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midazolam

Generic Versed
Used for Anxiety, Sedation

Midazolam is used for sedation before surgery and other medical procedures in children and adults, as well as treatment for status epilepticus (long-lasting seizures) in adults. It comes as an injection and oral syrup. The medication is typically given by a healthcare provider in a monitored setting and can't be used at home. Some side effects of midazolam include nausea, agitation, drowsiness, and pain at the injection site for the injection form. And although the brand name Versed has been discontinued, there are many generics still available.

Reviewed by:
reviewerHope Chang, PharmD, AAHIVP
reviewerKristianne Hannemann, PharmD
Last reviewed on April 26, 2023
basics-icon

What is Midazolam?

What is Midazolam used for?

  • Sedation for surgery or other medical procedure
  • Long-lasting seizure (status epilepticus) - Seizalam

How Midazolam works

Midazolam is a fast-acting benzodiazepine. It slows down activity in your brain and spinal cord and causes sedation, anxiety relief, and memory loss (amnesia) for a short period of time.

The way it works to treat long-lasting seizures isn't fully known, but it's thought to involve slowing down signals in the brain.

Drug facts

Common BrandsSeizalam
Drug ClassBenzodiazepine
Controlled Substance ClassificationSchedule IV
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Risks and warnings for Midazolam

Midazolam can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Severe difficulty breathing

  • Risk factors: Taking midazolam with opioids, alcohol, or other sedating medications | History of breathing problems

Black Box Warning Midazolam can cause severe drowsiness, tiredness, and trouble breathing. This can be worse if opioid medications are also used for the procedure. If you're receiving midazolam for sedation before a procedure, your care team will start the medication in small doses and will monitor your breathing very carefully.

Continued memory problems after procedure

You might have memory problems and feel drowsy or "out of it" for a few hours after your procedure. If you're not admitted to the hospital, you'll most likely need someone to drive you home and take care of you. You might also feel dizzy and uncoordinated, which raises your risk of falls. Don't drive or operate machinery until the effects of midazolam have worn off or until after 1 day after the procedure, whichever is longer.

Harm to unborn baby if used in late pregnancy

Midazolam can cause harm to your unborn baby if the medication is used late in pregnancy. Babies whose mothers have taken benzodiazepines during pregnancy have experienced trouble breathing, extreme sleepiness, and withdrawal symptoms right after birth. If you're planning to conceive or are already pregnant, let your healthcare provider know so they can make adjustments.

Worsening of glaucoma

Midazolam can raise pressure in the eye, which could worsen glaucoma. Tell your provider if you've ever been told you have glaucoma so they can make sure this medication is safe for you.

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Side effects of Midazolam

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Oral syrup

  • Vomiting (8%)
  • Nausea (4%)

Injection for sedation

  • Pain at injection site (4-5%)
  • Hiccups (4%)
  • Nausea (3%)
  • Vomiting (3%)

Injection for long-lasting seizure

  • Upper airway blockage (5%)
  • Agitation (4%)
  • Fever (4%)
  • Confusion (3%)

Less Common Side Effects

  • Drowsiness
  • Headache
  • Coughing

Midazolam serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Severe difficulty breathing

Source: DailyMed

The following Midazolam side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

Less common

Aggressiveness

agitation

anxiety

choking

confusion

decreased awareness or responsiveness

decreased urine output

difficulty walking, speaking, or writing

discouragement

dizziness

feeling sad or empty

fever

headache

irritability

lack of appetite

loss of bladder or bowel control

loss of consciousness

loss of interest or pleasure

memory loss

muscle twitching

nausea

nightmares or unusually vivid dreams

rapid weight gain

seizures

severe sleepiness

strong urge to urinate

swelling of the face, ankles, or hands

thirst

trouble concentrating

trouble sleeping

trouble breathing

unable to speak

unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Lack of coordination

relaxed and calm feeling

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site

Rare

Muscle stiffness

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Midazolam

Pros

  • Works within minutes to help you relax and feel calm before a medical procedure
  • Available as an injection and an oral syrup
  • Can be used in young children for sedation before a procedure

Cons

  • Risk of severe breathing problems so it should only be used in a healthcare facility
  • Can cause hangover effect and raise the risk of falls
  • Not safe to use late in pregnancy
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Pharmacist tips for Midazolam

pharmacist
  • Because of the risk of severe breathing problems, midazolam oral syrup and injections should only be given by a trained healthcare provider right before a procedure or to treat a long-lasting seizure. You won't be able to use this on your own.
  • You might feel really drowsy after your procedure, and the effects of midazolam could last for several hours. If you're going home right after your procedure, make sure you have a ride and someone who can take care of you.
  • Many medications can interact with midazolam, especially ones that can make you dizzy or drowsy like other benzodiazepines or opioids. Don't take any additional medications unless your healthcare provider says it's okay.
  • Interestingly, some people have experienced agitation and uncontrollable muscle movements (e.g., tremor) after taking midazolam. Your healthcare provider will monitor you for any of these side effects.
  • Tell your provider if you're breastfeeding, since midazolam can pass into breast milk and cause drowsiness and poor feeding in babies. Your healthcare provider might recommend that you pump and throw away your breastmilk for at least 4 to 8 hours after receiving midazolam to reduce exposure to your baby.
dosage-icon

Midazolam dosage

bottle of syrupBottle of syrup
DosageQuantityPrice as low asPrice per unit
118ml of 2mg/ml1 bottle$32.84$32.84

Typical dosage for Midazolam

Midazolam is available as an intravenous (IV) injection, intramuscular (IM) injection, and oral syrup that's administered by a healthcare provider.

The dose depends on your weight, dosage form you're using, and the reason you're taking it (e.g., type of medical procedure, long-lasting seizure).

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Interactions between Midazolam and other drugs

Midazolam may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Midazolam. Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Midazolam contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Midazolam will not be safe for you to take.

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What are alternatives to Midazolam?

There are a number of medications that your doctor can prescribe in place of Midazolam. Compare a few possible alternatives below.
Midazolam
Used for:
  • Sedation for surgery or other medical procedure
  • Long-lasting seizure (status epilepticus) - Seizalam
$32.84Lowest GoodRx priceView prices
Used for:
View prices

References

Best studies we found

Bounds, C. G., et al. (2023). Benzodiazepines. StatPearls.

Drugs and Lactation Database (LactMed). (2023). Midazolam.

Hospira. (2023). MIDAZOLAM HYDROCHLORIDE injection, solution [package insert]. DailyMed.

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