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Midazolam for rapid tranquillisation: its place in practice

Published online by Cambridge University Press:  11 February 2014

Caroline Parker
Caroline Parker*
Affiliation:
Consultant Pharmacist, Adult Mental Health, Central and North West London NHS Foundation Trust
*
Correspondence to: Dr Caroline Parker, CNWL NHS Foundation Trust, Pharmacy, St Charles Mental Health Unit, Exmoor St, London, W10 6DZ. E-mail: [email protected]
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Abstract

Benzodiazepines are mainstay medicines in rapid tranquillisation. Midazolam is a short acting benzodiazepine. It is not available for oral administration as this route of administration leads to poor bioavailability. It has recently become available in a new formulation specifically designed for buccal administration, and is also available as a solution for injection.

The absorption of intramuscular midazolam is erratic and it has an unpredictable propensity for causing profound oversedation. Healthcare providers who include IM midazolam in their rapid tranquillisation guidelines or policies need to ensure that clinicians using it have the necessary knowledge, skills and competencies surrounding its use including clinical sequelae and the use of the ‘antidote’ flumazenil.

This brief review describes midazolam's potential role in rapid tranquillisation via these routes, and discusses the risks and benefits of these options in order to help readers consider their places in regular clinical practice, particularly in light of the shortage of lorazepam injection.

Keywords

Rapid tranquillisationmidazolambuccalintramuscular
Type
Review Articles
Information
Journal of Psychiatric Intensive Care , Volume 11 , Issue 1 , April 2015 , pp. 66 - 72
Copyright
Copyright © NAPICU 2014 

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