Medication Corner

Midazolam is a fast-acting benzodiazepine. Similar class drugs include diazepam, clonazepam, lorazepam and temazepam.  

Key points about midazolam include:

It is fast acting. This means it is absorbed quickly and its effects usually are cleared out of the body faster than other benzodiazepines

It has sedative, anxiolytic, muscle relaxant, and anticonvulsant properties

It can also result in amnesia thus making it useful prior to procedures or activities that cause people discomfort / distress

In the palliative care setting it is most often used intra-nasally, via the buccal route (i.e on the inside of the mouth) and subcutaneously.

Most commonly it is used to minimise anxiety associated with breathlessness. Key points to remember if it is being used in this way include:

• Usually starts to have effect within 5 - 10 minutes and peaking at 30 to 60 minutes.

• Due to its short action, doses often need to be repeated

• Each spray will deliver 0.5mgs of midazolam

• Patients should be up right if possible and avoid tipping the head back or sniffing

• If possible it is best if the patient can administer the dose themselves.

• If used intra-nasally some people may experience nasal irritation or bleeding.

• For those sensitive to intra-nasal use and alternative route is buccal i.e. on the inside of the mouth

Considerations:

People may feel drowsy, but are rarely sedated due to its low dose and short action

Some find the taste unpleasant especially if given into the mouth

It may make people feel nauseated or alternatively can be helpful in treating nausea that is induced by anxiety

If anxiety/distress is ongoing and you are needing to given multiple doses of midazolam it is worth considering using a more long acting anxiolytic

Always remember to record in the persons record e.g. medimap and during handover if the dose(s) given has been effective or not.

As midazolam can have an amnesic effect avoid giving new information to a person after you have administered the medication- as they may not remember what you have told them.