Midazolam:
Intravenous, benzodiazepine gamma-aminobutyric acid (GABA) receptor agonist
ECMO Dose Adjustment:
YES—an increased dose may be warranted in some patients.
Renal Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
CRRT Dose Adjustment:
YES—a decreased dose may be warranted in some patients.
Hepatic Impairment Dose Adjustment*:
YES—a decreased dose may be warranted in some patients.
Adult Starting Dose^:
Adult Intermittent: 0.02-0.05 mg/kg IV every 0.5-2 hrs (1-2 mg IV every 0.5-2 hrs)
Adult Continuous Infusion: 0.01-0.02 mg/kg/hr (1-2 mg/hrs)
Pediatric Starting Dose^:
Pediatric Intermittent: 0.03-0.05 mg/kg IV every 0.5-2 hrs
Pediatric Continuous Infusion: 0.03-0.05 mg/kg/hr
Neonatal Starting Dose^:
Neonatal Intermittent: 0.03-0.05 mg/kg IV every 0.5-2 hrs
Neonatal Continuous Infusion: 0.03-0.05 mg/kg/hr
*Dose Adjustment will be dependent on acuity and severity of impairment.
^Always use the lowest effect dose to an objective endpoint (e.g., sedation scale).
Intravenous sedative physicochemical and pharmacokinetic characteristics
Drug Midazolam
   
Onset (min) 2-5
Log P 2.7-3.9
Protein Binding (%) 97
Metabolism / Elimination Hepatic; active metabolite renally eliminated
Dose Adjustment on ECMO +++
Dose Range*
Adult: 0.01-0.2 mg/kg/hr (1-10 mg/hr)
Pediatric: 0.03-0.2 mg/kg/hr
Neonatal: 0.03-0.2 mg/kg/hr
- Minimal sequestration; no need for Dose Adjustment
++ Moderate sequestration; may require Dose Adjustment
+++ Significant sequestration; need for Dose Adjustment
*Titrate to patient-specific goals, using the lowest effective dose. Dose ranges represent doses typically used in clinical practice; in some situations, patients may require doses above the usual dose range to achieve patient-specific goals.