lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonApnoea.asthenia.coma.
disinhibition.euphoric mood.extrapyramidal symptoms.
hypothermia.memory loss.speech slurred.suicide
attempt.vision blurred
▶UncommonAllergic dermatitis.constipation.sexual
dysfunction
▶Rare or very rareAgranulocytosis.hyponatraemia.
pancytopenia.SIADH.thrombocytopenia
SPECIFIC SIDE-EFFECTS
▶Rare or very rare
▶With oral useSaliva altered
▶Frequency not known
▶With parenteral useLeucopenia
lBREAST FEEDINGBenzodiazepines are present in milk, and
should be avoided if possible during breast-feeding.
lHEPATIC IMPAIRMENTCan precipitate coma. Avoid in
severe impairment.
Dose adjustmentsStart with smaller initial doses or reduce
dose.
lRENAL IMPAIRMENT
Dose adjustmentsStart with small doses in severe
impairment.
lDIRECTIONS FOR ADMINISTRATIONForintravenous
injection, dilute with an equal volume of Sodium Chloride
0. 9 % (for neonates, dilute injection solution to a
concentration of 100 micrograms/mL). Give over
3 – 5 minutes; max. rate 50 micrograms/kg over 3 minutes.
lPATIENT AND CARER ADVICE
Driving and skilled tasksMay impair judgement and
increase reaction time, and so affect ability to drive or
operate machinery; they increase the effects of alcohol.
Moreover the hangover effects of a night dose may impair
driving on the following day.
Patients given sedatives and analgesics during minor
outpatient procedures should be very carefully warned
about the risks of undertaking skilled tasks (e.g. driving)
afterwards. For intravenous benzodiazepines the risk
extends toat least 24 hoursafter administration.
Responsible persons should be available to take patients
home afterwards. The dangers of takingalcoholshould be
emphasised.
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution, solution
for injection
Solution for injection
EXCIPIENTS:May contain Benzyl alcohol, propylene glycol
▶Ativan(Pfizer Ltd)
Lorazepam 4 mg per 1 mlAtivan 4 mg/ 1 ml solution for injection
ampoules| 10 ampouleP£ 3. 54 d
Tablet
CAUTIONARY AND ADVISORY LABELS2, 19
▶Lorazepam (Non-proprietary)
Lorazepam 1 mgLorazepam 1 mg tablets| 28 tabletP£ 6. 59 DT
=£ 3. 83 d
Lorazepam 2.5 mgLorazepam 2. 5 mg tablets| 28 tabletP
£ 11. 43 DT = £ 9. 14 d
eiiiiF 218Midazolam 21-Mar-2018
lINDICATIONS AND DOSE
Status epilepticus|Febrile convulsions
▶BY BUCCAL ADMINISTRATION
▶Neonate: 300 micrograms/kg, then 300 micrograms/kg
after 10 minutes if required.▶Child 1–2 months: 300 micrograms/kg (max. per dose
2. 5 mg), then 300 micrograms/kg after 10 minutes
(max. per dose 2. 5 mg) if required
▶Child 3–11 months: 2. 5 mg, then 2. 5 mg after 10 minutes
if required
▶Child 1–4 years: 5 mg, then 5 mg after 10 minutes if
required
▶Child 5–9 years: 7. 5 mg, then 7. 5 mg after 10 minutes if
required
▶Child 10–17 years: 10 mg, then 10 mg after 10 minutes if
required
▶INITIALLY BY INTRAVENOUS INJECTION
▶Neonate:Initially 150 – 200 micrograms/kg, followed by
(by continuous intravenous infusion)
60 micrograms/kg/hour, (by continuous intravenous
infusion) increased in steps of 60 micrograms/kg/hour
every 15 minutes (max. per dose
300 micrograms/kg/hour) until seizure controlled.▶Child:Initially 150 – 200 micrograms/kg, followed by (by
continuous intravenous infusion)
60 micrograms/kg/hour, (by continuous intravenous
infusion) increased in steps of 60 micrograms/kg/hour
every 15 minutes (max. per dose
300 micrograms/kg/hour) until seizure controlled
Conscious sedation for procedures
▶BY MOUTH
▶Child: 500 micrograms/kg (max. per dose 20 mg), to be
administered 30 – 60 minutes before procedure
▶BY BUCCAL ADMINISTRATION
▶Child 6 months–9 years: 200 – 300 micrograms/kg (max.
per dose 5 mg)
▶Child 10–17 years (body-weight up to 70 kg): 6 – 7 mg
▶Child 10–17 years (body-weight 70 kg and above): 6 – 7 mg
(max. per dose 8 mg)
▶BY RECTUM
▶Child 6 months–11 years: 300 – 500 micrograms/kg, to be
administered 15 – 30 minutes before procedure
▶BY INTRAVENOUS INJECTION
▶Child 1 month–5 years:Initially 25 – 50 micrograms/kg, to
be administered over 2 – 3 minutes, 5 – 10 minutes
before procedure, dose can be increased if necessary in
small steps to maximum total dose per course;
maximum 6 mg per course
▶Child 6–11 years:Initially 25 – 50 micrograms/kg, to be
administered over 2 – 3 minutes, 5 – 10 minutes before
procedure, dose can be increased if necessary in small
steps to maximum total dose per course; maximum
10 mg per course
▶Child 12–17 years:Initially 25 – 50 micrograms/kg, to be
administered over 2 – 3 minutes, 5 – 10 minutes before
procedure, dose can be increased if necessary in small
steps to maximum total dose per course; maximum
7. 5 mg per course
Premedication
▶BY MOUTH
▶Child: 500 micrograms/kg (max. per dose 20 mg), to be
taken 15 – 30 minutes before the procedure
▶BY RECTUM
▶Child 6 months–11 years: 300 – 500 micrograms/kg, to be
administered 15 – 30 minutes before induction
Induction of anaesthesia (but rarely used)
▶BY SLOW INTRAVENOUS INJECTION
▶Child 7–17 years:Initially 150 micrograms/kg (max. per
dose 7. 5 mg), dose to be given in steps of
50 micrograms/kg (max. 2. 5 mg) over 2 – 5 minutes; wait
for 2 – 5 minutes before subsequent dosing, then
50 micrograms/kg every 2 minutes (max. per dose
2. 5 mg) if required; maximum 500 micrograms/kg per
course; maximum 25 mg per course continued→BNFC 2018 – 2019 Status epilepticus 223
Nervous system4