A short-acting benzodiazepine for sedation, seizures and palliative care
Midazolam
A short-acting benzodiazepine used for sedation during procedures, to stop prolonged seizures, and in palliative care.
What is Midazolam?
Midazolam is a short-acting benzodiazepine used in several ways: to provide sedation during medical and dental procedures, to stop prolonged or repeated seizures (often given into the cheek as a buccal liquid), and to ease symptoms in palliative care. Its most important risk is that it can slow or depress breathing, especially when combined with opioid painkillers, so it is given in settings where breathing and the airway can be supported. It is a controlled drug. Its effects come on quickly and wear off relatively fast, which is part of why it suits short procedures.
Education and reference only. This is a plain-language guide to Midazolam — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Midazolam is a benzodiazepine, a group of medicines that calm the brain and nervous system, and it is one of the shorter-acting members of the group. It is used mainly in three ways: to sedate and relax people during procedures such as endoscopies or dental work, to stop prolonged or repeated epileptic seizures, and to relieve agitation and other symptoms in palliative (end-of-life) care. It can be given as an injection, as a liquid squirted into the cheek (buccal), or by other routes depending on the situation. It is a controlled drug and is given by, or under the close supervision of, healthcare professionals or trained carers.
How it works
Midazolam boosts the effect of a natural calming chemical in the brain called GABA, which quietens nerve activity. This produces sedation, relaxation, reduced anxiety, and a degree of forgetfulness of the procedure, and it also helps stop the runaway electrical activity that causes seizures. Because it acts quickly and is then broken down relatively fast, its effects come on and wear off sooner than many other benzodiazepines, which makes it well suited to short procedures and to emergency seizure control. The same calming action on the brain can also slow breathing, which is the main reason it is used where breathing can be watched and supported.
Company & origin
Originated / developed by: Generic and branded manufacturers.
A short-acting benzodiazepine used in the UK for sedation during procedures, to stop prolonged seizures, and in palliative care, used as a controlled drug.
What it treats
Conditions Midazolam is used for
Practical use
How to take Midazolam
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by a healthcare professional, or by a trained carer following a clear plan, rather than self-administered casually.
- For seizures, the buccal liquid is given into the cheek exactly as shown, with clear instructions on when to call for emergency help.
- Be aware it can cause drowsiness and forgetfulness, so arrange for someone to be with you after procedure sedation.
- Do not drink alcohol or take other sedating medicines around the time it is used, as this increases the risk to breathing.
- Follow the recovery advice given, including not driving or operating machinery until the effects have fully worn off.
Weighing it up
Advantages & disadvantages of Midazolam
Advantages
- Acts quickly and wears off relatively fast, which suits short procedures and emergency seizure control.
- Can be given in several ways, including into the cheek for treating prolonged seizures outside hospital.
- Provides effective sedation and helps keep people comfortable in palliative care.
Disadvantages
- Can slow or depress breathing, especially when combined with opioid painkillers or other sedatives.
- Often causes forgetfulness around the time it is given, so you may not remember the procedure.
- Is a controlled drug, and longer use can lead to tolerance and dependence.
Practical use
Good to know
The single most important safety point with midazolam is that it can slow or depress breathing, and this risk is much greater when it is combined with opioid painkillers or other sedating medicines; for this reason it is given where the airway and breathing can be monitored and supported if needed. It often causes a degree of forgetfulness around the time it is given, which is usually helpful for procedures but means you may not remember what happened. It is a controlled drug, reflecting the need for careful handling. For seizures, the buccal liquid given into the cheek allows quick treatment of a prolonged seizure outside hospital by a trained carer, with clear instructions on when to call for emergency help. In palliative care it is used to keep people comfortable. As with all benzodiazepines, longer use can lead to tolerance and dependence, though many of its uses are short term.
Who should not take it / use with caution
- People who have had a serious allergic reaction to midazolam or other benzodiazepines should not be given it.
- It is used with great caution in people with severe breathing problems or sleep apnoea, where airway support must be available.
- It is used cautiously in older or frail people and those with serious liver problems, who may be more sensitive to it.
- It is used with particular care alongside opioids or other sedating medicines because of the risk to breathing.
Monitoring
- Watching breathing, oxygen levels, blood pressure and how alert the person is during and after sedation.
- Having equipment and trained staff ready to support breathing and reverse its effects if needed.
- Reviewing the response and recovery, and, in palliative care, comfort and symptom control.
Side effects
- Drowsiness, sedation and forgetfulness around the time it is given.
- Slowed or depressed breathing, especially with opioids or other sedatives.
- A drop in blood pressure, hiccups or, occasionally, restlessness or agitation.
- Rarely but seriously, dangerously slow breathing or severe allergic reactions, which need immediate treatment.
Key interactions
- Opioid painkillers greatly increase the risk of slowed breathing and deep sedation when used with it.
- Alcohol and other sedating medicines add to its calming effect and its risk to breathing.
- Some antifungal, antibiotic and other medicines can raise its level and prolong its effects.
Available as: Injections, and a liquid given into the cheek (buccal); used by professionals or trained carers.
Answers
Midazolam: frequently asked questions
What is midazolam used for?
It is a short-acting benzodiazepine used for sedation during procedures, to stop prolonged or repeated seizures, and to ease symptoms in palliative care.
Why must my breathing be watched?
Midazolam can slow or depress breathing, especially when combined with opioid painkillers, so it is given where breathing and the airway can be monitored and supported.
Why won't I remember the procedure?
It often causes a degree of forgetfulness around the time it is given, which is usually helpful for uncomfortable procedures but means you may not recall what happened.
How is it given for a seizure at home?
It can be given as a liquid into the cheek by a trained carer following a clear plan, which allows a prolonged seizure to be treated quickly, with instructions on when to call for emergency help.
Why is it a controlled drug?
As a benzodiazepine with sedating effects and a potential for misuse and dependence, midazolam is a controlled drug, so it is handled and prescribed with extra care.
The wider class
About Short-acting benzodiazepine
Midazolam belongs to the short-acting benzodiazepine class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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