Common brand names: Versed Injection, Versed Syrup


Description: Midazolam is classified as an antianxiety, sedative and hypnotic drug; it relaxes the patient, makes him or her drowsy and induces sleep. It is closely related to diazepam (Valium).


Dental uses: Midazolam is used in dentistry as both an intravenous (given through a vein in the arm) sedative for anxious adult patients and as an oral sedative, given as a sweet-tasting syrup, to anxious and uncooperative pediatric patients. As an intravenous sedative, midazolam in now more widely used than diazepam because midazolam causes less burning sensations on injection and less venous irritation (pain).


Dosages for dental purposes: The dose of intravenous midazolam varies from patient to patient but is usually in the range of 1 milligram to 5 milligrams given immediately before the procedure. The dose of midazolam given to pediatric patients as an oral syrup is based on the child’s body weight and can range from 0.25 milligram to 1 milligrams per kilogram (2.2 pounds) with an absolute maximum dose of 20 milligrams.


Concerns and possible side effects: Intravenous midazolam should only be administered by practitioners with advanced training in anesthesiology (typically, oral surgeons and dental anesthesiologists). Patients must be properly monitored with a device known as a pulse oximeter, which measures heart rate and how well the patient is breathing. This is because occasionally, intravenous midazolam can impair breathing. Patients who are to undergo any form of intravenous sedation are encouraged to ask their doctors about their level of training and experience with these techniques.


Oral midazolam syrup also should be only administered by practitioners with advanced training in pediatric sedative techniques and anesthesiology (typically, pediatric dentists, dental anesthesiologists and oral surgeons). As with intravenous midazolam, pediatric patients receiving oral midazolam syrup must be properly monitored with a pulse oximeter, which measures heart rate and how well the patient is breathing. This is because occasionally, midazolam syrup can impair breathing.


Midazolam syrup causes nausea and/or vomiting in some patients. Sedation procedures with either oral or intravenous midazolam frequently cause drowsiness, forgetfulness, impaired thinking and lack of coordination. Therefore, adult patients should not operate machinery or drive automobiles, and pediatric patients must be well supervised by their parents and should refrain from outdoor activities for up to 24 hours.


Occasionally, midazolam may temporarily cause a dry mouth (xerostomia). Patients with narrow-angle glaucoma (increased pressure in the eye) should not take midazolam or related benzodiazepines (such as diazepam or triazolam) because these drugs can precipitate a glaucoma attack.


Pregnant women should not receive midazolam or related benzodiazepines because these drugs, especially when taken in the first trimester, increase the risk of birth defects.


Certain other drugs may cause midazolam to accumulate in the body and increase the risks of side effects. These include:


The antibiotics erythromycin (Eryc) and clarithromycin (Biaxin)

Azole antifungal drugs such as ketoconazole (Nizoral) and fluconazole (Diflucan)

The ulcer medications cimetidine (Tagamet) and omeprazole (Prilosec)

This list is not complete and it continues to grow. These interactions can be serious, so it is imperative to inform your dentist of all medications you are taking.

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