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This factsheet answers some common questions about your child's medicine. It does not contain all available information. It does not take the place of talking to your child's doctor or pharmacist. This information may be different from the information in the manufacturer's consumer information. The information in this factsheet reflects the usage of medicine under medical supervision by patients of The Royal Children's Hospital (RCH). Medicine may be used in children in different ways or for different reasons than in adults - for more information see the Kids Health Info factsheet: Medicines for Children.
Midazolam is a benzodiazepine medication like diazepam and clonazepam. Midazolam works more quickly than diazepam but does not last as long.
What is midazolam used for?
Midazolam is used for:
Midazolam can be:
Ambulance officers and emergency doctors give midazolam by injection into a muscle or vein.
Buccal midazolam is absorbed directly into the blood stream through the lining of the inside of the cheek.
Swallowing midazolam is not recommended as it is not absorbed well through the stomach.
Although the plastic ampoules are labelled 'for slow IV or IM injection', they can be used for buccal and intranasal use.
Buccal midazolam can be used for the emergency treatment of seizures. Buccal midazolam may be prescribed for a child with epilepsy who:
Buccal midazolam is not necessary for all children with epilepsy. Your doctor will tell you whether your child might benefit from you being able to give buccal midazolam.
First aid for seizures is very important. It includes:
Use only 1ml plastic ampoules containing 5mg of midazolam. Do not use midazolam in glass ampoules.
Each ampoule delivers approximately 18 drops (the volume can vary slightly from 16-20 drops, but this is OK).
Buccal midazolam can be given by either drops squeezed directly from the ampoule (ampoule method) or from drops trickled from a syringe into which the midazolam has been drawn up (syringe method).
1: Open the plastic ampoule of midazolam by twisting off the top.
2: Drip onto a tissue the drops that you do NOT need. For example, if your doctor prescribes half the contents of one ampoule (2.5 mg), first drip out nine drops so that nine drops remain in the ampoule to give to your child. If by accident you drip out eight or 10 drops, just give the remainder as it is still a safe dose.
3: Lay your child on their side in the first aid (coma) position. Open their lips and squeeze the remaining midazolam from the ampoule into the inside of the lower cheek (closest to the ground), between the lips and side teeth. There is no need to open your child's jaw. The solution does not need to be swallowed. Give three squeezes of the ampoule to make sure it has all been given. Remove the ampoule to check that all of the solution has been squeezed out. If any remains, reinsert the ampoule and give three more squeezes.
4: Watch your child's breathing and seizure activity while they remain lying on their side in the first aid (coma) position.
5: Write down the time that the seizure started, when the midazolam was given and when the seizure stopped.
2: Insert the syringe into the ampoule and hold the ampoule and syringe upright with the ampoule above the syringe. Withdraw the required dose as prescribed by your doctor into a 1ml syringe. Push out any big air bubbles and check the amount of midazolam in the syringe. Pull the ampoule and the syringe apart.
3: Lay your child on their side in the first aid (coma) position. Open their lips and slowly trickle the midazolam from the syringe into the inside of the lower cheek (closest to the ground), between the lips and side teeth. There is no need to open your child's jaw. The solution does not need to be swallowed.
5: Write down the time that the seizure started, when the miadzolam was given and when the seizure stopped.
Produced in consultation with the RCH Children's Neuroscience Centre & RCH Pharmacy. First published Jan 2006. Updated April 2014.