Midazolam

What is midazolam?

Midazolam is a benzodiazepine used for its sedative, anti-anxiety, and muscle relaxant properties. It is primarily used as a sedative before surgery and to stop seizures. This medication is a controlled substance.

It is used “off label” or “extra label” in animals. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully.

How do I give my pet midazolam?

Midazolam comes in injectable, liquid suspension, and nasal spray forms.

• The injectable form is most used in veterinary medicine. 
• This medication may be given intravenously (into the vein), intramuscularly (into the muscle), intranasally (into the nostrils), or intrarectally (into the rectum).
• Your veterinarian will administer this medication if given by intravenous or intramuscular injections. 
• Your veterinarian may prescribe this medication for your pet for intranasal or intrarectal administration at home; follow your veterinarian’s directions on administration.

This medication will take effect quickly. This medication is short-acting, meaning that effects will last 1–6 hours, depending on dose and administration method, though effects may last longer in pets with kidney or liver disease.

What if I miss giving my pet the medication?

Follow your veterinarian’s recommendations on missed doses. Do not give the pet two doses at once.

Are there any potential side effects from midazolam?

Midazolam may cause the following side effects:

• dysphoria, agitation
• lethargy, sedation
• reduced appetite, vomiting
• changes in blood pressure

The following reactions are rare, but if they occur, contact your veterinarian immediately:

• an allergic reaction such as irregular breathing, rash, fever, puffiness and swelling around the face

Drug sensitivities can develop over time with repeated exposure. It is important to watch for signs of an allergic reaction over the entire course of treatment. Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. 

Are there any risk factors for this medication?

This medication should be AVOIDED in animals with: 

• known allergies to any components
• known sensitivities to benzodiazepines
• acute narrow-angle glaucoma

This medication should be USED WITH CAUTION in pets:

• with liver disease, kidney disease, or heart disease
• who are ill or geriatric

Are there any drug interactions I should be aware of?

Certain medications should be USED WITH CAUTION when given with midazolam, including: 

• azole antifungals (e.g., ketoconazole, itraconazole, fluconazole)
• antihypertensive agents (e.g., amlodipine, enalapril, telmisartan)
• trazodone, gabapentin, phenobarbital, and other nervous system depressants
• cimetidine, erythromycin
• opioids and opioid-like medications (e.g., tramadol)
• rifampin
• tricyclic antidepressants (e.g., amitriptyline, clomipramine)
• theophylline

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Is any monitoring needed with this medication?

• Your veterinarian may prescribe two different medications, and a drug interaction may be anticipated. In this case, your veterinarian may vary the dose and/or monitor your pet more closely.
• Your veterinarian may schedule follow-up visits for monitoring. In this case, follow your veterinarian’s directions.

How do I store midazolam?

• If prescribed for intranasal or intrarectal use at home, follow your veterinarian’s recommendations on storing and discarding this medication.
• Keep medication out of reach of children and pets.

Midazolam is a controlled substance, which means that it has been designated by the Drug Enforcement Administration (DEA) as having a potential for diversion to people other than the patient it was prescribed for. Use of a controlled substance in any person or animal other than that for which it is prescribed is illegal. Therefore, this medication should be stored in a locked cabinet or safe that cannot be easily moved, with access limited to only those that need to administer the medication. Monitor the amount of medication remaining to ensure the expected amount is present.  

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.