Talk:Midazolam

Cleanup
So I very rarely comment on Wikipedia so sorry if this is in the wrong place, someone please move it if needed. I wanted to point out that the phrase "The risk factors for dependence include dependent personality...", specifically "dependent personality" is a non sequitur. Drug dependence is purely physiological phenomenon where as drug addiction is a physiological one. They are very distinct from each other so I think the "dependent personality" trait should be completely removed from that section. 24.54.118.61 (talk) 03:53, 30 June 2022 (UTC)

requested cleanup, but I don't think that is necessary. This article does need to be expanded though. JFW | T@lk  08:20, 7 November 2005 (UTC)


 * Cleanup is very necessary; I started it by correcting at least some of the atrocious spelling/grammar, sentence structure, lack of citation, POV, etc. etc. — Preceding unsigned comment added by Arabhorse (talk • contribs) 15:49, 21 May 2006 (UTC)

mraaronkaufman@gmail.com |  08:20, 7 October 2020(UTC)


 * The entirety of the article confuses midazolam and midazolam HCl.  And its really critical to certain issues, e.g., the solubility, the reason it's preferred IV over almost any other benzo in emergency situations (most - or daresay all - other licit benzodiazepines do not readily form acid salts and, if injected must be in a medium that readily solvates the free base, usually propylene glycol.   A bolus of PG is not - how to best state this - something I wouldn't be jumping off the table if I heard I was about to get one.   This is presumably the basis for the note about lorazepam and diazepam IV causing pain at the injection site.  And while I understand this is a minor point due to the molecular masss of versed being much greater than that of HCl, but the whole article uses mass units that do not differentiate between the salt form and the base.  Similarly the pharmacology of the tablet and syrup form (where again the distinction between midazolam HCl and midazolam free base) should be looked into as -- and this is guesswork really -- I would expect the lipophillic free base to be most readily absorbed;  of course pill / syrup vector design might or might not play a part, particularly if say one compared two similar pills formulated to delay release until the small intestine but one contained the free base.  I would conjecture that the midazolam HCl pill would be significantly less absorbed than the lipophillic free base.   But Ive seen no dissolution kinetics experiments (in aqueous high pH conditions set to emulate the small bowel especially)?   Has anyone?  Another interesting aspect is why midazolam (which is quite similar to the triazolobenzodiazepines but has the triazole ring substituted by methylimidazole) will form an acid salt while the other triazolo- and keto-benzodiazepines famously do not.  Some chemistry-based explanation would certainly prove helpful.  I would expect that the comparitive aromaticity of both the (triazolo/methylimidazolo), the comparitive basicity of the free Nitrogen lone pairs make the difference, perhaps in connection with single electron donation by the seven membered ring and/or the potentiality for the seven-membered diazepine ring to gain antiaromatic character when adjacent to a good electron donor.

In sum, I believe the most important pharmaco-chemical aspect of this wonder-drug is being brushed aside in the article. (If you dont believe midazolam is a wonder drug ask an ER doc and/or consider the unfortunate property of all other benzos in the USP that no instant onset is possible without giving someone a bolus of excipient that might cause an immediate stroke)

Anticonvulsant
Midazolam most certainly is used as an anticonvulsant, in the treatment of status epilepticus. It is an important new development for the treatment of status by non medical staff. Prior to this, the only option in the UK is rectal diazepam, with all the social problems of that method of delivery!

"Buccal midazolam is currently not licensed for the treatment of epilepsy in the UK although there is an increasing trend for doctors to prescribe it as an emergency treatment for prolonged seizures" - Epilepsy Action UK


 * BNF 50. Indications: ..., status epilepticus [unlicensed use]; ...
 * ICL Institute of Child Health: Buccal Midazolam (Great Ormond Street Hospital for Children Factsheet).
 * A Google for midazolam and status will find loads more.
 * A Google for midazolam and status will find loads more.

Whilst I'm not much of a fan of the big Anticonvulsants table (which was removed from this article), I think this usage should be added to the article. --Colin 22:08, 15 February 2006 (UTC)


 * Yes, what's the beef with this? I've added some stuff; the above references and anticonvulsant table can/should be added too.  - ikkyu2  ( talk ) 07:55, 17 February 2006 (UTC)


 * The "beef" was just the removal of the Anticonvulsants table with the history comment "this drug is not used as an anticonvulsant.". I didn't want to make the change if Fuzzform was still in the middle of working on the article --Colin 09:14, 17 February 2006 (UTC)

Yes, I apologize for that. I'm not really a fan of the huge anticonvulsants template either. All of the benzodiazepines can be used for treatment of epilepsy (as they all share similar inhibitory properties), so I didn't think it necessary to have this template as well. Also, the benzodiazepine template is a sub-template of the anticonvulsants template. It seems silly to use both templates, but midazolam is first and foremost a benzodiazepine, and I think it would be improper not to include the benzodiazepine template.

I think that all the benzo pages should use the same templates, but it would be unnecessary (not to mention messy-looking) to have the anticonvulsant template on every benzo page. The more I think about this, the more I'm unsure about what to do. Any ideas for a compromise? Fuzzform 20:02, 18 February 2006 (UTC)


 * I'm glad you've asked this because I've been tidying the benzo listing on anticonvulsant. Whilst I agree that these drugs (like the barbiturates) probably all have some anticonvulsant effect, they are not all used / indicated / licensed for treating epilepsy or acute seizures. I think the current list on anticonvulsant is a subset of benzodiazepines that I am happy with classifying as anticonvulsants based on their clinical use. If someone more experienced than me wants to correct that listing, then I'd welcome their input. You can get the UK drug usage situation from the BNF - it is free to register for access.


 * As I said on the anticonvulsant page, the benzodiazepines share a lot of properties but these vary in usefuless/strength from drug to drug. Some might be too weak an anticonvulsant to be useful at non-toxic doses, or at non-hypnotic doses. I think that in your upgrade-drive for these drugs, you should try to differentiate them so the reader knows clearly why certain benzodiazepines are chosen over another.


 * Re: the anticonvulsant template - I don't think it should contain the benzodiazepines template. Instead, a new template should be created "benzodiazepine anticonvulsants", which is in keeping with most of the other templates inside anticonvulsant. The same is true of the barbiturates template. I don't have the time to do this over the weekend so go ahead if you like.
 * Just done it --Colin 22:50, 18 February 2006 (UTC)


 * Re: "midazolam for intramuscular buccal injection" - I half-laughed and half-squirmed when I read this. I had visions of a mad dentist missing my gum and stabbing his needle through my cheek. If you read the GOSH leaflet, it has kinder instructions. You just squirt the liquid slowy between the gum and the cheeks. I'll correct the wording. --Colin 21:53, 18 February 2006 (UTC)

Abuse and Side Effects
The section on side effects should not be used for discussion of abuse. I did not have time to separate into two sections, so I just retitled the existing section while I focused on doing some serious cleanup work. At the very least, abuse should not be intermingled with medical side effects (such as you'd read on literature accompanying prescription) but perhaps have its own distinct paragraph if it was going to be kept in the side effect section. — Preceding unsigned comment added by Arabhorse (talk • contribs) 15:49, 21 May 2006 (UTC)

Pop culture mention
Apparently the Duran Duran album Medazzaland was named after this drug. Probably not worth a mention in the article, but you learn something new every day, and look what I wasted today on! :)  &mdash; Catherine\talk 01:47, 14 April 2006 (UTC)

The article states that midazolam was first synthesized in 1976. But in the "Indications" section, it states that midazolam was used as a truth serum during the Vietnam War. Since the Vietnam War ended in 1973, before the stated first-synthesis date of 1976, how is this possible? 68.7.45.142 15:56, 31 August 2006 (UTC)


 * Well spotted, thank-you. There are plenty sources to back up the synthesis date but none can be found about the Vietnam stuff. The Vietnam paragraph was added along with other unsourced, speculative and just plain wrong stuff by user 24.63.58.100. Some of that has been removed already and I've now removed the rest. Colin°Talk 17:56, 31 August 2006 (UTC)

Dosage
Under dosage info it says Versed is often paired with 50mg of Fentanyl. This can't possibly be right. Unless it's rewritten as "Endoscopy: if 3-5mg (rarely 10mg) is not enough to adequately sedate the patient, the only viable option is a super-massive overdose of opiods, preferrably inserted directly into the jugular. Be prepared with naloxone syringe. Repeat as necessary with problem patients." —The preceding unsigned comment was added by 63.165.238.2 (talk • contribs) 17:11, 14 June 2006 (UTC) --Legomancer 15:52, 19 June 2006 (UTC)

Please remove any text that you think is erroneous. This is preferable to adding "citation needed" - especially for important facts. See WP:VERIFY, especially policy point 3. Colin°Talk 21:56, 14 June 2006 (UTC)

Done. Reference to fentanyl now says a more reasonable 2.5-5 micrograms. Would a digression about benzo/opiod interaction be appropriate for this page? --Legomancer 15:52, 19 June 2006 (UTC) —The preceding unsigned comment was added by 63.165.238.2 (talk • contribs) 12:09, 15 June 2006 (UTC)

Unless specific to Midazolam, then perhaps the benzodiazepine page would be better. Although if this combination is used for a specific medical treatment/procedure then maybe that would indicate a more suitable place. You could ask on Wikipedia talk:WikiProject Drugs or Wikipedia talk:WikiProject Clinical medicine?

Please consider getting an account. It takes only a few seconds and makes discussion much easier. Colin°Talk 12:41, 15 June 2006 (UTC)

Oops, thought I was signed in. I've added my sig behind the anonymous. It looks like this: --Legomancer 15:52, 19 June 2006 (UTC)

My father is here, dying from cholangiocarcinoma. He has had a Fentanyl 25 patch for 3 weeks (changed every 3 days) which has been very efective in controlling pain. Now he has, in addition, Midazolam in a 24-hour syringe pump to control anxiety, restlessness and twitchiness. 58.106.182.143 (talk) 12:29, 15 September 2008 (UTC)

I'm still not happy with the Dosage section. Looking at the reference Clinical Use of Midazolam by John Shu or the RxList link, I think that dosing is a very complex issue. IMO this section should either be removed or else totally revised by somebody with the skills to do a good (well referenced) job. Colin°Talk 18:51, 31 August 2006 (UTC)

As a side note: Midasolam is also marketed in Europe under the brand name Dormicum® (La Roche) as a sleep aid. Two dosages are available 7.5mg (white colored tablets) and 15mg (blue). ...thought it's worth mentioning. — Preceding unsigned comment added by 67.171.24.88 (talk) 04:47, 27 February 2007 (UTC)

Possible redirect?
I heard the drug name midazolan used on the show Prison Break and wanted to know what it was. Wikipedia has no mention of the drug so I am wondering if midazolam is the same drug, and should there be a redirect here? 70.48.129.107 23:12, 22 November 2006 (UTC)strideranne

Ring opening in acidic aqueous solution
The imidazoline ring will not open in acidic aqueous solution, because it is too stable, due to its aromaticity; instead, the diazepine ring opens upon protonisation and hydrolysis: http://img144.imageshack.us/img144/6521/midazolamringopeningob4.png I therefore change the remark in the article.--84.163.87.66 11:39, 28 April 2007 (UTC)

Romoved Nikolai Telsa reference
Versed was first synthesized in 1972, therefore it could not have been used to kill this guy. —Preceding unsigned comment added by 71.198.28.242 (talk) 08:07, 18 July 2008 (UTC)

Mickey Finn
http://www.mirror.co.uk/news/top-stories/2009/11/29/couple-in-rape-drug-horror-115875-21858452/

One news article proves nothing, but here it is, if there's any other evidence of such use. Bustter (talk) 11:40, 29 November 2009 (UTC)

Indications / Therapeutic uses
I changed 'indications' to 'therapeutic uses' in this article, and it was quickly reverted, with the comment of "Drug articles generally use 'Indications' per Wikipedia:MEDMOS#Drugs)". I really don't think that's the right approach, even if MEDMOS "recommends" it. "Indications" to me, makes it sounds way too formal and technical, and we're not writing the drug information for the pharmaceutical company. We're writing an encyclopedia that's going to be read by individual people, most of whom don't have a pharmacy background. That's why I think a heading like "therapeutic uses" sounds better in this case -- "indications" is simply just too technical. WTF? (talk) 18:54, 5 February 2010 (UTC)


 * You make a reasonable point but you are posting in the wrong place. You should go to the talk page of WP:MEDMOS and post your views there to seek consensus for a change to the guideline. :) -- Literature geek |  T@1k?  19:09, 5 February 2010 (UTC)


 * It probably goes without saying, but MEDMOS is just a guideline. It's not a hard-and-fast rule, as far as I know. WTF? (talk) 19:21, 5 February 2010 (UTC)


 * You are correct but the point you raised (which is a good point), applies to all articles. Why seek consensus on one article when we can seek consensus for all articles is my point?. I am happy if it is left as therapeutic uses.-- Literature geek |  T@1k?  19:25, 5 February 2010 (UTC)
 * I agree with LG yes MEDMOS is not a hard and fast rule but one needs a good reason not to follow it and I do not see that in this case. Indications just means when this medication could be used based on the literature.-- Doc James  (talk · contribs · email) 22:26, 5 February 2010 (UTC)
 * Looks like there are more people in favour of sticking with indications and the guideline currently says indications is the term to use so unless the guideline changes indications it should be. I personally don't mind one way or the other.-- Literature geek |  T@1k?  23:31, 5 February 2010 (UTC)

Looks like the conversation has moved to MEDMOS talk page.Wikipedia_talk:Manual_of_Style_(medicine-related_articles).-- Literature geek |  T@1k?  23:58, 5 February 2010 (UTC)
 * For the moment, it doesn't matter what individuals think, this article is under review as a Good Article. One of the criteria requires compliance with MOS, and for a medical article, that includes MEDMOS. Without compliance, Midazolam won't pass GAR. MEDMOS may be "just a guideline", but it documents the present consensus and exceptions to it need a better reason than thinking it looks too formal. --RexxS (talk) 01:37, 6 February 2010 (UTC)

Midazolam in end-stage end-of-life care
Just a nit, but as the article is up for GA review, I thought I'd raise it.

At the moment we say Midazolam is considered a first line agent in palliative sedation therapy during the last weeks of life to alleviate intolerable suffering unresponsive to other treatments

Whilst this is true (and referenced), it seems to me it gives a misleading impression of how midazolam is typically used in end of life care.

Taking "palliative sedation" above as a synonym for "continuous deep sedation", ie rendering the patient unconscious when all else fails, it is true that midazolam is indeed the first line agent when this is necessary.

But a more common use in the end-stage of end-of-life care (as our page on end-of-life care discusses here) is in much lower doses, to manage psychological and/or nervous-system symptoms -- eg monoclonus, restlessness (eg thrashing, plucking, twitching), delirium, anguish -- rather than "intolerable suffering". (See for example page 15 of this sample hospital implementation template for the Liverpool Care Pathway (version 11, 2005). ).

A recent 2009 study of almost 4000 patients who had followed the LCP in 2008-9, sampled from three-quarters of hospitals in England, found that while 31% had received low doses of medication to control distress from agitation or restlessness, only 4% had required higher doses [ie full "palliative sedation"]. .

I'm not sure whether the study currently cited in this article drew that distinction, but it seems to me that it is a useful one; and we should therefore note routine use of midazolam at end-of-life that is not for continuous deep sedation. Jheald (talk) 12:35, 8 February 2010 (UTC)


 * Thank you Jheald, I appreciate feedback, I need input from people knowledgable about the use of midazolam in a medical environment to get this up to top notch. I have made some changes to the article, let me know your thoughts.-- Literature geek |  T@1k?  23:24, 8 February 2010 (UTC)

Where is the dosage information?
I was given Midazolam recently to sedate me, because I couldn't sleep. I was given 2.5 mg through IV. I didn't feel it at all. Six hours later, I was given another 5 mg through IV. I felt a little for about a minute, but it failed to put me to sleep. Finally, I was given 50 mg of Diphenhydramine. It knocked me out! I'm looking at the page to find out what the normal dosage for sedation is? I don't see any dosage information. Are the dosages I was given high? Oh, just in case you were wondering: I don't use drugs. Never have, never will.Highdrugtolerance (talk) 04:32, 31 August 2011 (UTC)
 * Wikipedia does not give dosage information... Doc James  (talk · contribs · email) 06:31, 31 August 2011 (UTC)

It's worth noting that Highdrugtolerance saying he doesn't use drugs is patently false; in the same breath he mentions imbibing a dose of drugs that was prescribed to him by a physician that I could see myself taking, illegally, just because I decided to do so, though for the same exact reasons. Difference is, I'm likely to know something about a regimen I've self-prescribed whereas Highdrugtolerance would rather defer all responsibility to an expert. People are a laugh riot sometimes. --TheRealDoctorJoe (talk) 21:41, 13 May 2014 (UTC)

History
"The benzodiazepine drug alprazolam was synthesised in 1976 from midazolam". No. 1. This is chemically impossible; 2. alprazolam was patented in 1969, long before midazolam. --FK1954 (talk) 19:29, 23 July 2012 (UTC)

Synthesis
http://www.chemdrug.com/databases/SYNTHESIS/SYN/09/09113102a.gif — Preceding unsigned comment added by 86.30.243.179 (talk) 08:12, 27 July 2012 (UTC)

Removal of recently added section on use of midazolam without consent during anaesthesia
Removed the section and its link to http://versedbusters.blogspot.com.au/ as it was not a credible source, and with respect, had more the character of a rant than a balanced, accurate discussion. The issue raised of patients not being properly informed about the action of midazolam is interesting and plausible, but I would suggest the author find better sources. Perhaps the proposed ethical issue could be the subject of a separate topic.58.173.244.129 (talk) 09:57, 26 June 2013 (UTC)

Use in capital punishment
the state of Florida recently used Midazolam as a replacement for pentobarbital in the execution of William Happ. It's use was controversial as this drug has not been properly tested for this use. — Preceding unsigned comment added by 143.166.255.115 (talk) 00:58, 17 October 2013 (UTC)
 * ditto Joseph Wood, 24/7/2014 in Arizona.

amnesia is good medicine?
This bland article is worded so as to obscure the different interests of patients and doctors. Inducing amnesia is convenient for doctors. Sometimes patients want it, sometimes they do not -- but as a practical matter they are seldom given the choice; they are usually unaware that there might be a choice. In many contexts, such as colonoscopies, this is a standard drug, and patients simply accept it as a presumed necessity.-71.174.175.150 (talk) 23:01, 8 December 2014 (UTC)

Capital punishment
The issue about capital punishment in the US is not of significant importance for the lead IMO and thus I removed "and with the last remaining manufacturer of phenobarbitol refusing to allow its use for that purpose, midazolam is one of the "three drug cocktail" pharmaceuticals used for executions by lethal injection" Doc James  (talk · contribs · email) 03:33, 19 August 2015 (UTC)

External links modified
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External links modified (January 2018)
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Use in prisons
It is interesting and relevant that one of the uses of Midazolam is in prisons to sedate prisoners and I don't know why it was removed.124.148.162.217 (talk) 11:06, 17 July 2018 (UTC)
 * The content that I removed was specific to one incident of use in one individual in one prison in Australia. Highlighting a single use such as this puts undue weight on the incident and isn't reflective of the general use of the drug as a whole.  See WP:UNDUE for details about why this type of thing is inappropriate content for an encyclopedia article.  -- Ed (Edgar181) 14:07, 17 July 2018 (UTC)
 * The content did not refer to that one incident and did not highlight "one incident of use in one individual in one prison in Australia", it stated only that Midazolam is used by law enforcement to sedate prisoners, which is an interesting use of the drug. The citation was about a specific incident yes but its use in the article was solely as a reference to support the text. 203.213.39.154 (talk) 01:49, 18 July 2018 (UTC)

Midazolam used in murder
Dateline episode The Good Husband (airdate 11/04/2016) discusses a murder where Midazolam was used. The victim was named Tom Kolman, and the coroner listed Kolman's cause of death as Midazolam overdose. The State believes Kolman was killed by family friend Gilberto Nunez. Nunez is a dentist that used Midazolam in his practice for anesthesia. Nunez was having an affair with Kolman's wife, but the wife ended the affair three days before the murder.

Also see A prominent New York dentist acquitted of murder after the death of his best friend faces more legal challenges.

Jeffrey Walton (talk) 08:45, 16 November 2019 (UTC)

Covid-19 / SARS-CoV-2 Nursing Homes
During the early stages of the Covid-19 pandemic (April 2000 onward) there was quite a lot of talk about the heavy use of Midazolam to sedate those senior citizens moved to nursing homes and care homes, particularly those released from hospital geriatric wards who were showing signs and symptoms of the Covid-19 virus. Care home staff and funeral directors have reported on this. During the earlier days of the Covid-19 "lock-downs", small independent and family run funeral directors contacted fellow (undertaker) businesses so they could cover for one-another should any become ill, and unable to provide or complete their service. It seems there was a common understanding that widespread, large doses of Midazolam were regularly used in care homes (on people already struggling with respiration). Though this was dismissed, (because undertakers do not have access to medical notes) disease control precautions were in place for known Covid-19 deaths. Also Undertakers talked with care home staff, as well as talking with bereaved as part of their normal (sympathetic and inquisitive) interactions - while talking about "the loved one". They were also aware that there were almost none of the usual "Post Shipman" checks being carried out (to prevent rogue doctors bumping off old folk). — Preceding unsigned comment added by 109.152.201.79 (talk) 21:36, 2 October 2021 (UTC) j

LCP used as citation
We are using the Liverpool care pathway a source. Since it was withdrawn with some controversy we might like another source:

Also the authors of this summary can't read:

^That is involuntary terminal sedation reported in an official enquiry. Talpedia (talk) 03:24, 1 March 2023 (UTC)

8
Use of benzodiazepine preceding Ketamine injection

Since it appears to this admitted novice in writing for Wikipedia I may be posting in the wrong place and using the wrong format, I apologize to the more acquainted with this procedure for any inconvenience my inexperience causes.

I want to suggest that with the slow but steady surge in the popularity of Ketamine for Major Depressive Disorders (as witnessed by Elon Musk's recent remarks about his use of the Ketamine enantiomer for treating his depressive events, and the FDA's approval of the enantiomer for resistant MDD), as a general anesthetic, and in chronic pain management, specific mention that IV injection of a benzodiazepine before IV injection of Ketamine or its enantiomer is - to the best of my knowledge, and personal experience on five occasions - required to avoid disruptive, and often violent, coming off Ketamine's effects on the patient.

From my multiple successful requests for Ketamine in surgery, I enthusiastically suggest that a conversation occur between the patient and the supervising physician to discuss if Ketamine therapy is the best general anesthetic for your procedure.

I have no personal experience with the Ketamine enantiomer for MDD, however, as cited above, the FDA approval and general citation in the public literature - with Musk's celebrity revelation - makes me believe Ketamine's use as a general anesthetic, a non-opioid agent for pain management, and an effective treatment for resistant MDD,  makes informing readers about these trends in Ketamine use a legitimate and respectable drug of choice, worthy of coverage by Wikipedia scholars, who far surpass my ability to write about the topic at a level far beyond any struggling effort I could contribute to this intellectual presentation.

Thank you in advance for your notice of this suggestion and thankfulness to those who selflessly give so much to make Wikipedia the Gold Standard for user-edited fonts of knowledge.

Kenneth E. Lamb (talk) 05:33, 2 April 2024 (UTC)