Midazolam

VersedDormicumMidazolam hydrochlorideBuccal midazolam
Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.wikipedia
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Anesthesia

anaesthesiaanestheticanesthetized
Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
Drugs like midazolam produce amnesia through different pathways by blocking the formation of long-term memories.

Anterograde amnesia

anterogradeamnesia, anterogradeamnesia
It works by inducing sleepiness, decreasing anxiety, and causing a loss of ability to create new memories.
This disorder is usually acquired in one of four ways: One cause is benzodiazepine drugs such as; midazolam, flunitrazepam, lorazepam, temazepam, nitrazepam, triazolam, clonazepam, alprazolam, diazepam, and nimetazepam; all of which are known to have powerful amnesic effects.

WHO Model List of Essential Medicines

World Health Organization's List of Essential MedicinesList of Essential MedicinesModel List of Essential Medicines
It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system.

Benzodiazepine

benzodiazepinesbenzodiazapinesbenzo
Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
In the community, intravenous administration is not practical and so rectal diazepam or buccal midazolam are used, with a preference for midazolam as its administration is easier and more socially acceptable.

Procedural sedation and analgesia

conscious sedationprocedural sedationconscious analgesia
Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
Midazolam is a benzodiazepine that acts by stimulating inhibitory GABA receptors.

Lorazepam

Ativanbenzodiazepine lorazepamdrug of the same name
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.
While it can be used for severe agitation, midazolam is usually preferred.

Status epilepticus

super-refractory status epilepticusnonconvulsive status epilepticusprolonged seizures
Midazolam is effective for status epilepticus that has not improved following other treatments or when intravenous access cannot 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.
Possible benzodiazepines include intravenous lorazepam as well as intramuscular injections of midazolam.

General anaesthesia

general anesthesiageneralgeneral anesthetic
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, a benzodiazepine characterized by a rapid onset and short duration, is effective in reducing preoperative anxiety, including separation anxiety in children.

Psychomotor agitation

agitationrestlessnessexcitement
Midazolam, marketed under the trade name Versed, among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
Intramuscular midazolam, lorazepam, or another benzodiazepine can be used to both sedate agitated patients, and control semi-involuntary muscle movements in cases of suspected akathisia.

Propofol

Diprivan2,6-diisopropylphenolMilk of amnesia
Midazolam is superior to diazepam in impairing memory of endoscopy procedures, but propofol has a quicker recovery time and a better memory-impairing effect.
Its use in these settings results in a faster recovery compared to midazolam.

Buccal administration

buccalcheekin the cheek
Midazolam can be given by mouth, intravenously, or injection into a muscle, by spraying into the nose, or through the cheek.
As of May 2014, the psychiatric drug asenapine; the opioid drugs buprenorphine, naloxone, and fentanyl; the cardiovascular drug nitroglycerin; the nausea medication Prochlorperazine; the hormone replacement therapy testosterone; and nicotine as a smoking cessation aid were commercially available in buccal forms, as was midazolam, an anticonvulsant, used to treat acute epileptic seizures.

Benzodiazepine withdrawal syndrome

benzodiazepine withdrawalwithdrawal syndromebenzodiazepine
Tolerance to its effects and withdrawal syndrome may occur following long-term use.
Benzodiazepines with a half-life of less than 24 hours include alprazolam, bromazepam, brotizolam, flunitrazepam, loprazolam, lorazepam, lormetazepam, midazolam, nitrazepam, oxazepam, and temazepam.

End-of-life care

end-of-lifeend of lifeend 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.

Palliative sedation

terminal sedationcontinuous deep sedation therapy
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.
A typical drug is midazolam, a short acting benzodiazepine.

Flumazenil

AnexateRomazicon
In extreme situations, flumazenil can be administered to inhibit or reverse the effects of midazolam.
Many benzodiazepines (including midazolam) have longer half-lives than flumazenil.

Glossip v. Gross

Charles Frederick Warner5-4 rulingWarner v. Gross
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.
14-7955, 576 U.S. ___ (2015), was a United States Supreme Court case in which the Court held, 5–4, that lethal injections using midazolam to kill prisoners convicted of capital crimes do not constitute cruel and unusual punishment under the Eighth Amendment to the United States Constitution.

Hypericum perforatum

St. John's wortSt John's wortSt. John’s wort
St John's wort, rifapentine, rifampin, rifabutin, phenytoin enhance the metabolism of midazolam leading to a reduced action.

CYP3A4

cytochrome P450 3A43A4cytochrome P450-3A4
Midazolam is metabolized almost completely by cytochrome P450-3A4.

Execution of Clayton Lockett

Clayton LockettClayton Darrell Locketta botched execution
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.
Due to the supply issues, Oklahoma used an untested mixture of midazolam (to make the victim fall unconscious), vecuronium bromide (to paralyse), and potassium chloride (used to stop the heart) for Lockett's execution.

Hoffmann-La Roche

RocheHoffmann–La RocheHoffman-La Roche
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.

Lethal injection

Executed by lethal injectionlethal injectionsdeath by lethal injection
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. The drug has been introduced for use in executions by lethal injection in certain jurisdictions in the United States in combination with other drugs.
The first state to switch to use midazolam as the first drug in a new three-drug protocol was Florida on October 15, 2013.

Ledell Lee

Ledell T. Lee
Two of them were granted a stay of execution, and another, Ledell T. Lee, 51, was executed on April 20, 2017.
In April 2017, Arkansas planned to execute eight death row inmates including Ledell Lee, along with Don W Davis, Stacey Johnson, Jack Jones Jr, Jason McGehee, Bruce Earl Ward, Kenneth Williams and Marcel Williams, before the stocks of the sedative Midazolam expired at the end of April.

Capital punishment in the United States

death penaltycapital punishmentsentenced to death
The drug has been introduced for use in executions by lethal injection in certain jurisdictions in the United States in combination with other drugs.
Since then, some states have used other anesthetics, such as pentobarbital, etomidate, or fast-acting benzodiazepines like midazolam.

Paediatric-use marketing authorisation

This was the first application of a paediatric-use marketing authorisation.
It was Buccolam, a buccal application form of midazolam for the treatment of seizures.