Tolerance develops rapidly to the anticonvulsant effect, and the dose may need to be increased by several times to maintain anticonvulsant therapeutic effects. ĭrawbacks 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. Midazolam is effective for status epilepticus 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 is not required due to its solubility in water), which occurs with other benzodiazepines. A benefit of midazolam is that in children it can be given in the cheek or in the nose for acute seizures, including status epilepticus. 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.
Midazolam is sometimes used for the acute management of prolonged seizures. 4.3 Tolerance, dependence, and withdrawal.In many countries, it is a controlled substance. Midazolam is available as a generic medication. It is on the World Health Organization's List of Essential Medicines. Midazolam was patented in 1974 and came into medical use in 1982. It belongs to the benzodiazepine class of drugs and works by increasing the activity of the GABA neurotransmitter in the brain. There is evidence of risk when used during pregnancy but no evidence of harm with a single dose during breastfeeding. Paradoxical effects, such as increased activity, can occur especially in children and older people. Tolerance to its effects and withdrawal syndrome may occur following long-term use. Side effects can include a decrease in efforts to breathe, low blood pressure, and sleepiness. When given intravenously, it typically begins working within five minutes when injected into a muscle, it can take fifteen minutes to begin working. Midazolam can be given by mouth, intravenously, by injection into a muscle, by spraying into the nose, or through the cheek. It is also useful for the treatment of prolonged (lasting over 5 minutes) seizures. The drug does not cause an individual to become unconscious, merely to be sedated. It works by inducing sleepiness, decreasing anxiety, and causing a loss of ability to create new memories. Midazolam, sold under the brand name Versed among others, is a benzodiazepine medication used for anesthesia, procedural sedation, trouble sleeping, and severe agitation.
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