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Uses

What is midazolam used for?

Midazolam is commonly used to treat the following conditions.

  • To relax you and make you sleepy before a surgery or medical procedure.
  • Certain type of seizure disorders (epilepsy) 

Midazolam may also be used for other conditions as determined by your healthcare provider.

Midazolam is also available as a nasal spray. See Nayzilam for more information.

How does midazolam work (mechanism of action)?

Midazolam produces a calming effect on the brain and nerves, which helps to promote relaxation for surgery or medical procedures or treat seizures.

How is midazolam supplied (dosage forms)?

Midazolam is available as a 2 mg/mL oral syrup and in injectable forms. 

How should I store midazolam?

Midazolam should be stored at room temperature, between 68 F to 77 F (20 C to 25 C). It can be exposed to temperatures between 59 F to 86 F (15 C to 30 C) for shorter periods of time, such as when transporting it. Store in a cool, dry place.

Side Effects

What are the most common side effects of midazolam?

The most common side effects of midazolam are listed below. Tell your healthcare provider if you have any of these side effects that bother you.

  • Sleepiness
  • Headache
  • Feeling agitated
  • Fever (injectable forms)
  • Pain, swelling, redness, or muscle stiffness near the injection (injectable forms)

There may be other side effects of midazolam that are not listed here. Contact your healthcare provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088. In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of midazolam?

While less common, the most serious side effects of midazolam are described below, along with what to do if they happen.

Severe Allergic Reactions. Midazolam may cause allergic reactions, which can be serious. Stop using midazolam and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Trouble swallowing or throat tightness
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain

Risk of Misuse and Addiction. Misusing midazolam can lead to serious side effects like coma or death. Misuse means taking a medicine in a way other than how it was prescribed. Use midazolam exactly as prescribed. Tell your healthcare provider if you feel that midazolam is not working. Call your healthcare provider right away or go to the nearest emergency room if you experience any of the following serious symptoms.

  • Sudden confusion or feeling disoriented
  • Feeling paranoid
  • Suicidal thoughts or actions
  • Seizures
  • Trouble breathing

Dependence and Withdrawal Reactions. Midazolam can cause physical dependence, which means your body relies on the medicine to function properly. If you stop midazolam suddenly, it could lead to withdrawal symptoms, which may be life-threatening. Do not stop taking midazolam without talking with your healthcare provider. Your healthcare provider will tell you how to stop midazolam to reduce the risk of withdrawal reactions. Call your healthcare provider right away or go to the nearest emergency room if you experience any of the following serious symptoms.

  • Unusual movements, responses, or expressions
  • Seizures
  • Sudden and severe mental or nervous system changes
  • Seeing or hearing things that others do not see or hear, also called hallucinations
  • An extreme increase in activity or talking
  • Losing touch with reality

Some people may experience the following symptoms of a withdrawal reaction that can last for several weeks to more than 12 months.

  • Anxiety
  • Trouble remembering, learning, or concentrating
  • Depression
  • Problems sleeping
  • Feeling like insects are crawling under the skin
  • Weakness
  • Shaking
  • Muscle twitching
  • Burning or prickling feeling in the hands, arms, legs, or feet
  • Ringing in the ears

Breathing Problems. Midazolam may cause slow or shallow breathing, especially if you have breathing problems from another condition or take other medicines that can slow your breathing. Tell your healthcare provider if you develop severe sleepiness or trouble breathing, especially when you start midazolam or when your dose is increased. Get emergency help if you have any of the following symptoms.

  • Changes in the color of your skin, including bluish color to your lips and fingernails
  • Confusion
  • Shortness of breath
  • Feeling dizzy, lightheaded, or fainting
  • Changes in your heart rate or rhythm, such as a fast, slow, pounding or skipping heartbeat
  • Slow or shallow breathing
  • Excessive sleepiness or trouble staying awake

Risk With Opioid Medicines. Taking midazolam with an opioid medicine, such as codeine, morphine, and oxycodone, may lead to severe drowsiness, breathing problems, coma, and death. Get emergency help right away if you experience the following symptoms.

  • Slow or shallow breathing
  • Breathing stops (which may lead to the heart stopping)
  • Excessive sleepiness or trouble staying awake 

Suicidal Thoughts and Actions. Midazolam may cause suicidal thoughts or actions in a small number of people. If you are about to harm yourself, call 911 or call or text 988, the Suicide & Crisis Lifeline. Call your healthcare provider right away if you have any of the following symptoms.

  • New or increased thoughts of suicide or death
  • Suicide attempt
  • New or increased feelings of anxiety, depression, or other unusual changes in mood or behavior

Decreased Alertness or Coordination. Midazolam can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how midazolam affects you.

Warnings & Precautions

Who should not use midazolam?

Allergies to Ingredients. People who are allergic to any of the following should not use/take midazolam.

  • Midazolam
  • Seizalam
  • Cherries (oral syrup)
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific midazolam products they stock.

Glaucoma. Do not use midazolam if you have acute narrow-angle glaucoma. There are different types of glaucoma. If you do not know what type you have, talk with your healthcare provider before taking midazolam.

What should I know about midazolam before using it?

Do not use midazolam unless it has been prescribed to you by a healthcare provider. Use it as prescribed.

Do not share midazolam with other people, even if they have the same condition as you. It may harm them.

Keep midazolam out of the reach of children. Midazolam is a controlled substance because it can be misused or lead to dependence. Store midazolam in a safe place to protect it from theft. It is illegal to sell or give away this medicine.

Midazolam can affect your alertness or coordination. Do not drive or do other activities that require alertness or coordination until you know how midazolam affects you.

What should I tell my healthcare provider before using midazolam?

Tell your healthcare provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them determine if midazolam is right for you.

In particular, make sure that you discuss any of the following.

Mental Health Problems. Tell your healthcare provider about your recent and current mental health problems, especially if you have had depression, thoughts of suicide or dying, or have ever attempted suicide.

Substance Use Disorder. Midazolam is a controlled substance and may be misused or lead to dependence. Tell your healthcare provider if you have a history of a drug or alcohol disorder. 

Current and Past Health Conditions. Tell your healthcare provider if you have any of the following.

Other Medicines and Supplements. Midazolam may interact with other medicines and supplements. Before using midazolam, tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. It is not known if or how midazolam could affect pregnancy or harm an unborn baby. Taking midazolam during the later stages of pregnancy can cause withdrawal and the following symptoms in newborns.

  • Breathing problems
  • Sluggish
  • Low muscle tone
  • Jittery
  • Fussiness or irritability
  • Restlessness
  • Shaking
  • Excessive crying
  • Feeding problems

Tell your healthcare provider if you are or plan to become pregnant. Your healthcare provider will advise you if you should take midazolam while you are pregnant or trying to get pregnant. If you become pregnant while using midazolam, talk to your healthcare provider about registering with the North American Antiepileptic Drug Pregnancy Registry. This registry collects information about the safety of antiepileptic medicines during pregnancy. You can register by calling 888-233-2334 or online at www.aedpregnancyregistry.org. 

Breastfeeding. Midazolam passes into breast milk. Tell your healthcare provider if you are breastfeeding or plan to breastfeed. Your healthcare provider will advise you if you should take midazolam while breastfeeding.

Interactions

Does midazolam interact with foods or drinks?

Eating grapefruit or drinking grapefruit juice may increase midazolam levels and side effects.

Do not drink alcohol while taking midazolam. The risk of serious problems such as severe dizziness, sleepiness, and trouble breathing may be increased if you drink alcohol while taking midazolam.

Does midazolam interact with other medicines (drug interactions)?

Always tell your healthcare provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. 

In particular, make sure to discuss if you are using any of the following before taking midazolam.

  • An opioid, such as oxycodone, morphine, codeine, or fentanyl, which is a medicine used for certain types of pain
  • Any other medicine that causes dizziness and sleepiness, such as prescription pain medicines, sleep medicines, and medicines for anxiety
  • Flumazenil (Romazicon), which is a medicine used to manage benzodiazepine overdose
  • Cimetidine (Tagamet), which is a medicine for stomach acid and stomach ulcers
  • Erythromycin (Erythrocin), which is an antibiotic
  • Diltiazem (Cardizem) and Verapamil (Verelan), which are medicines for high blood pressure
  • Ketoconazole (Nizoral) and itraconazole (Sporanox), which are medicines for fungal infections

Some other medicines may alter the blood levels of midazolam. Tell your healthcare provider about all medicines that you take or have recently taken.

This may not be a complete list of medicines that can interact with midazolam. Always check with your healthcare provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much midazolam?

If you or someone else has used too much midazolam, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of midazolam?

Midazolam is meant to be used only when needed. Use it as your healthcare provider recommends. Do not take double or extra doses.