Dosage should be individualized and drug should be administered slowly. Lower doses may be required in elderly or debilitated patients, in patients, in patients with hepatic or renal insufficiency, or when Midazolam is used in conjunction with opioid analgesics. When Midazolam is used, respiratory and cardiac functions should be monitored continuously, and facilities for resuscitation should always be available. It is advisable to keep the patient supine during intravenous administration and throughout the procedure. Because serious and life-threatening cardiorespiratory adverse events have been reported, provision for monitoring, detection and correction of these reactions must be made for every patient to whom Midazolam injection is administered, regardless of age or health status.
Midazolam may be given for premedication before general anaesthesia or to provide for minor surgical or investigative procedures. A usual sedative dose for dental and minor surgical and other procedures ranges from 2.5 to 7.5 mg (about 70 mcg per kg body-weight) intravenously; an initial dose of 2 mg over 30seconds has been suggested, with further incremental doses of 0.5 to 1 mg at intervals of 2 minutes if required until the desired end-points is reached.
The dosage of Midazolam should be determined by the response of the individual patient. The usual dose of Midazolam for induction of anaesthesia is about 200mcg per kg by slow I.V. injection in premedicated patients and at least 300 mcg per kg in those who not received a premedicant. A dose of 150 mcg per kg has been recommended for the induction of anaesthesia in children over 7 years of age.
Patients in intensive care who requires continuous sedation can be given Midazolam by I.V. infusion. The dosage should be individualized and Midazolam titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication. An initial loading dose of 30 to 300mcg per kg may be given by I.V. infusion over 5 minutes to induce sedation. The maintenance dose required varies considerable but a dose of between 20 and 200 mcg per kg per hour has been suggested. The loading dose should be reduced or omitted and the maintenance dose reduced, for patients with hypovolemia, vasoconstriction, or hypothermia. The need for continuous administration should be reassessed on a daily basis to reduce the risk of accumulation and prolonged recovery. Sedation may also be achieved by giving intermittent I.V. bolus injections of Midazolam; doses of 1 to 2 mg may be given and repeated, until the desired level of sedation has been reached. Midazolam is given intramuscularly as a premedicant about 30 to 60 minutes before surgery. The usual dose is about 5 mg; doses range from 70 to 100 mcg per kg. Or as prescribed by the physician.