Midazolam 299people have suffered crippling brain damage or death from respiratory arrest
caused by the drug while a medical procedure was being performed. Respi-
ratory emergencies have also occurred from oral dosage. Midazolam is not
recommended for persons suffering from breathing trouble. Nonetheless, de-
spite the drug’s potential hazards, examination of 5,439 records of patients
receiving the drug at one hospital revealed only 3 instances of respiratory
arrest. Examination of 9,842 medical records of persons who received mida-
zolam in 14 hospitals did not reveal serious respiratory events caused by the
drug; indeed, the study concluded that people were more likely to die from
diazepam. That conclusion, of course, was based on administration of the
drugs in a medical setting, not misuse on the street.
A rat study found the drug to have “minimal” ability to cause brain dam-
age, and then only in older rats, even after four months of daily dosing. In a
subsequent and related report investigators stated flatly that the drug does
not cause brain damage, although once again slight differences were observed
when older rats were compared to others.
Researchers have noted that midazolam harms white blood cells. Other un-
wanted effects include headache, coughing and hiccups, nausea, and vomit-
ing. Less commonly, the drug can prompt euphoria, hallucinations, tremor,
rapid heartbeat, discomposure, and aggression. Two researchers tracking vi-
olent deaths in Finland concluded that the drug was found in victims more
often than would be expected through chance occurrence. Hallucinations by
surgical patients have occurred often enough and can be realistic enough (such
as patients perceiving imaginary sexual assault by medical personnel) that
medical staff have been advised to have someone witness all contact with
patients receiving the drug.
Midazolam lengthens reaction times, although two experiments found that
users performed normally 4 hours after a dose such as a patient would receive
for outpatient surgery. Those findings are supported by other studies as well,
including one using test equipment to measure performance of commercial
airline pilots. Nonetheless, persons are supposed to avoid activity requiring
careful vigilance (such as driving) for at least 24 hours after taking midazolam.
A small study found that a dose of midazolam produces higher blood levels
of the drug and lasts longer in ethnic Mexicans than in ethnic whites.
Abuse factors.Among monkeys dependence has been established with the
drug after 5 to 10 weeks of steady dosage. Sudden cessation of dosage can
provoke a withdrawal syndrome: perspiration, tremors and cramps, vomiting,
convulsions, and hallucinations. The syndrome can be avoided by gradually
reducing drug use instead of stopping all at once. Some researchers believe
tolerance has been demonstrated. The substance is considered to have at least
the same addiction potential as diazepam, which is three or four times weaker
than midazolam.
Drug interactions.In some circumstances midazolam can lower blood pres-
sure drastically and cause seizures; administering the drug withfentanylor
other opiates can increase the likelihood of such severe actions. Rat experi-
ments unexpectedly found that the stimulantcaffeineboosts difficulties in
movement caused by midazolam, andcocainealso worsened that perfor-
mance. Opiates oralcoholcan deepen some midazolam effects in humans,