View source for Midazolam

{{Short description|Benzodiazepine used for anesthesia and procedural sedation}}
{{Redirect|Versed|the book of poetry|Versed (poetry collection)}}
{{Use dmy dates|date=June 2024}}
{{cs1 config|name-list-style=vanc|display-authors=6}}
{{Good article}}
{{Infobox drug
| Watchedfields = changed
| verifiedrevid = 459437650
| image = Midazolam.svg
| image_class = skin-invert-image
| width = 165
| alt = 
| image2 = Midazolam-from-xtal-3D-bs-17.png
| image_class2 = bg-transparent
| alt2 = 
| caption = <!-- Clinical data -->
| pronounce = {{IPAc-en|m|ɪ|ˈ|d|æ|z|ə|l|æ|m}}
| tradename = Versed, others
| Drugs.com = {{drugs.com|monograph|midazolam-hydrochloride}}
| MedlinePlus = a609003
| DailyMedID = Midazolam
| pregnancy_AU = C
| pregnancy_AU_comment = 
| addiction_liability = Moderate<ref>{{cite book | vauthors = Ries RK | veditors = Fiellin DA, Miller SC, Saitz R |title=Principles of Addiction Medicine |date=2009 |publisher=[[Lippincott Williams & Wilkins]] |location=Philadelphia, PA |isbn=978-0-7817-7477-2 |pages=105–106 |edition=Fourth |chapter-url=https://books.google.com/books?id=j6GGBud8DXcC&pg=PA106 |access-date=14 August 2025 |chapter-format=Hardcover |chapter=2}}</ref>
| routes_of_administration = [[Oral administration|By mouth]], [[intramuscular]], [[intravenous]], [[Buccal administration|buccal]], [[intranasal]]
| class = [[Benzodiazepine]]
| ATC_prefix = N05
| ATC_suffix = CD08
| ATC_supplemental = <!-- Legal status -->
| legal_AU = S4
| legal_AU_comment = 
| legal_BR = B1
| legal_BR_comment = <ref>{{cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=31 March 2023 |title=RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |url-status=live |archive-url=https://web.archive.org/web/20230803143925/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-784-de-31-de-marco-de-2023-474904992 |archive-date=3 August 2023 |access-date=16 August 2023 |publisher=[[Diário Oficial da União]] |language=pt-BR |publication-date=4 April 2023}}</ref>
| legal_CA = Schedule IV
| legal_CA_comment = <ref>{{cite web | title=Product information | website=[[Health Canada]] | date=28 June 2004 | url=https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=8457 | access-date=14 April 2024}}</ref><ref>{{cite web | title=Health product highlights 2021: Annexes of products approved in 2021 | website=[[Health Canada]] | date=3 August 2022 | url=https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/health-product-highlights-2021/appendices.html | access-date=25 March 2024 | archive-date=25 March 2024 | archive-url=https://web.archive.org/web/20240325234307/https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/health-product-highlights-2021/appendices.html | url-status=live }}</ref>
| legal_DE = Rx-only/Anlage III
| legal_DE_comment = 
| legal_NZ = Class C
| legal_NZ_comment = 
| legal_UK = POM
| legal_UK_comment = <ref>{{cite web | title=Buccolam 10 mg oromucosal solution - Summary of Product Characteristics (SmPC) | website=(emc) | date=7 June 2022 | url=https://www.medicines.org.uk/emc/product/7460/smpc | access-date=16 June 2022 | archive-date=4 July 2024 | archive-url=https://web.archive.org/web/20240704192408/https://www.medicines.org.uk/emc/product/7460/smpc | url-status=live }}</ref><ref>{{cite web | title=Hypnovel 10mg in 2ml - Summary of Product Characteristics (SmPC) | website=(emc) | date=16 February 2022 | url=https://www.medicines.org.uk/emc/product/10948/smpc | access-date=16 June 2022 | archive-date=4 July 2024 | archive-url=https://web.archive.org/web/20240704192407/https://www.medicines.org.uk/emc/product/10948/smpc | url-status=live }}</ref>
| legal_US = Schedule IV
| legal_US_comment = <ref>{{cite web | title=Seizalam- midazolam hydrochloride injection, solution | website=DailyMed | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cb2381bf-984a-48a8-95c0-3017c34cc170 | access-date=1 January 2021 | archive-date=12 May 2021 | archive-url=https://web.archive.org/web/20210512084730/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=cb2381bf-984a-48a8-95c0-3017c34cc170 | url-status=live }}</ref><ref>{{cite web | title=Nayzilam- midazolam spray | website=DailyMed | date=19 January 2023 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2b29422e-54d5-4a49-8522-e9cf752368c3 | access-date=4 July 2024 | archive-date=10 December 2023 | archive-url=https://web.archive.org/web/20231210210721/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=2b29422e-54d5-4a49-8522-e9cf752368c3 | url-status=live }}</ref>
| legal_EU = Rx-only
| legal_EU_comment = <ref name="Buccolam EPAR">{{cite web | title=Buccolam EPAR | website=European Medicines Agency | date=5 September 2011 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/buccolam | access-date=4 July 2024 | archive-date=25 February 2024 | archive-url=https://web.archive.org/web/20240225032700/https://www.ema.europa.eu/en/medicines/human/EPAR/buccolam | url-status=live }}</ref>
| legal_UN = <!-- N I, II, III, IV / P I, II, III, IV -->
| legal_UN_comment = 
| legal_status = <!-- For countries not listed above -->

<!-- Pharmacokinetic data -->| bioavailability = [[By mouth]]: variable, around 40%<ref>{{cite journal | vauthors = Heizmann P, Eckert M, Ziegler WH | title = Pharmacokinetics and bioavailability of midazolam in man | journal = British Journal of Clinical Pharmacology | volume = 16 | issue = Suppl 1 | pages = 43S–49S | year = 2012 | pmid = 6138080 | pmc = 1428091 | doi = 10.1111/j.1365-2125.1983.tb02270.x }}</ref><ref>{{cite journal | vauthors = Johnson TN, Rostami-Hodjegan A, Goddard JM, Tanner MS, Tucker GT | title = Contribution of midazolam and its 1-hydroxy metabolite to preoperative sedation in children: a pharmacokinetic-pharmacodynamic analysis | journal = British Journal of Anaesthesia | volume = 89 | issue = 3 | pages = 428–437 | date = September 2002 | pmid = 12402721 | doi = 10.1093/bja/aef213 }}</ref><br />[[Intramuscular injection|Intramuscular]]: ≥90%
| protein_bound = 97%
| metabolism = [[Liver]]: [[CYP3A3]], [[CYP3A4]], [[CYP3A5]]
| metabolites = 
| onset = Within 5 min (IV), 15 min (IM), 20 min (oral)<ref name=AHFS2015/>
| elimination_half-life = 1.5–2.5 hours<ref name=medsafe2012/>
| duration_of_action = 1–6 hours<ref name=AHFS2015/>
| excretion = [[Kidney]]

<!-- Identifiers -->| index2_label = as HCl
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 59467-70-8
| CAS_supplemental = 
| PubChem = 4192
| IUPHAR_ligand = 3342
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00683
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 4047
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = R60L0SM5BC
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00550
| KEGG2_Ref = {{keggcite|correct|kegg}}
| KEGG2 = D00696
| ChEBI = 6931
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 655
| NIAID_ChemDB = 
| PDB_ligand = 
| synonyms = <!-- Chemical and physical data -->
| IUPAC_name = 8-chloro-6-(2-fluorophenyl)-1-methyl-4''H''-imidazo[1,5-a] [1,4]benzodiazepine
| C = 18
| H = 13
| Cl = 1
| F = 1
| N = 3
| SMILES = ClC1=CC=C2C(C(C3=CC=CC=C3F)=NCC4=CN=C(C)N42)=C1
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 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
| StdInChI_comment = 
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = DDLIGBOFAVUZHB-UHFFFAOYSA-N
| density = 
| density_notes = 
| melting_point = 
| melting_high = 
| melting_notes = 
| boiling_point = 
| boiling_notes = 
| solubility = 
| sol_units = 
| specific_rotation = 
}}

<!-- Definition and medical uses -->
'''Midazolam''', sold under the brand name '''Versed''' among others, is a [[benzodiazepine]] medication used for [[anesthesia]], [[premedication]] before surgical anesthesia, and [[procedural sedation]], and to treat [[psychomotor agitation|severe agitation]].<ref name="AHFS2015">{{cite web|title=Midazolam Hydrochloride|url=https://www.drugs.com/monograph/midazolam-hydrochloride.html|publisher=The American Society of Health-System Pharmacists|access-date=1 August 2015|url-status=live|archive-url=https://web.archive.org/web/20150905074829/http://www.drugs.com/monograph/midazolam-hydrochloride.html|archive-date=5 September 2015}}</ref> It induces sleepiness, decreases anxiety, and causes [[anterograde amnesia]].<ref name=AHFS2015/>

The drug does not cause an individual to become unconscious, merely to be sedated.<ref name="AHFS2015" /> It is also useful for the treatment of prolonged (lasting over five minutes) [[seizure]]s.<ref name="Sei2015">{{cite journal | vauthors = Brigo F, Nardone R, Tezzon F, Trinka E | title = Nonintravenous midazolam versus intravenous or rectal diazepam for the treatment of early status epilepticus: A systematic review with meta-analysis | journal = Epilepsy & Behavior | volume = 49 | pages = 325–336 | date = August 2015 | pmid = 25817929 | doi = 10.1016/j.yebeh.2015.02.030 | s2cid = 33207030 }}</ref> Midazolam can be given [[Oral administration|by mouth]], [[intravenously]], by [[Intramuscular injection|injection into a muscle]], by spraying into the [[intranasal|nose]], or through the [[buccal administration|cheek]].<ref name=AHFS2015/><ref name=Sei2015/> When given intravenously, it typically begins working within five minutes; when injected into a muscle, it can take fifteen minutes to begin working;<ref name=AHFS2015/> when taken orally, it can take 10–20&nbsp;minutes to begin working.<ref>{{cite web |title=Midazolam, Midazolam Hydrochloride Monograph for Professionals |url=https://www.drugs.com/monograph/midazolam-midazolam-hydrochloride.html |website=Drugs.com |access-date=3 September 2024 |language=en}}</ref>

<!-- Side effects and mechanism-->
Side effects can include a decrease in efforts to breathe, [[hypotension|low blood pressure]], and sleepiness.<ref name=AHFS2015/> [[Drug tolerance|Tolerance]] to its effects and [[Benzodiazepine withdrawal syndrome|withdrawal syndrome]] may occur following long-term use.<ref name="Riss-2008"/> [[Paradoxical reaction|Paradoxical effects]], such as increased activity, can occur especially in children and older people.<ref name="Riss-2008">{{cite journal | vauthors = Riss J, Cloyd J, Gates J, Collins S | title = Benzodiazepines in epilepsy: pharmacology and pharmacokinetics | journal = Acta Neurologica Scandinavica | volume = 118 | issue = 2 | pages = 69–86 | date = August 2008 | pmid = 18384456 | doi = 10.1111/j.1600-0404.2008.01004.x | s2cid = 24453988 | doi-access = free }}</ref> There is evidence of risk when used during pregnancy but no evidence of harm with a single dose during [[breastfeeding]].<ref name=Ric2015/><ref>{{cite web|title=Midazolam use while Breastfeeding|url=https://www.drugs.com/breastfeeding/midazolam.html|access-date=29 August 2015|url-status=live|archive-url=https://web.archive.org/web/20150905082026/http://www.drugs.com/breastfeeding/midazolam.html|archive-date=5 September 2015}}</ref>

<!-- History, society and culture -->
Midazolam was patented in 1974 and came into medical use in 1982.<ref name=Fis2006>{{cite book |vauthors=Fischer J, Ganellin CR |title=Analogue-based Drug Discovery |date=2006 |publisher=John Wiley & Sons |isbn=978-3-527-60749-5 |page=539 |url=https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA539 |access-date=24 August 2020 |archive-date=30 November 2021 |archive-url=https://web.archive.org/web/20211130140909/https://books.google.com/books?id=FjKfqkaKkAAC&pg=PA539 |url-status=live }}</ref> It is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> Midazolam is available as a [[generic medication]].<ref name=Ric2015>{{cite book |  vauthors = Hamilton R | title = Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition |date=2015|publisher=Jones & Bartlett Learning|isbn=978-1-284-05756-0|page=21 }}</ref> In many countries, it is a [[controlled substance]].<ref name=AHFS2015/>

==Medical uses==

===Seizures===
Midazolam is sometimes used for the acute management of prolonged [[seizure]]s. 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.<ref>{{cite journal | vauthors = Isojärvi JI, Tokola RA | title = Benzodiazepines in the treatment of epilepsy in people with intellectual disability | journal = Journal of Intellectual Disability Research | volume = 42 | issue = Suppl 1 | pages = 80–92 | date = December 1998 | pmid = 10030438 }}</ref> A benefit of midazolam is that in children it can be given [[buccal administration|in the cheek]] or [[intranasally|in the nose]] for acute seizures, including [[status epilepticus]].<ref>{{cite journal | vauthors = McTague A, Martland T, Appleton R | title = Drug management for acute tonic-clonic convulsions including convulsive status epilepticus in children | journal = The Cochrane Database of Systematic Reviews | volume = 1 | article-number = CD001905 | date = January 2018 | issue = 1 | pmid = 29320603 | pmc = 6491279 | doi = 10.1002/14651858.CD001905.pub3 }}</ref><ref name="Walker-2005">{{cite journal | vauthors = Walker M | title = Status epilepticus: an evidence based guide | journal = BMJ | volume = 331 | issue = 7518 | pages = 673–677 | date = September 2005 | pmid = 16179702 | pmc = 1226249 | doi = 10.1136/bmj.331.7518.673 }}</ref>

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.<ref name="Riss-2008"/><ref>{{cite journal | vauthors = Murthy JM | title = Refractory status epilepticus | journal = Neurology India | volume = 54 | issue = 4 | pages = 354–358 | date = December 2006 | pmid = 17114841 | doi = 10.4103/0028-3886.28104 | doi-access = free }}</ref> [[Buccal tablets|Buccal]] and [[intranasal]] midazolam may be both easier to administer and more effective than rectally administered [[diazepam]] in the emergency control of seizures.<ref>{{cite journal | vauthors = Eriksson K, Kälviäinen R | title = Pharmacologic management of convulsive status epilepticus in childhood | journal = Expert Review of Neurotherapeutics | volume = 5 | issue = 6 | pages = 777–783 | date = November 2005 | pmid = 16274335 | doi = 10.1586/14737175.5.6.777 | s2cid = 2865644 }}</ref><ref name="Wolfe-2006">{{cite journal | vauthors = Wolfe TR, Macfarlane TC | title = Intranasal midazolam therapy for pediatric status epilepticus | journal = The American Journal of Emergency Medicine | volume = 24 | issue = 3 | pages = 343–346 | date = May 2006 | pmid = 16635708 | doi = 10.1016/j.ajem.2005.11.004 }}</ref><ref name="Sofou-2009">{{cite journal | vauthors = Sofou K, Kristjánsdóttir R, Papachatzakis NE, Ahmadzadeh A, Uvebrant P | title = Management of prolonged seizures and status epilepticus in childhood: a systematic review | journal = Journal of Child Neurology | volume = 24 | issue = 8 | pages = 918–926 | date = August 2009 | pmid = 19332572 | doi = 10.1177/0883073809332768 | s2cid = 41731847 }}</ref>

===Procedural sedation===
Intravenous midazolam is indicated for procedural sedation (often in combination with an [[opioid]], such as [[fentanyl]]), preoperative sedation, for the induction of [[general anesthesia]], and for sedation of people who are [[medical ventilator|ventilated]] in [[intensive-care medicine|critical care]] units.<ref name="Brown-2005">{{cite journal | vauthors = Brown TB, Lovato LM, Parker D | title = Procedural sedation in the acute care setting | journal = American Family Physician | volume = 71 | issue = 1 | pages = 85–90 | date = January 2005 | pmid = 15663030 }}</ref><ref name="O'Connor-2009">{{cite journal | vauthors = O'Connor M, Bucknall T, Manias E | title = Sedation management in Australian and New Zealand intensive care units: doctors' and nurses' practices and opinions | journal = American Journal of Critical Care | volume = 19 | issue = 3 | pages = 285–295 | date = May 2010 | pmid = 19770414 | doi = 10.4037/ajcc2009541 }}</ref> Midazolam is superior to [[diazepam]] in impairing memory of endoscopy procedures, but [[propofol]] has a quicker recovery time and a better memory-impairing effect.<ref name="McQuaid-2008">{{cite journal | vauthors = McQuaid KR, Laine L | title = A systematic review and meta-analysis of randomized, controlled trials of moderate sedation for routine endoscopic procedures | journal = Gastrointestinal Endoscopy | volume = 67 | issue = 6 | pages = 910–923 | date = May 2008 | pmid = 18440381 | doi = 10.1016/j.gie.2007.12.046 }}</ref> It is the most popular benzodiazepine in the intensive care unit (ICU) because of its short [[Biological half-life|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,<ref>{{cite journal | vauthors = Arcangeli A, Antonelli M, Mignani V, Sandroni C | title = Sedation in PACU: the role of benzodiazepines | journal = Current Drug Targets | volume = 6 | issue = 7 | pages = 745–748 | date = November 2005 | pmid = 16305452 | doi = 10.2174/138945005774574416 }}</ref> and propofol has advantages over midazolam when used in the ICU for sedation, such as shorter weaning time and earlier tracheal [[extubation]].<ref>{{cite journal | vauthors = De Cosmo G, Congedo E, Clemente A, Aceto P | title = Sedation in PACU: the role of propofol | journal = Current Drug Targets | volume = 6 | issue = 7 | pages = 741–744 | date = November 2005 | pmid = 16305451 | doi = 10.2174/138945005774574425 }}</ref>

Midazolam is sometimes used in neonatal intensive care units. When used, additional caution is required in [[neonates|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 (medicine)|Bolus]] injections should be avoided due to the increased risk of cardiovascular depression, as well as neurological complications.<ref>{{cite journal | vauthors = Rawicz M | title = [Recommendations for analgesia and sedation in neonatal intensive care] | journal = Medycyna Wieku Rozwojowego | volume = 12 | issue = 4 Pt 1 | pages = 958–967 | date = Oct–Dec 2008 | pmid = 19471072 }}</ref>

Sedation using midazolam can be used to relieve anxiety and manage behaviour in children undergoing dental treatment.<ref>{{cite journal | vauthors = Ashley PF, Chaudhary M, Lourenço-Matharu L | title = Sedation of children undergoing dental treatment | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 12 | article-number = CD003877 | date = December 2018 | pmid = 30566228 | pmc = 6517004 | doi = 10.1002/14651858.CD003877.pub5 }}</ref>

===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.<ref>{{cite journal | vauthors = Huf G, Alexander J, Gandhi P, Allen MH | title = Haloperidol plus promethazine for psychosis-induced aggression | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | issue = 11 | article-number = CD005146 | date = November 2016 | pmid = 27885664 | pmc = 6464403 | doi = 10.1002/14651858.CD005146.pub3 }}</ref>

===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, restlessness or anxiety in the last hours or days of life.<ref>{{cite web |url=http://www.mcpcil.org.uk/liverpool-care-pathway/pdfs/LCP%20HOSPITAL%20VERSION%2011%20%28printable%20version%29.pdf |title=Care of the Dying Pathway (lcp) (Hospital) |author=Liverpool Care Pathway |date=January 2005 |location=United Kingdom |archive-url=https://web.archive.org/web/20111008072445/http://www.mcpcil.org.uk/liverpool-care-pathway/pdfs/LCP%20HOSPITAL%20VERSION%2011%20%28printable%20version%29.pdf |archive-date=8 October 2011 }}</ref> 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,<ref>{{cite journal | vauthors = de Graeff A, Dean M | title = Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards | journal = Journal of Palliative Medicine | volume = 10 | issue = 1 | pages = 67–85 | date = February 2007 | pmid = 17298256 | doi = 10.1089/jpm.2006.0139 }}</ref> but the need for this is rare.<ref>{{cite web|url=http://www.rcplondon.ac.uk/media/press-releases/Pages/National-care-of-the-dying-audit-2009.aspx|title=National care of the dying audit 2009|author=Royal College of Physicians|date=September 2009|location=United Kingdom|archive-url=https://web.archive.org/web/20100120111123/http://www.rcplondon.ac.uk/media/Press-releases/Pages/National-care-of-the-dying-audit-2009.aspx|archive-date=20 January 2010|author-link=Royal College of Physicians|access-date=10 February 2010}} "[I]n their last 24 hours... 31% had low doses of medication to [control distress from agitation or restlessness]... the remaining 4% required higher doses"</ref>

==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]].<ref>{{cite journal | vauthors = Authier N, Balayssac D, Sautereau M, Zangarelli A, Courty P, Somogyi AA, Vennat B, Llorca PM, Eschalier A | title = Benzodiazepine dependence: focus on withdrawal syndrome | journal = Annales Pharmaceutiques Françaises | volume = 67 | issue = 6 | pages = 408–413 | date = November 2009 | pmid = 19900604 | doi = 10.1016/j.pharma.2009.07.001 }}</ref> Additional caution is required in critically ill patients, as accumulation of midazolam and its active metabolites may occur.<ref name="Cox-2008">{{cite journal | vauthors = Cox CE, Reed SD, Govert JA, Rodgers JE, Campbell-Bright S, Kress JP, Carson SS | title = Economic evaluation of propofol and lorazepam for critically ill patients undergoing mechanical ventilation | journal = Critical Care Medicine | volume = 36 | issue = 3 | pages = 706–714 | date = March 2008 | pmid = 18176312 | pmc = 2763279 | doi = 10.1097/CCM.0B013E3181544248 }}</ref> Kidney or liver impairments may slow down the elimination of midazolam leading to prolonged and enhanced effects.<ref name="Olkkola-2008"/><ref>{{cite journal | vauthors = Verbeeck RK | title = Pharmacokinetics and dosage adjustment in patients with hepatic dysfunction | journal = European Journal of Clinical Pharmacology | volume = 64 | issue = 12 | pages = 1147–1161 | date = December 2008 | pmid = 18762933 | doi = 10.1007/s00228-008-0553-z | s2cid = 27888650 }}</ref>

==Side effects==
{{See also|Long-term effects of benzodiazepines}}
[[File:Midazolam.JPG|thumb|alt=Two 10-ml bottles labeled Midazolam. The bottle on the left has a label in red and says 1 mg/ml; the one on the right is in green and says 5 mg/ml. Both bottles have much fine print.|Injectable midazolam in 1 and 5&nbsp;mg/ml strengths]]

Side effects of midazolam in the elderly are listed above.<ref name="Riss-2008"/> People experiencing [[Anterograde amnesia|amnesia]] as a side effect of midazolam are generally unaware their memory is impaired, unless they had previously known it as a side effect.<ref>{{cite journal | vauthors = Merritt P, Hirshman E, Hsu J, Berrigan M | title = Metamemory without the memory: are people aware of midazolam-induced amnesia? | journal = Psychopharmacology | volume = 177 | issue = 3 | pages = 336–343 | date = January 2005 | pmid = 15290003 | doi = 10.1007/s00213-004-1958-8 | s2cid = 7142863 }}</ref>

Long-term use of benzodiazepines has been associated with long-lasting deficits in memory, and show only partial recovery six months after stopping benzodiazepines.<ref name="Riss-2008" /> It is unclear whether full recovery occurs after longer periods of abstinence. Benzodiazepines can cause or worsen depression.<ref name="Riss-2008" /> Paradoxical excitement occasionally occurs with benzodiazepines, including a worsening of seizures. Children and elderly individuals or those with a history of excessive [[alcohol (drug)|alcohol]] use and individuals with a history of aggressive behavior or anger are at increased risk of paradoxical effects.<ref name="Riss-2008" /> [[Paradoxical reaction]]s are particularly associated with intravenous administration.<ref name="Rosenbaum-2009"/> 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]].<ref>{{cite journal | vauthors = Vermeeren A | title = Residual effects of hypnotics: epidemiology and clinical implications | journal = CNS Drugs | volume = 18 | issue = 5 | pages = 297–328 | year = 2004 | pmid = 15089115 | doi = 10.2165/00023210-200418050-00003 | s2cid = 25592318 }}</ref> Sedation, [[respiratory depression]] and [[hypotension]] due to a reduction in systematic vascular resistance, and an increase in heart rate can occur.<ref name="Walker-2005" /><ref name="Olkkola-2008" /> If intravenous midazolam is given too quickly, hypotension may occur. A "midazolam infusion syndrome" may result from high doses, 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.<ref name="Mencía-2007" />

In rare 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.<ref>{{cite journal | vauthors = Mancuso CE, Tanzi MG, Gabay M | title = Paradoxical reactions to benzodiazepines: literature review and treatment options | journal = Pharmacotherapy | volume = 24 | issue = 9 | pages = 1177–1185 | date = September 2004 | pmid = 15460178 | doi = 10.1592/phco.24.13.1177.38089 | url = http://www.medscape.com/viewarticle/489358_6 | url-status = live | s2cid = 38614605 | archive-url = https://web.archive.org/web/20110606053502/http://www.medscape.com/viewarticle/489358_6 | archive-date = 6 June 2011 | url-access = subscription }}</ref>

Midazolam is known to cause respiratory depression. In healthy humans, 0.15&nbsp;mg/kg of midazolam may cause respiratory depression, which is postulated to be a [[central nervous system]] (CNS) effect.<ref>{{cite journal | vauthors = Reves JG, Fragen RJ, Vinik HR, Greenblatt DJ | title = Midazolam: pharmacology and uses | journal = Anesthesiology | volume = 62 | issue = 3 | pages = 310–324 | date = March 1985 | pmid = 3156545 | doi = 10.1097/00000542-198503000-00017 | s2cid = 28308031 | doi-access = free }}</ref> When midazolam is administered in combination with fentanyl, the incidence of hypoxemia or apnea becomes more likely.<ref name="Bailey-1990">{{cite journal | vauthors = Bailey PL, Pace NL, Ashburn MA, Moll JW, East KA, Stanley TH | title = Frequent hypoxemia and apnea after sedation with midazolam and fentanyl | journal = Anesthesiology | volume = 73 | issue = 5 | pages = 826–830 | date = November 1990 | pmid = 2122773 | doi = 10.1097/00000542-199011000-00005 | doi-access = free }}</ref>

Although the incidence of respiratory depression/arrest is low (0.1–0.5%) when midazolam is administered alone at normal doses,<ref name="Classen-1992">{{cite journal | vauthors = Classen DC, Pestotnik SL, Evans RS, Burke JP | title = Intensive surveillance of midazolam use in hospitalized patients and the occurrence of cardiorespiratory arrest | journal = Pharmacotherapy | volume = 12 | issue = 3 | pages = 213–216 | year = 1992 | pmid = 1608855 | doi = 10.1002/j.1875-9114.1992.tb04512.x | s2cid = 42657347 }}</ref><ref>{{cite journal | vauthors = Wright SW, Chudnofsky CR, Dronen SC, Wright MB, Borron SW | title = Midazolam use in the emergency department | journal = The American Journal of Emergency Medicine | volume = 8 | issue = 2 | pages = 97–100 | date = March 1990 | pmid = 2302291 | doi = 10.1016/0735-6757(90)90192-3 }}</ref> 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.<ref name="Bailey-1990"/><ref name="Classen-1992"/><ref>{{cite journal | vauthors = Yaster M, Nichols DG, Deshpande JK, Wetzel RC | title = Midazolam-fentanyl intravenous sedation in children: case report of respiratory arrest | journal = Pediatrics | volume = 86 | issue = 3 | pages = 463–467 | date = September 1990 | pmid = 2388795 | doi = 10.1542/peds.86.3.463 | s2cid = 36531097 }}</ref><ref>{{cite journal | vauthors = West JM, Estrada S, Heerdt M | title = Sudden hypotension associated with midazolam and sufentanil | journal = Anesthesia and Analgesia | volume = 66 | issue = 7 | pages = 693–694 | date = July 1987 | pmid = 2955719 | doi = 10.1213/00000539-198707000-00026 | doi-access = free }}</ref> 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.<ref name="Kawano-2009">{{cite journal | vauthors = Kawano DF, Ueta J, Sankarankutty AK, Pereira LR, de Freitas O | title = Midazolam-related drug interactions: detection of risk situations to the patient safety in a brazilian teaching hospital | journal = Journal of Patient Safety | volume = 5 | issue = 2 | pages = 69–74 | date = June 2009 | pmid = 19920444 | doi = 10.1097/PTS.0b013e3181a5dafa | s2cid = 12973546 }}</ref> 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.<ref name="Kawano-2009"/>

===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.<ref>{{cite journal | vauthors = McElhatton PR | title = The effects of benzodiazepine use during pregnancy and lactation | journal = Reproductive Toxicology | volume = 8 | issue = 6 | pages = 461–475 | date = Nov–Dec 1994 | pmid = 7881198 | doi = 10.1016/0890-6238(94)90029-9 | bibcode = 1994RepTx...8..461M }}</ref> Other [[neonatal withdrawal]] symptoms include hyperexcitability, tremor, and gastrointestinal upset (diarrhea or vomiting). [[Breastfeeding]] by mothers using midazolam is not recommended.<ref name="Serreau-2010">{{cite journal | vauthors = Serreau R | title = [Drugs during preeclampsia. Fetal risks and pharmacology] | journal = Annales Françaises d'Anesthésie et de Réanimation | volume = 29 | issue = 4 | pages = e37–e46 | date = April 2010 | pmid = 20347563 | doi = 10.1016/j.annfar.2010.02.016 }}</ref>

===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.<ref name="Riss-2008"/>

===Tolerance, dependence, and withdrawal===
A benzodiazepine dependence occurs in about one-third of individuals who are treated with benzodiazepines for longer than 4 weeks,<ref name="Riss-2008"/> 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 [[GABAA receptor|GABA<sub>A</sub> receptor]] alterations in gene expression, which causes long-term changes in the function of the GABAergic neuronal system.<ref name="Riss-2008"/><ref>{{cite journal | vauthors = Fukuda K, Shoda T, Mima H, Uga H | title = Midazolam induces expression of c-Fos and EGR-1 by a non-GABAergic mechanism | journal = Anesthesia and Analgesia | volume = 95 | issue = 2 | pages = 373–8, table of contents | date = August 2002 | pmid = 12145054 | doi = 10.1097/00000539-200208000-00024 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Cho HH, O'Connell JP, Cooney MF, Inchiosa MA | title = Minimizing tolerance and withdrawal to prolonged pediatric sedation: case report and review of the literature | journal = Journal of Intensive Care Medicine | volume = 22 | issue = 3 | pages = 173–179 | year = 2007 | pmid = 17569173 | doi = 10.1177/0885066607299556 | s2cid = 42497090 }}</ref>

Chronic users of benzodiazepine medication who are given midazolam experience reduced therapeutic effects of midazolam, due to tolerance to benzodiazepines.<ref name="Mencía-2007"/><ref>{{cite journal | vauthors = Potokar J, Coupland N, Wilson S, Rich A, Nutt D | title = Assessment of GABA(A)benzodiazepine receptor (GBzR) sensitivity in patients on benzodiazepines | journal = Psychopharmacology | volume = 146 | issue = 2 | pages = 180–184 | date = September 1999 | pmid = 10525753 | doi = 10.1007/s002130051104 | url = http://link.springer.de/link/service/journals/00213/bibs/9146002/91460180.htm | s2cid = 31542770 | archive-url = https://web.archive.org/web/20020112111526/http://link.springer.de/link/service/journals/00213/bibs/9146002/91460180.htm | archive-date = 12 January 2002 | url-access = subscription }}</ref> 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]], [[tremor]]s, [[clonus]], [[hypertonicity]], [[delirium]] and [[seizures]], [[nausea]], [[vomiting]], [[diarrhea]], [[tachycardia]], [[hypertension]], and [[tachypnea]].<ref name="Mencía-2007">{{cite journal | vauthors = Mencía SB, López-Herce JC, Freddi N | title = Analgesia and sedation in children: practical approach for the most frequent situations | journal = Jornal de Pediatria | volume = 83 | issue = 2 Suppl | pages = S71–S82 | date = May 2007 | pmid = 17530139 | doi = 10.2223/JPED.1625 | doi-broken-date = 1 July 2025 | url = http://www.jped.com.br/conteudo/07-83-S71/ing.asp?cod=1625 | doi-access = free | archive-url = https://web.archive.org/web/20111004181028/http://www.jped.com.br/conteudo/07-83-S71/ing.asp?cod=1625 | archive-date = 4 October 2011 | url-access = subscription }}</ref>

===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 the risk of death are 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]].<ref name="Olkkola-2008" /> 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.<ref name="davidsons_principles_and_practice_of_medicine_a15">{{cite book | vauthors = Boon NA, Davidson S, Colledge NR, Walker B, Hunter JG |title=Davidson's principles practice of medicine |year=2006 |publisher=Elsevier/Churchill Livingstone |location=Edinburgh |url=https://books.google.com/books?id=TI8DHMKDF-4C&pg=PA212 |isbn=978-0-443-10057-4 |pages=212–213 }}</ref><ref name="the_addiction_medicine">{{cite book | vauthors = Rastegar DA, Fingerhood MI |title=Addiction medicine: an evidence-based handbook |url=https://books.google.com/books?id=DKUQ5YrFZd8C&pg=PA80 |year=2005 |publisher=Lippincott Williams Wilkins |location=Philadelphia, PA |isbn=978-0-7817-6154-3 |page=80 }}</ref>

Symptoms of midazolam overdose can include:<ref name="davidsons_principles_and_practice_of_medicine_a15"/><ref name="the_addiction_medicine"/>
{{col-begin}}
{{col-2}}
* [[Ataxia]]
* [[Dysarthria]]
* [[Nystagmus]]
* Slurred speech
* [[Somnolence]] (difficulty staying awake)
* Mental confusion
* [[Hypotension]]
* [[Respiratory arrest]]
* [[Vasomotor]] collapse
{{col-2}}
* Impaired motor functions
** Impaired reflexes
** Impaired coordination
** Impaired balance
** [[Dizziness]]
* [[Coma]]
* [[Death]]
{{col-end}}

===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.<ref name="Baselt2008">{{cite book | vauthors = Baselt RC |title=Disposition of Toxic Drugs and Chemicals in Man |publisher=Biomedical Publications |location=Foster City CA |year=2008 |edition=8th |pages=1037–40 |isbn=978-0-9626523-7-0 }}</ref>

== Interactions ==

[[Protease inhibitor (pharmacology)|Protease inhibitors]], [[nefazodone]], [[sertraline]], [[grapefruit]], [[fluoxetine]], [[erythromycin]], [[diltiazem]], and [[clarithromycin]] inhibit the metabolism of midazolam, leading to a prolonged action. [[Hypericum perforatum|St John's wort]], [[rifapentine]], [[rifampin]], [[rifabutin]], and [[phenytoin]] enhance the metabolism of midazolam leading to a reduced action. Sedating antidepressants, antiepileptic drugs (e.g., [[phenobarbital]], phenytoin, and [[carbamazepine]]), [[H1 antagonist|first-generation antihistamines]], [[opioid]]s, [[antipsychotics]], and [[Alcohol (drug)|alcohol]] enhance the sedative effects of midazolam.<ref name="Riss-2008" /> Midazolam is metabolized almost completely by [[CYP3A4|cytochrome P450-3A4]]. [[Atorvastatin]] administration along with midazolam results in a reduced elimination rate of midazolam.<ref>{{cite journal | vauthors = Mc Donnell CG, Harte S, O'Driscoll J, O'Loughlin C, Van Pelt FN, Shorten GD, Van Pelt FD | title = The effects of concurrent atorvastatin therapy on the pharmacokinetics of intravenous midazolam | journal = Anaesthesia | volume = 58 | issue = 9 | pages = 899–904 | date = September 2003 | pmid = 12911366 | doi = 10.1046/j.1365-2044.2003.03339.x | s2cid = 25382546 | doi-access = free }}</ref> St John's wort decreases the blood levels of midazolam.<ref>{{cite journal | vauthors = Hu Z, Yang X, Ho PC, Chan SY, Heng PW, Chan E, Duan W, Koh HL, Zhou S | title = Herb-drug interactions: a literature review | journal = Drugs | volume = 65 | issue = 9 | pages = 1239–1282 | year = 2005 | pmid = 15916450 | doi = 10.2165/00003495-200565090-00005 | s2cid = 46963549 | url = http://scholarbank.nus.edu.sg/handle/10635/106657 }}</ref> Grapefruit juice reduces intestinal 3A4 and results in less metabolism and higher plasma concentrations.<ref>{{cite journal | vauthors = Arayne MS, Sultana N, Bibi Z | title = Grape fruit juice-drug interactions | journal = Pakistan Journal of Pharmaceutical Sciences | volume = 18 | issue = 4 | pages = 45–57 | date = October 2005 | pmid = 16380358 }}</ref>

==Pharmacology==
Midazolam is a short-acting benzodiazepine in adults with an elimination half-life of 1.5–2.5&nbsp;hours.<ref name="medsafe2012">{{cite web |url=http://www.medsafe.govt.nz/profs/datasheet/m/MidazolaminjPfizer.pdf |title=Midazolam Injection |website=[[Medsafe]] |publisher=New Zealand [[Ministry of Health (New Zealand)|Ministry of Health]] |access-date=6 April 2016 |date=26 October 2012 |archive-url=https://web.archive.org/web/20160222123316/http://www.medsafe.govt.nz/profs/datasheet/m/MidazolaminjPfizer.pdf |archive-date=22 February 2016 }}</ref> In the elderly, as well as young children and adolescents, the elimination half-life is longer.<ref name="Rosenbaum-2009">{{cite journal | vauthors = Rosenbaum A, Kain ZN, Larsson P, Lönnqvist PA, Wolf AR | title = The place of premedication in pediatric practice | journal = Pediatric Anesthesia | volume = 19 | issue = 9 | pages = 817–828 | date = September 2009 | pmid = 19691689 | doi = 10.1111/j.1460-9592.2009.03114.x | s2cid = 7743205 }}</ref><ref name="clinical_anesthesia_a07">{{cite book | vauthors = Barash PG, Cullen BF, Stoelting RK, Cahalan MD |title=Clinical Anesthesia |url=https://books.google.com/books?id=-YI9P2DLe9UC&pg=PA588 |date=1 April 2009 |publisher=Lippincott Williams Wilkins |edition=6th |isbn=978-0-7817-8763-5 |page=588 |url-status=live |archive-url=https://web.archive.org/web/20170220091947/https://books.google.com/books?id=-YI9P2DLe9UC |archive-date=20 February 2017 }}</ref> Midazolam is metabolised into an active metabolite alpha-hydroxymidazolam. Age-related deficits, renal and liver status affect the pharmacokinetic factors of midazolam as well as its active metabolite.<ref>{{cite journal | vauthors = Spina SP, Ensom MH | title = Clinical pharmacokinetic monitoring of midazolam in critically ill patients | journal = Pharmacotherapy | volume = 27 | issue = 3 | pages = 389–398 | date = March 2007 | pmid = 17316150 | doi = 10.1592/phco.27.3.389 | s2cid = 24319062 }}</ref> However, the active metabolite of midazolam is minor and contributes to only 10% of biological activity of midazolam. Midazolam is poorly absorbed orally, with only 50% of the drug reaching the bloodstream.<ref name="Riss-2008" /> Midazolam is metabolised by [[cytochrome P450]] (CYP) enzymes and by [[glucuronide conjugation]]. Oxidation of midazolam is the major metabolite in human liver microsome (HLM).<ref name = "Zhu_2022">{{cite journal | vauthors = Zhu Y, Chen G, Zhang K, Chen C, Chen W, Zhu M, Jiang H | title = High-Throughput Metabolic Soft-Spot Identification in Liver Microsomes by LC/UV/MS: Application of a Single Variable Incubation Time Approach | journal = Molecules | volume = 27 | issue = 22 | page = 8058 | date = November 2022 | pmid = 36432161 | pmc = 9693510 | doi = 10.3390/molecules27228058 | doi-access = free }}</ref> The half-life (t<sub>{{frac|1|2}}</sub>) of midazolam in HLM is 3.3&nbsp;minutes.<ref name = "Zhu_2022" /> The therapeutic as well as adverse effects of midazolam are due to its effects on the GABA{{sub|A}} receptors; midazolam does not activate GABA{{sub|A}} receptors directly but, as with other benzodiazepines, it enhances the effect of the endogenous neurotransmitter GABA on the GABA{{sub|A}} receptors (increasing the frequency of Cl{{sup|−}} channel opening) resulting in neural inhibition. Almost all of the properties can be explained by the actions of benzodiazepines on GABA{{sub|A}} receptors. This results in the following pharmacological properties being produced: sedation, induction of sleep, reduction in anxiety, anterograde amnesia, muscle relaxation and anticonvulsant effects.<ref name="Olkkola-2008">{{cite book |vauthors=Olkkola KT, Ahonen J |chapter=Midazolam and other benzodiazepines |volume=182 |issue=182 |pages=335–360 |year=2008 |pmid=18175099 |doi=10.1007/978-3-540-74806-9_16 |isbn=978-3-540-72813-9 |series=Handbook of Experimental Pharmacology |title=Modern Anesthetics}}</ref>

==History==
Midazolam is among about 35 benzodiazepines currently used medically,<ref name="short_textbook_of_pharmacology"/> and was synthesized in 1975 by Walser and Fryer at [[Hoffmann-LaRoche, Inc]] in the United States.<ref>{{cite patent |country=US |number=4166185 |status=patent |title=Imidazo[1,5-α] [1,4]benzodiazepines |pubdate=1979-08-28 |gdate=1979-08-28 |fdate=1978-07-27 |pridate=1977-03-11 |inventor=Walser A, Fryer RI, Benjamin L |assign1=Hoffmann La Roche Inc |url=https://worldwide.espacenet.com/publicationDetails/biblio?II=0&ND=3&adjacent=true&locale=en_EP&FT=D&date=19790828&CC=US&NR=4166185A&KC=A |postscript=. }} {{Webarchive|url=https://web.archive.org/web/20220617060624/https://worldwide.espacenet.com/publicationDetails/biblio?II=0&ND=3&adjacent=true&locale=en_EP&FT=D&date=19790828&CC=US&NR=4166185A&KC=A |date=17 June 2022 }}</ref> Owing to its water solubility, it was found to be less likely to cause [[thrombophlebitis]] than similar drugs.<ref>{{cite book | vauthors = Kaplan JM, Reich DL, Lake CL, Konstadt SN |edition= 5th | title = Cardiac Anesthesia | date = 15 May 2006 | publisher = W.B. Saunders Company | isbn = 978-1-4160-0253-6 }}</ref><ref>{{cite book | vauthors = Malamed MF | title = Sedation: a guide to patient management | url = https://books.google.com/books?id=StZpAAAAMAAJ | date = 16 October 2002 | publisher = Mosby | location = St. Louis | isbn = 978-0-323-01226-3 | page = 335 }}</ref> 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.<ref>{{cite book | vauthors = Wheeler DS, Wong HR, Shanley TP | title = Pediatric critical care medicine: basic science and clinical evidence | year = 2007 | publisher = Springer | location = London | url = https://books.google.com/books?id=ml5bx1PxxOQC | isbn = 978-1-84628-463-2 | page = 984 | url-status = live | archive-url = https://web.archive.org/web/20170908150253/https://books.google.com/books?id=ml5bx1PxxOQC | archive-date = 8 September 2017 }}</ref> {{as of|2010}}, it is the most commonly used benzodiazepine in anesthetic medicine.<ref>{{cite book | vauthors = Oparil S, Weber M | title = Hypertension: a companion to Brenner and Rector's the kidney | url = https://books.google.com/books?id=6YUJXURDEZkC | date = 22 April 2005 |edition= 2 | publisher = Elsevier Mosby | location = Philadelphia | isbn = 978-0-7216-0258-5 | page = 816 }}</ref> 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.<ref name="short_textbook_of_pharmacology">{{cite book | vauthors = Udaykumar P | title = Short Textbook of Pharmacology for Dental and Allied Health Sciences | url = https://books.google.com/books?id=L1DgbIE0V9sC | date = 30 May 2008 | publisher = Jaypee Brothers Medical Publishers | isbn = 978-81-8448-149-5 | page = 128 }}</ref> Midazolam is also becoming increasingly popular in veterinary medicine due to its water solubility.<ref>{{cite book | vauthors = Riviere J, Papich MG | title = Veterinary Pharmacology and Therapeutics | url = https://books.google.com/books?id=ievLulSqwBAC | date = 30 March 2009 | publisher = Wiley-Blackwell | isbn = 978-0-8138-2061-3 | page = 358 | url-status = live | archive-url = https://web.archive.org/web/20121112124724/http://books.google.com/books?id=ievLulSqwBAC | archive-date = 12 November 2012 }}</ref> In 2018 it was revealed the CIA considered using midazolam as a "truth serum" on terrorist suspects in project "Medication".<ref>{{cite web| url=https://www.nbcnews.com/news/us-news/cia-considered-potential-truth-serum-terror-suspects-after-9-11-n935911| title=CIA considered potential truth serum for terror suspects after 9/11| website=[[NBC News]]| date=13 November 2018| access-date=27 November 2018| archive-date=27 November 2018| archive-url=https://web.archive.org/web/20181127234248/https://www.nbcnews.com/news/us-news/cia-considered-potential-truth-serum-terror-suspects-after-9-11-n935911| url-status=live}}</ref>

==Society and culture==

===Cost===
Midazolam is available as a generic medication.<ref name=Ric2015/>

===Availability===
Midazolam is available in the United States as a syrup or as an injectable solution.<ref>{{cite book |url=https://www.fda.gov/media/71474/download |format=PDF |title=Orange Book: Approved Drug Products With Therapeutic Equivalence Evaluations |edition=44th |publisher=U.S. [[Food and Drug Administration]] (FDA) |year=2024 |access-date=4 July 2024 |archive-date=5 July 2021 |archive-url=https://web.archive.org/web/20210705144133/https://www.fda.gov/media/71474/download |url-status=live }}</ref>

Dormicum brand midazolam is marketed by Roche as white, oval, 7.5&nbsp;mg tablets in boxes of two or three blister strips of 10 tablets, and as blue, oval, 15&nbsp;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&nbsp;mL ampoules at a concentration of 5&nbsp;mg/mL. Another manufacturer, Novell Pharmaceutical Laboratories, makes it available as Miloz in 3 and 5&nbsp;mL ampoules. Midazolam is the only water-soluble benzodiazepine available. Another maker is Roxane Laboratories; the product in an oral solution, midazolam HCl Syrup, 2&nbsp;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.<ref name="Riss-2008"/> It can be administered [[intramuscularly]],<ref name=Walker-2005/> [[intravenously]],<ref>{{cite journal | vauthors = Steib A, Hausberger D, Robillart A, Roche A, Franckhauser D, Dupeyron JP | title = [Anaesthetic considerations for interventional radiology] | journal = Annales Françaises d'Anesthésie et de Réanimation | volume = 25 | issue = 6 | pages = 615–625 | date = June 2006 | pmid = 16632296 | doi = 10.1016/j.annfar.2006.01.018 }}</ref> [[intrathecally]],<ref>{{cite journal | vauthors = Ho KM, Ismail H | title = Use of intrathecal midazolam to improve perioperative analgesia: a meta-analysis | journal = Anaesthesia and Intensive Care | volume = 36 | issue = 3 | pages = 365–373 | date = May 2008 | pmid = 18564797 | doi = 10.1177/0310057X0803600307 | s2cid = 19088163 | doi-access = free }}</ref> [[intranasally]],<ref name="Wolfe-2006"/> [[cheek|buccally]],<ref>{{cite journal | vauthors = Beran RG | title = An alternative perspective on the management of status epilepticus | journal = Epilepsy & Behavior | volume = 12 | issue = 3 | pages = 349–353 | date = April 2008 | pmid = 18262847 | doi = 10.1016/j.yebeh.2007.12.013 | hdl-access = free | s2cid = 42219786 | hdl = 10072/22410 }}</ref> or [[mouth|orally]].<ref name="Riss-2008"/>

===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]].<ref name="ScheduleIV">{{cite web|url=http://www.incb.org/pdf/e/list/green.pdf |title=List of psychotropic substances under international control |access-date=17 December 2008 |author=International Narcotics Control Board |author-link=International Narcotics Control Board |date=August 2003 |publisher=incb.org |archive-url=https://web.archive.org/web/20120831222336/http://www.incb.org/pdf/e/list/green.pdf |archive-date=31 August 2012 }}</ref> In the United Kingdom, midazolam is a Schedule 3/Class C controlled drug.<ref>{{cite web|author=Blackpool NHS Primary Care Trust |title=Medicines Management Update |url=http://www.blackpool.nhs.uk/images/uploads/CD-update-GP-v2-may08.pdf |publisher=[[National Health Service]] |location=United Kingdom |year=2007 |archive-url=https://web.archive.org/web/20101204070730/http://www.blackpool.nhs.uk/images/uploads/CD-update-GP-v2-may08.pdf |archive-date=4 December 2010 }}</ref> 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.<ref>{{cite web|title=US DEA Schedules|url=http://www.deadiversion.usdoj.gov/schedules/|url-status=live|archive-url=https://web.archive.org/web/20130516164501/http://www.deadiversion.usdoj.gov/schedules/|archive-date=16 May 2013}}</ref>

===Marketing authorization===
In 2011, the [[European Medicines Agency]] (EMA) granted a marketing authorisation for a buccal application form of midazolam, sold under the brand name Buccolam.<ref name="Buccolam EPAR" /> Buccolam was initially approved for the treatment of prolonged, acute, convulsive seizures in people from three months to less than 18 years of age.<ref name="Buccolam EPAR" /> This is the first application of a [[paediatric-use marketing authorisation]] by the EMA.<ref>{{cite web|url=http://www.ema.europa.eu/docs/en_GB/document_library/Committee_meeting_report/2011/07/WC500108232.pdf|title=Monthly Report|publisher=[[Committee for Medicinal Products for Human Use]] (CHMP)|page=1|date=5 July 2011|url-status=live|archive-url=https://web.archive.org/web/20120123141032/http://www.ema.europa.eu/docs/en_GB/document_library/Committee_meeting_report/2011/07/WC500108232.pdf|archive-date=23 January 2012}}</ref><ref>{{cite press release | title=ViroPharma's Buccolam (Midazolam, Oromucosal Solution) Granted European Marketing Authorization for Treatment of Acute Seizures | publisher=ViroPharma | via=PR Newswire | date=6 September 2011 | url=https://www.prnewswire.com/news-releases/viropharmas-buccolam-midazolam-oromucosal-solution-granted-european-marketing-authorization-for-treatment-of-acute-seizures-129295588.html | access-date=4 July 2024 | archive-date=31 October 2014 | archive-url=https://web.archive.org/web/20141031212015/http://www.prnewswire.com/news-releases/viropharmas-buccolam-midazolam-oromucosal-solution-granted-european-marketing-authorization-for-treatment-of-acute-seizures-129295588.html | url-status=live }}</ref>

=== Use in executions ===
[[File:OklahomaStatePen (retouched).jpg|thumb|[[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 [[Capital punishment in the United States|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.<ref name="spiegel">{{cite news |url=http://www.spiegel.de/panorama/justiz/todesstrafe-qualvolle-hinrichtung-loest-streit-ueber-todesstrafe-aus-a-1125340.html | vauthors = Schulz S |title=Die fahrlässige Hinrichtung des Ronald Smith | trans-title = The Neglected Execution of Ronald Smith |publisher=[[der Spiegel]] |language=de |date=10 December 2016 |access-date=10 December 2016 |url-status=live |archive-url=https://web.archive.org/web/20161210184033/http://www.spiegel.de/panorama/justiz/todesstrafe-qualvolle-hinrichtung-loest-streit-ueber-todesstrafe-aus-a-1125340.html |archive-date=10 December 2016 }}</ref> Midazolam acts as a sedative, resulting in the prisoner being in a state of deep anesthesia comparable to that experienced during surgery. One or more other drugs are usually used to stop the prisoner's heart, rendering them medically dead.

Midazolam has been used as part of a three-drug cocktail with vecuronium bromide and potassium chloride in Florida and Oklahoma prisons<ref name="url_Death_Penalty_Information_Center">{{cite web |url=http://www.deathpenaltyinfo.org/state-lethal-injection |title=State by State Lethal Injection |publisher=Death Penalty Information Center |access-date=10 April 2015 |url-status=live |archive-url=https://web.archive.org/web/20150403093930/http://www.deathpenaltyinfo.org/state-lethal-injection | archive-date=3 April 2015 }}</ref> and has also been used along with [[hydromorphone]] in a two-drug protocol in Ohio and Arizona.<ref name= "url_Death_Penalty_Information_Center"/>

====Notable incidents====
The state of Florida used midazolam to execute William Frederick Happ in October 2013.<ref name="Watkins M">{{cite news |title=Happ executed using new drug |url=http://www.gainesville.com/article/20131015/ARTICLES/131019753 |work=The Gainesville Sun |date=15 October 2013 |vauthors=Watkins M |url-status=live |archive-url=https://web.archive.org/web/20131212145118/http://www.gainesville.com/article/20131015/ARTICLES/131019753 |archive-date=12 December 2013 }}</ref>

The state of Ohio used midazolam in the [[execution of Dennis McGuire]] in January 2014; he was heavily anesthetized and unconscious within 4 minutes of starting the administration of midazolam and 20 more minutes after that point before he was declared medically dead. Controversy arose after he was observed [[Agonal respiration|gasping]] and appeared to choke during that time according to reporters who were allowed to be present, leading to questions about the dosing and timing of the drug administration, as well as the choice of drugs.<ref>{{cite news |title=Controversial execution in Ohio uses new drug combination |url=http://www.cnn.com/2014/01/16/justice/ohio-dennis-mcguire-execution/ |vauthors = Ford D, Fantz A |publisher=CNN |date=16 January 2014 |url-status=live |archive-url=https://web.archive.org/web/20140117001936/http://www.cnn.com/2014/01/16/justice/ohio-dennis-mcguire-execution/ |archive-date=17 January 2014 }}</ref>

The usage of midazolam in executions became controversial after condemned inmate [[Execution of Clayton Lockett|Clayton Lockett]] apparently regained consciousness and started speaking midway through his 2014 execution when the state of Oklahoma attempted to execute him with an untested three-drug [[lethal injection]] combination including 100{{nbsp}}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 whether his death was caused by one or more of the drugs or by a problem in the administration procedure, nor is it clear what quantities of vecuronium bromide and potassium chloride were released to his system before the execution was cancelled.<ref name="url_ NYTimes.com">{{cite web |url=https://www.nytimes.com/2014/04/30/us/oklahoma-executions.html |title=One execution botched, Oklahoma delays the next |vauthors=Ekholm E |newspaper=[[The New York Times]] |date=29 April 2014 |url-status=live |archive-url=https://web.archive.org/web/20170313154447/https://www.nytimes.com/2014/04/30/us/oklahoma-executions.html |archive-date=13 March 2017 }}</ref><ref name="url_Guardian">{{cite news |url=https://www.theguardian.com/world/2014/apr/30/oklahoma-execution-botched-clayton-lockett |title=Oklahoma execution: Clayton Lockett writhes on gurney in botched procedure |newspaper=The Guardian |location=London |url-status=live |archive-url=https://web.archive.org/web/20140430024414/http://www.theguardian.com/world/2014/apr/30/oklahoma-execution-botched-clayton-lockett |archive-date=30 April 2014 |date=30 April 2014 | vauthors = Fretland K }}</ref>

According to news reports, the execution of Ronald Bert Smith in the state of Alabama on 8 December 2016 allegedly went awry due to the fact he displayed movement soon after midazolam was injected, although prison staff confirmed twice that he was still unconscious before injecting the two fatal drugs.<ref>{{cite magazine |url=https://time.com/4596573/alabama-execution-ronald-bert-smith-midazolam/ | vauthors = Sanburn J |title=The Drug Used in Alabama's Problematic Execution Has a Controversial History |magazine=[[Time (magazine)|Time]] |date=9 December 2016 |access-date=10 December 2016 |url-status=live |archive-url=https://web.archive.org/web/20161209191237/http://time.com/4596573/alabama-execution-ronald-bert-smith-midazolam/ |archive-date=9 December 2016 }}</ref> This controversy again stirred concern among the public regarding the effectiveness of the drug in question.<ref name=spiegel/>

In October 2016, the state of Ohio announced that it would resume executions in January 2017, using a formulation of midazolam, vecuronium bromide, and potassium chloride, but this was blocked by a federal judge.<ref>{{cite news |url=https://www.npr.org/sections/thetwo-way/2017/01/26/511792736/federal-judge-blocks-ohios-lethal-injection-protocol |title=Federal Judge Blocks Ohio's Lethal Injection Protocol | vauthors = Rebecca H |date=26 January 2017 |publisher=NPR |access-date=15 March 2017 |url-status=live |archive-url= https://web.archive.org/web/20170316024604/http://www.npr.org/sections/thetwo-way/2017/01/26/511792736/federal-judge-blocks-ohios-lethal-injection-protocol |archive-date=16 March 2017 }}</ref><ref>{{cite news |url=https://www.nytimes.com/2017/03/13/us/midazolam-death-penalty-arkansas.html |title=When a Common Sedative Becomes an Execution Drug| vauthors = Blinder A |date=13 March 2017 |work=The New York Times |access-date=15 March 2017 |issn=0362-4331 |url-status=live |archive-url=https://web.archive.org/web/20170314212357/https://www.nytimes.com/2017/03/13/us/midazolam-death-penalty-arkansas.html |archive-date=14 March 2017 }}</ref> On 26 July 2017, [[Ronald Phillips (murderer)|Ronald Phillips]] was executed with a three-drug cocktail including midazolam after the Supreme Court refused to grant a stay.<ref>{{cite web |url=http://www.nydailynews.com/news/national/state-ohio-executes-killer-3-year-old-girl-article-1.3358523 |title=Ohio puts killer of 3&nbsp;year-old to death in first execution in more than three years |website=[[Daily News (New York)|Daily News]] |location=New York |date=25 July 2017 |access-date=27 July 2017 |archive-date=29 July 2017 |archive-url=https://web.archive.org/web/20170729101420/http://www.nydailynews.com/news/national/state-ohio-executes-killer-3-year-old-girl-article-1.3358523 |url-status=live }}</ref> Prior to this, the last execution in Ohio had been that of Dennis McGuire.<ref>{{cite news |url=https://www.bbc.co.uk/news/world-us-canada-37545854 |title=Ohio to resume executions with new jab |access-date=3 October 2016 |url-status=live |archive-url=https://web.archive.org/web/20161005073917/http://www.bbc.co.uk/news/world-us-canada-37545854 |archive-date=5 October 2016 |publisher=[[BBC News]] |date=3 October 2016 }}</ref> 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 was pronounced dead without incident in about 14 minutes on 13 September 2017.<ref>{{cite news |url=https://www.cbsnews.com/news/ohio-executes-man-convicted-of-killing-two-in-back-to-back-robberies/ |title=Ohio executes man convicted of killing two in back-to-back robberies |publisher=[[CBS News]] |agency=[[Associated Press]] |access-date=15 September 2017 |archive-date=14 September 2017 |archive-url=https://web.archive.org/web/20170914052050/https://www.cbsnews.com/news/ohio-executes-man-convicted-of-killing-two-in-back-to-back-robberies/ |url-status=live }}</ref>

In April 2017, the state of Arkansas carried out a double-execution, of [[Jack Harold Jones]], 52, and [[Murder of Stacy Errickson|Marcel Williams]], 46. Arkansas attempted to execute eight people before its supply of midazolam expired on 30 April 2017. Two of them were granted a stay of execution, and another, [[Ledell Lee]], 51, was executed on 20 April 2017.<ref>{{cite news |url=http://www.nbcnews.com/storyline/lethal-injection/arkansas-executes-ledell-lee-states-first-inmate-put-death-2005-n749156/ | vauthors = McCausland P |title=Arkansas Executes Ledell Lee, State's First Inmate Put to Death Since 2005 |publisher=[[NBC News]] |date=21 April 2017 |access-date=28 April 2017 |url-status=live |archive-url=https://web.archive.org/web/20170428111924/http://www.nbcnews.com/storyline/lethal-injection/arkansas-executes-ledell-lee-states-first-inmate-put-death-2005-n749156 |archive-date=28 April 2017 }}</ref>

In October 2021, the state of Oklahoma executed inmate [[John Marion Grant]], 60, using midazolam as part of its three-drug cocktail hours after the U.S. Supreme Court ruled to lift a stay of execution for Oklahoma death row inmates. The execution was the state's first since 2015. Witnesses to the execution said that when the first drug, midazolam, began to flow at 4:09{{nbsp}}p.m., Grant started [[Convulsion|convulsing]] about two dozen times and [[vomit]]ed. Grant continued breathing, and a member of the execution team wiped the vomit off his face. At 4:15{{nbsp}}p.m., officials said Grant was unconscious, and he was pronounced dead at 4:21{{nbsp}}p.m.<ref>{{cite news |url=http://www.nbcnews.com/storyline/lethal-injection/arkansas-executes-ledell-lee-states-first-inmate-put-death-2005-n749156/ |author=KOCO Staff |title=Oklahoma executes death row inmate John Grant |publisher=[[ABC News (United States)|ABC News]] |date=28 October 2021 |access-date=29 October 2021 |url-status=live |archive-date=28 April 2017 |archive-url=https://web.archive.org/web/20170428111924/http://www.nbcnews.com/storyline/lethal-injection/arkansas-executes-ledell-lee-states-first-inmate-put-death-2005-n749156 }}</ref>

====Legal challenges====
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 that they had failed to prove that midazolam was cruel and unusual when compared to known, available alternatives.<ref>{{cite web |url=https://www.bbc.com/news/world-us-canada-33314067 |title=US Supreme Court backs use of contentious execution drug |date=29 June 2015 |publisher=[[BBC News]] |access-date=29 June 2015 |url-status= live |archive-url=https://web.archive.org/web/20150701191846/http://www.bbc.com/news/world-us-canada-33314067 |archive-date=1 July 2015 }}</ref>

The state of Nevada is also known to use midazolam in execution procedures. In July 2018, one of the manufacturers accused state officials of obtaining the medication under pretences. This incident was the first time a drug company successfully, though temporarily, halted an execution.<ref>{{cite news |vauthors=Porter T |title=Death row prisoner kills himself after execution halted |url=https://www.newsweek.com/scott-dozier-death-row-prisoner-kills-himself-after-execution-halted-1280675?amp=1 |access-date=6 January 2019 |work=[[Newsweek]] |date=6 January 2019 |archive-date=6 January 2019 |archive-url=https://web.archive.org/web/20190106155525/https://www.newsweek.com/scott-dozier-death-row-prisoner-kills-himself-after-execution-halted-1280675 |url-status=live }}</ref> A previous attempt in 2017, to halt an execution in the state of Arizona by another drug manufacturer was not successful.<ref>{{cite web |vauthors=Bowden J |title=Nevada inmate on death row whose execution was delayed commits suicide |url=https://thehill.com/blogs/blog-briefing-room/news/424035-nevada-inmate-on-death-row-whose-execution-was-delayed-commits |website=The Hill |access-date=6 January 2019 |date=5 January 2019 |archive-date=6 January 2019 |archive-url=https://web.archive.org/web/20190106050205/https://thehill.com/blogs/blog-briefing-room/news/424035-nevada-inmate-on-death-row-whose-execution-was-delayed-commits |url-status=live }}</ref>

== References ==
{{Reflist}}

== External links ==
* [https://www.inchem.org/documents/pims/pharm/pim674.htm Inchem - Midazolam]

{{Benzodiazepines}}
{{Anticonvulsants}}
{{General anesthetics}}
{{Hypnotics and sedatives}}
{{GABAAR PAMs}}
{{Portal bar | Medicine}}
{{Authority control}}

[[Category:21-Hydroxylase inhibitors]]
[[Category:Chemical substances for emergency medicine]]
[[Category:2-Fluorophenyl compounds]]
[[Category:GABAA receptor positive allosteric modulators]]
[[Category:Drugs developed by Hoffmann-La Roche]]
[[Category:Imidazobenzodiazepines]]
[[Category:Lethal injection components]]
[[Category:World Health Organization essential medicines]]
[[Category:Wikipedia medicine articles ready to translate]]