Midazolam is a prescription benzodiazepine used for sedation and other specific medical purposes, which can also include treatment for seizures and symptom relief in palliative care.
While it has legitimate medical uses, it also has potential risks that require appropriate supervision. In this article, we will answer the question, ‘What is midazolam?’, explore its uses and look at some of the potential risks associated with this medication…
What Is Midazolam?
Midazolam is a medication of a class known as benzodiazepines (often colloquially shortened to ‘benzos’).
In the UK, it is available under several brand names, including Buccolam, Epistatus, and Hypnovel, as well as under its generic name, midazolam. The specific name will often depend on how the drug is being administered and the purpose for which it is being prescribed.
How Does Midazolam Work?
Like other benzodiazepines, it works by enhancing the effects of GABA, a chemical that reduces activity in the brain. This produces a sedating effect, relaxing skeletal muscles, and inducing sleep, anaesthesia and amnesia.
It is prescribed for these sedative, anxiety-reducing and anticonvulsant effects, and sometimes for temporary memory impairment. This can be desirable so that a patient does not recall pain, discomfort or stress experienced during medical or dental procedures. Midazolam is not an analgesic or painkiller, and other medications may be used at the same time to provide pain relief.
What Is Midazolam Used For?
Midazolam can have a number of legitimate medical uses, which can include:
Sedation and Anaesthesia
This is the most common use for midazolam. The sedative, anxiety-reducing and amnesic properties are often used as part of anaesthesia and sedation in a number of settings. This can include intensive care sedation, such as helping to keep a patient calm while they are on a ventilator, during minor surgeries and diagnostic procedures like endoscopies, as part of general anaesthesia and in other settings such as dentistry.
Rescue Treatment for Seizures
‘Buccal’ or ‘oromucosal’ is a term used for when a medicine is administered by placing it directly against the gums and inside of the cheek, helping it to quickly enter the bloodstream. Buccal midazolam can be used for certain prolonged seizures.
This treatment can be delivered in hospital but in some cases, individuals including parents and carers may be given training to administer buccal midazolam under certain defined circumstances.
Symptom Relief in Palliative Care
Midazolam may sometimes be used for symptoms such as agitation or anxiety in palliative care, which may involve ‘off-label’ use. This means using a medicine outside the terms of its licence where the prescriber judges it to be in the best interest of the patient on the basis of available evidence.
What Side Effects and Safety Risks Should You Know
Like other benzo-type medications, there are a number of potential midazolam side effects.
The expected effects of midazolam include drowsiness, reduced alertness, impaired coordination and potential memory impairment. However, other paradoxical reactions such as unusual agitation, excitement, combativeness and shaking can sometimes occur.
Other side effects can include:
- Dizziness
- Fatigue
- Nausea
- Muscle weakness
- Mood alteration
- Sleep issues
- Vision problems
- Hallucinations
Slowed breathing can be a potentially dangerous side effect. You should seek emergency help for breathing difficulties, including unresponsiveness or collapse.
You should always follow your treating team’s instructions about supervision, driving and recovery after sedation.
Mixing Midazolam With Alcohol or Other Sedatives
Benzodiazepines have a sedating effect and combining these medications with opioids and other sedating medicines can increase sedation and breathing risks.
Clinicians may use combinations of sedatives and other substances for particular circumstances and with appropriate monitoring in place, but you should never combine drugs without appropriate instruction and there is never a need to combine midazolam and alcohol.
You should always disclose any medicines and other substances you are using to your prescriber. It is not advisable to stop taking a prescribed medication without discussing it first.
Can Midazolam Cause Dependence or Addiction?
Like other benzos, midazolam can lead to dependence and addiction. Midazolam dependence can develop with repeated or prolonged exposure, including legitimate usage such as during prolonged intensive-care sedation. However, the risks may be higher in cases of misuse, which is typically less controlled and unmonitored.
Physical dependence can produce an increased tolerance – meaning more of the drug is needed to produce the same effect – and potential withdrawal symptoms when it is removed. Users may also experience cravings and a preoccupation with obtaining and using the drug.
A loss of control, escalating use or continued use despite harm can be seen as good reasons to seek assessment.
Midazolam Withdrawal and Stopping Safely
During repeated or long-term use, the system gets used to the presence of the drug and internal chemistry changes to compensate for it. A sudden discontinuation after dependence develops can cause a range of physical and psychological withdrawal symptoms, which can include anxiety, sleep disturbance, confusion, dizziness, nausea, tremors and seizures.
A prescriber-led review is safer than stopping abruptly or attempting to taper (wean off) at home. In particular, you should not withhold prescribed seizure rescue medicine, but follow your emergency plan and seek medical advice about any concerns. Benzodiazepine addiction treatment may include monitored withdrawal and detox to help deal with potential withdrawal symptoms in a safe and controlled manner.
How Cassiobury Court Can Help
For misuse or dependence concerns, a thorough assessment, medically supported withdrawal, and psychological support may be appropriate. Any treatment plan should also consider any other substances used, mental health, existing physical conditions and the original reason for prescribing midazolam.
Cassiobury Court is a private residential drug and alcohol rehab based in Watford, with a wealth of experience in helping people with a wide range of substance and addiction issues, including benzodiazepines.
If you are concerned about benzodiazepine misuse or dependence, to discuss assessment and treatment suitability, contact Cassiobury Court today to find out more.
