to prove that midazolam was cruel and unusual when compared to known, available alternatives. The execution of Ronald Bert Smith in Alabama on December 8, 2016 `` went awry soon after ( midazolam ) was administered '' again putting the effectiveness of the drug in question. On April 24, 2017, Arkansas carried out a double - execution of Jack Jones, 52, and Marcel Williams, 46. 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External links PubPK - Midazolam Pharmacokinetics Rx - List - Midazolam ( Versed ) Inchem - Midazolam Benzodiazepines 1, 4 - Benzodiazepines 2 - Oxoquazepam 3 - Hydroxyphenazepam Bromazepam Camazepam Carburazepam Chlordiazepoxide Cinazepam Cinolazepam Clonazepam Cloniprazepam Clorazepate Cyprazepam Delorazepam Demoxepam Desmethylflunitrazepam Devazepide * Diazepam Diclazepam Doxefazepam Elfazepam Ethyl carfluzepate Ethyl dirazepate Ethyl loflazepate Flubromazepam Fletazepam Fludiazepam Flunitrazepam Flurazepam Flutemazepam Flutoprazepam Fosazepam Gidazepam Halazepam Iclazepam Irazepine Kenazepine Ketazolam Lorazepam Lormetazepam Lufuradom * Meclonazepam Medazepam Menitrazepam Metaclazepam Motrazepam N - Desalkylflurazepam Nifoxipam Nimetazepam Nitrazepam Nitrazepate Nordazepam Nortetrazepam Oxazepam Phenazepam Pinazepam Pivoxazepam Prazepam Proflazepam Quazepam QH - II - 66 Reclazepam RO4491533 * Ro5 - 4864 * Sulazepam Temazepam Tetrazepam Tifluadom * Tolufazepam Triflunordazepam Tuclazepam Uldazepam 1, 5 - Benzodiazepines Arfendazam Clobazam CP - 1414S Lofendazam Triflubazam 2, 3 - Benzodiazepines * Girisopam GYKI - 52466 GYKI - 52895 Nerisopam Talampanel Tofisopam Triazolobenzodiazepines Adinazolam Alprazolam Clonazolam Estazolam Flubromazolam Flunitrazolam Nitrazolam Pyrazolam Triazolam Imidazobenzodiazepines Bretazenil Climazolam EVT - 201 FG - 8205 Flumazenil Imidazenil I - Iomazenil L - 655,708 Loprazolam Midazolam PWZ - 029 Remimazolam Ro15 - 4513 Ro48 - 6791 Ro48 - 8684 Ro4938581 Sarmazenil SH - 053 - R - CH3 - 2 ′ F Oxazolobenzodiazepines Cloxazolam Flutazolam Haloxazolam Mexazolam Oxazolam Thienodiazepines Bentazepam Clotiazepam Thienotriazolodiazepines Brotizolam Ciclotizolam Deschloroetizolam Etizolam Israpafant * JQ1 * Metizolam Thienobenzodiazepines * Olanzapine Telenzepine ∗ Clonazolam Pyridodiazepines Lopirazepam Pyridotriazolodiazepines Zapizolam Pyrazolodiazepines Razobazam * Ripazepam Zolazepam Zomebazam Zometapine * Pyrrolodiazepines Premazepam Tetrahydroisoquinobenzodiazepines Clazolam Pyrrolobenzodiazepines * Anthramycin Benzodiazepine prodrugs Avizafone Rilmazafone * atypical activity profile ( not GABA receptor ligands ) Anticonvulsants ( N03 ) GABAergics GABA R PAMs Barbiturates : Barbexaclone Metharbital Methylphenobarbital Pentobarbital Phenobarbital Primidone ; Carbamates : Felbamate ; Benzodiazepines : Clobazam Clonazepam Clorazepate Diazepam Lorazepam Midazolam Nimetazepam Nitrazepam Temazepam ; Others : Bromide ( potassium bromide, sodium bromide ) Imepitoin Paraldehyde Stiripentol GABA - T inhibitors Fatty acids ( and related ) : Valproate Valpromide Valproate pivoxil Vigabatrin Others GABAR agonists : Progabide ; GAT - 1 inhibitors : Tiagabine Channel modulators Sodium blockers Hydantoins : Ethotoin Fosphenytoin Mephenytoin Phenytoin ; Ureides : Acetylpheneturide Chlorphenacemide Phenacemide Pheneturide ; Fatty acids : Valproate Valpromide Valproate pivoxil ; Carboxamides : Carbamazepine Eslicarbazepine acetate Oxcarbazepine ; Others : Lacosamide Lamotrigine Rufinamide Topiramate Zonisamide Calcium blockers Oxazolidinediones : Ethadione Paramethadione Trimethadione ; Succinimides : Ethosuximide Mesuximide Phensuximide ; Gabapentinoids : Gabapentin Pregabalin ; Others : Imepitoin Lamotrigine Topiramate Zonisamide Potassium openers Retigabine Others CA inhibitors Sulfonamides : Acetazolamide Ethoxzolamide Sultiame Topiramate Zonisamide Others Albutoin Beclamide Brivaracetam Cannabidiol Etiracetam Levetiracetam Perampanel WHO - EM Withdrawn from market Clinical trials : Phase III Never to phase III Anesthesia ( outline ) Types General Sedation Twilight anesthesia Local Topical Intercostal nerve block Neuraxial blockade Spinal Epidural Dental Inferior alveolar nerve Techniques Airway management Anesthesia provision in the US Arterial catheter Bronchoscopy Capnography Dogliotti 's principle Drug - induced amnesia Intraoperative neurophysiological monitoring Nerve block Penthrox inhaler Tracheal intubation Scientific principles Blood -- gas partition coefficient Concentration effect Fink effect Minimum alveolar concentration Second gas effect Measurements ASA physical status classification system Baricity Bispectral index Entropy monitoring Fick principle Goldman index Guedel 's classification Mallampati score Neuromuscular monitoring Thyromental distance Instruments Anaesthetic machine Anesthesia cart Boyle 's machine Gas cylinder Laryngeal mask airway Laryngeal tube Medical monitor Odom 's indicator Relative analgesia machine Vaporiser Double - lumen endotracheal tube Endobronchial blocker Complications Emergence delirium Allergic reactions Anesthesia awareness Local anesthetic toxicity Malignant hyperthermia Perioperative mortality Postanesthetic shivering Postoperative nausea and vomiting Postoperative residual curarization Fields of study Cardiothoracic Geriatric Oral sedation dentistry Professions Anesthesiologist Anesthesiologist assistant Nurse anesthetist Operating Department Practitioners Certified Anesthesia Technician Certified Anesthesia Technologist Anaesthetic technician History A.C.E. mixture Helsinki Declaration for Patient Safety in Anaesthesiology History of general anesthesia History of neuraxial anesthesia History of tracheal intubation Organizations American Association of Nurse Anesthetists American Society of Anesthesia Technologists & Technicians American Society of Anesthesiologists Anaesthesia Trauma and Critical Care Association of Anaesthetists of Great Britain and Ireland Association of Veterinary Anaesthetists Australian and New Zealand College of Anaesthetists Australian Society of Anaesthetists International Anesthesia Research Society Hypnotics / sedatives ( N05C ) GABA Alcohols 2M2B Chloralodol Ethanol ( alcohol ) Ethchlorvynol Methylpentynol Trichloroethanol Barbiturates Allobarbital Amobarbital Aprobarbital Barbital Butabarbital Butobarbital Cyclobarbital Ethallobarbital Heptabarb Hexobarbital Mephobarbital Methohexital Narcobarbital Pentobarbital Phenallymal Phenobarbital Propylbarbital Proxibarbal Reposal Secobarbital Talbutal Thiamylal Thiopental Thiotetrabarbital Vinbarbital Vinylbital Benzodiazepines Brotizolam Cinolazepam Climazolam Doxefazepam Estazolam Flunitrazepam Flurazepam Flutoprazepam Lorazepam Loprazolam Lormetazepam Midazolam Nimetazepam Nitrazepam Phenazepam Quazepam Temazepam Triazolam Carbamates Carisoprodol Emylcamate Ethinamate Hexapropymate Meprobamate Methocarbamol Phenprobamate Procymate Tybamate Imidazoles Etomidate Metomidate Propoxate Monoureides Acecarbromal Apronal ( apronalide ) Bromisoval Capuride Carbromal Ectylurea Neuroactive steroids Acebrochol Allopregnanolone Alphadolone Alphaxolone Eltanolone Hydroxydione Minaxolone Progesterone Nonbenzodiazepines Eszopiclone Indiplon Lirequinil Necopidem Pazinaclone Saripidem Suproclone Suriclone Zaleplon Zolpidem Zopiclone Phenols Propofol Piperidinediones Glutethimide Methyprylon Pyrithyldione Piperidione Quinazolinones Afloqualone Cloroqualone Diproqualone Etaqualone Mebroqualone Mecloqualone Methaqualone Methylmethaqualone Nitromethaqualone Others Acetophenone Acetylglycinamide chloral hydrate Bromide compounds Lithium bromide Potassium bromide Sodium bromide Centalun Chloral betaine Chloral hydrate Chloralose Clomethiazole Dichloralphenazone Gaboxadol Kavalactones Loreclezole Paraldehyde Petrichloral Sulfonylalkanes Sulfonmethane ( sulfonal ) Tetronal Trional Triclofos Sesquiterpene Isovaleramide Isovaleric acid Valerenic acid GABA 1, 4 - Butanediol 4 - Fluorophenibut Aceburic acid Baclofen GABOB GHB ( sodium oxybate ) GBL GVL Phenibut Tolibut Antihistamines Captodiame Cyproheptadine Diphenhydramine Doxylamine Hydroxyzine Methapyrilene Perlapine Pheniramine Promethazine Propiomazine Antidepressants Serotonin antagonists and reuptake inhibitors Etoperidone Nefazodone Trazodone Tricyclic antidepressants Amitriptyline Doxepin Trimipramine, etc. Tetracyclic antidepressants Mianserin Mirtazapine, etc. Antipsychotics Typical antipsychotics Chlorpromazine Thioridazine, etc. Atypical antipsychotics Olanzapine Quetiapine Risperidone, etc. α - Adrenergic Clonidine Detomidine Dexmedetomidine Lofexidine Medetomidine Romifidine Tizanidine Xylazine 5 - HT Antidepressants Trazodone Tricyclic antidepressants Amitriptyline Doxepin Trimipramine, etc. Tetracyclic antidepressants Mianserin Mirtazapine, etc. Antipsychotics Typical antipsychotics Chlorpromazine Thioridazine, etc. Atypical antipsychotics Olanzapine Quetiapine Risperidone, etc. Others Niaprazine Melatonin Agomelatine Melatonin Ramelteon Tasimelteon Orexin Almorexant Filorexant Suvorexant α δ VDCC Gabapentin Gabapentin enacarbil Mirogabalin Phenibut Pregabalin Others Cannabidiol Cannabis Chlorophenylalkyldiols Fenpentadiol Metaglycodol Phenaglycodol Diethylpropanediol Evoxine Fenadiazole Guaifenesin - related muscle relaxants Chlorphenesin Mephenesin Mephenoxalone Metaxalone Methocarbamol Opioids ( e.g., morphine ) Passion flower Scopolamine Trazodone UMB68 Valnoctamide GABA receptor positive modulators Alcohols Brometone Butanol Chloralodol Chlorobutanol ( cloretone ) Ethanol ( alcohol ) ( alcoholic drink ) Ethchlorvynol Isobutanol Isopropanol Menthol Methanol Methylpentynol Pentanol Petrichloral Propanol tert - Butanol ( 2M2P ) tert - Pentanol ( 2M2B ) Tribromoethanol Trichloroethanol Triclofos Trifluoroethanol Barbiturates ( - ) - DMBB Allobarbital Alphenal Amobarbital Aprobarbital Barbexaclone Barbital Benzobarbital Benzylbutylbarbiturate Brallobarbital Brophebarbital Butabarbital / Secbutabarbital Butalbital Buthalital Butobarbital Butallylonal Carbubarb Crotylbarbital Cyclobarbital Cyclopentobarbital Difebarbamate Enallylpropymal Ethallobarbital Eterobarb Febarbamate Heptabarb Heptobarbital Hexethal Hexobarbital Metharbital Methitural Methohexital Methylphenobarbital Narcobarbital Nealbarbital Pentobarbital Phenallymal Phenobarbital Phetharbital Primidone Probarbital Propallylonal Propylbarbital Proxibarbital Reposal Secobarbital Sigmodal Spirobarbital Talbutal Tetrabamate Tetrabarbital Thialbarbital Thiamylal Thiobarbital Thiobutabarbital Thiopental Thiotetrabarbital Valofane Vinbarbital Vinylbital Benzodiazepines 2 - Oxoquazepam 3 - Hydroxyphenazepam Adinazolam Alprazolam Arfendazam Avizafone Bentazepam Bretazenil Bromazepam Brotizolam Camazepam Carburazepam Chlordiazepoxide Ciclotizolam Cinazepam Cinolazepam Clazolam Climazolam Clobazam Clonazepam Clonazolam Cloniprazepam Clorazepate Clotiazepam Cloxazolam CP - 1414S Cyprazepam Delorazepam Demoxepam Diazepam Diclazepam Doxefazepam Elfazepam Estazolam Ethyl carfluzepate Ethyl dirazepate Ethyl loflazepate Etizolam EVT - 201 FG - 8205 Fletazepam Flubromazepam Flubromazolam Fludiazepam Flunitrazepam Flunitrazolam Flurazepam Flutazolam Flutemazepam Flutoprazepam Fosazepam Gidazepam Halazepam Haloxazolam Iclazepam Imidazenil Irazepine Ketazolam Lofendazam Lopirazepam Loprazolam Lorazepam Lormetazepam Meclonazepam Medazepam Menitrazepam Metaclazepam Mexazolam Midazolam Motrazepam N - Desalkylflurazepam Nifoxipam Nimetazepam Nitrazepam Nitrazepate Nitrazolam Nordazepam Nortetrazepam Oxazepam Oxazolam Phenazepam Pinazepam Pivoxazepam Prazepam Premazepam Proflazepam Pyrazolam QH - II - 66 Quazepam Reclazepam Remimazolam Rilmazafone Ripazepam Ro48 - 6791 Ro48 - 8684 SH - 053 - R - CH3 - 2 ′ F Sulazepam Temazepam Tetrazepam Tolufazepam Triazolam Triflubazam Triflunordazepam ( Ro5 - 2904 ) Tuclazepam Uldazepam Zapizolam Zolazepam Zomebazam Carbamates Carisbamate Carisoprodol Clocental Cyclarbamate Difebarbamate Emylcamate Ethinamate Febarbamate Felbamate Hexapropymate Lorbamate Mebutamate Meprobamate Nisobamate Pentabamate Phenprobamate Procymate Styramate Tetrabamate Tybamate Flavonoids 6 - Methylapigenin Ampelopsin ( dihydromyricetin ) Apigenin Baicalein Baicalin Catechin EGC EGCG Hispidulin Linarin Luteolin Rc - OMe Skullcap constituents ( e.g., baicalin ) Wogonin Imidazoles Etomidate Metomidate Propoxate Kava constituents 10 - Methoxyyangonin 11 - Methoxyyangonin 11 - Hydroxyyangonin Desmethoxyyangonin 11 - Methoxy - 12 - hydroxydehydrokavain 7, 8 - Dihydroyangonin Kavain 5 - Hydroxykavain 5, 6 - Dihydroyangonin 7, 8 - Dihydrokavain 5, 6, 7, 8 - Tetrahydroyangonin 5, 6 - Dehydromethysticin Methysticin 7, 8 - Dihydromethysticin Yangonin Monoureides Acecarbromal Apronal ( apronalide ) Bromisoval Carbromal Capuride Ectylurea Neuroactive steroids Acebrochol Allopregnanolone ( brexanolone ) Alfadolone Alfaxalone 3α - Androstanediol Androstenol Androsterone Certain anabolic - androgenic steroids Cholesterol DHDOC 3α - DHP 5α - DHP 5β - DHP DHT Etiocholanolone Ganaxolone Hydroxydione Minaxolone ORG - 20599 ORG - 21465 P1 - 185 Pregnanolone ( eltanolone ) Progesterone Renanolone SAGE - 105 SAGE - 217 SAGE - 324 SAGE - 516 SAGE - 689 SAGE - 872 Testosterone THDOC Nonbenzodiazepines β - Carbolines : Abecarnil Gedocarnil Harmane SL - 651,498 ZK - 93423 Cyclopyrrolones : Eszopiclone Pagoclone Pazinaclone Suproclone Suriclone Zopiclone Imidazopyridines : Alpidem DS - 1 Necopidem Saripidem Zolpidem Pyrazolopyrimidines : Divaplon Fasiplon Indiplon Lorediplon Ocinaplon Panadiplon Taniplon Zaleplon Others : Adipiplon CGS - 8216 CGS - 9896 CGS - 13767 CGS - 20625 CL - 218,872 CP - 615,003 CTP - 354 ELB - 139 GBLD - 345 Imepitoin JM - 1232 L - 838,417 Lirequinil ( Ro41 - 3696 ) NS - 2664 NS - 2710 NS - 11394 Pipequaline ROD - 188 RWJ - 51204 SB - 205,384 SX - 3228 TGSC01AA TP - 003 TPA - 023 TP - 13 U-89843A U-90042 Viqualine Y - 23684 Phenols Fospropofol Propofol Thymol Piperidinediones Glutethimide Methyprylon Piperidione Pyrithyldione Pyrazolopyridines Cartazolate Etazolate ICI - 190,622 Tracazolate Quinazolinones Afloqualone Cloroqualone Diproqualone Etaqualone Mebroqualone Mecloqualone Methaqualone Methylmethaqualone Nitromethaqualone SL - 164 Volatiles / gases Acetone Acetophenone Acetylglycinamide chloral hydrate Aliflurane Benzene Butane Butylene Centalun Chloral Chloral betaine Chloral hydrate Chloroform Cryofluorane Desflurane Dichloralphenazone Dichloromethane Diethyl ether Enflurane Ethyl chloride Ethylene Fluroxene Gasoline Halopropane Halothane Isoflurane Kerosine Methoxyflurane Methoxypropane Nitric oxide Nitrogen Nitrous oxide Norflurane Paraldehyde Propane Propylene Roflurane Sevoflurane Synthane Teflurane Toluene Trichloroethane ( methyl chloroform ) Trichloroethylene Vinyl ether Others / unsorted 3 - Hydroxybutanal α - EMTBL AA - 29504 Avermectins ( e.g., ivermectin ) Bromide compounds ( e.g., lithium bromide, potassium bromide, sodium bromide ) Carbamazepine Chloralose Chlormezanone Clomethiazole DEABL Dihydroergolines ( e.g., dihydroergocryptine, dihydroergosine, dihydroergotamine, ergoloid ( dihydroergotoxine ) ) DS2 Efavirenz Etazepine Etifoxine Fenamates ( e.g., flufenamic acid, mefenamic acid, niflumic acid, tolfenamic acid ) Fluoxetine Flupirtine Hopantenic acid Lanthanum Lavender oil Lignans ( e.g., 4 - O - methylhonokiol, honokiol, magnolol, obovatol ) Loreclezole Menthyl isovalerate ( validolum ) Monastrol Niacin Nicotinamide ( niacinamide ) Org 25,435 Phenytoin Propanidid Retigabine ( ezogabine ) Safranal Seproxetine Stiripentol Sulfonylalkanes ( e.g., sulfonmethane ( sulfonal ), tetronal, trional ) Terpenoids ( e.g., borneol ) Topiramate Valerian constituents ( e.g., isovaleric acid, isovaleramide, valerenic acid, valerenol ) Unsorted benzodiazepine site positive modulators : α - Pinene MRK - 409 ( MK - 0343 ) TCS - 1105 TCS - 1205 See also : Receptor / signaling modulators GABA receptor modulators GABA metabolism / transport modulators Pharmacy and pharmacology portal Medicine portal Retrieved from `` https://en.wikipedia.org/w/index.php?title=Midazolam&oldid=854483181 '' Categories : 21 - Hydroxylase inhibitors Chemical substances for emergency medicine GABAA receptor positive allosteric modulators Hoffmann - La Roche Imidazobenzodiazepines Fluoroarenes World Health Organization essential medicines Lethal injection components Hidden categories : CS1 German - language sources ( de ) Template : drugs.com link with non-standard subpage Drugs with non-standard legal status ECHA InfoCard ID from Wikidata Drug has EMA link Drugboxes which contain changes to watched fields Wikipedia articles in need of updating from July 2018 All Wikipedia articles in need of updating All articles with unsourced statements Articles with unsourced statements from May 2015 Articles containing potentially dated statements from 2010 All articles containing potentially dated statements Good articles RTT Talk Contents About Wikipedia Afrikaans Azərbaycanca تۆرکجه Bosanski Català Čeština Cymraeg Deutsch Español Euskara فارسی Français 한국어 Italiano עברית ქართული Magyar Nederlands 日本 語 Norsk ଓଡ଼ିଆ Polski Português Română Русский Српски / srpski Srpskohrvatski / српскохрватски Suomi Svenska ไทย Українська Tiếng Việt 中文 25 more Edit links This page was last edited on 11 August 2018, at 17 : 56 ( UTC ). 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Question: how long does the effect of midazolam last
Answer: between one and six hours