Intranasal Midazolam Administration

Uses

Handling

For more information

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Uses

How should I take or use Intranasal Midazolam Administration?

Note: Ensure nose is not blocked prior to administration of midazolam

Step 1:

Remove blunt needle cover

(Do not dispose blunt needle cover)

Assemble the blunt needle and the syringe as shown in this picture

Step 4:

Place the assembled needle and syringe into the ampoule as shown
Withdraw the prescribed volume of solution
Hold the syringe upright with nozzle facing up against the light to check that the solution is clear
Expel trapped air if present. Withdraw midazolam again if volume falls below prescribed
Cap the blunt needle once the required volume has been withdrawn
Remove the capped needle

Step 2:

Gently swirl the Midazolam ampoule (15mg/3mL) until all the solution is at the bottom as shown in the picture on the right
The solution should be clear; do not use if cloudy.

Step 5:

Assemble the atomizer to the syringe as shown

Step 3:

Hold the bottom part of the ampoule between the thumb and first finger of one hand.
Ensure that the spot on the ampoule is facing away from you
If possible, cover the top of the ampoule with a tissue or towel before holding the top between the thumb and first finger of your other hand.
Snap the top of the ampoule off by pushing away from the side with the spot (in the direction of the arrow).

Step 6:

Lie the child on a flat surface
Place the assembled atomizer and the syringe firmly on the nostril
Press the plunger of the syringe quickly to administer about half of the volume as atomised spray into a nostril
Move the device over to the opposite nostril and administer the remaining medication into that nostril

Intranasal midazolam dosing chart

Volume of midazolam = dose volume + 0.1 ml (atomizer dead space).
Patient age in months	Weight	Dose	* Volume (5mg/ml)
1 month to 5 months old	6 kg	1.2 mg	0.3 ml
6 month old and older	6.1 to 8 kg	1.6 mg	0.4 ml
	8.1 to 10 kg	2 mg	0.5 ml
	10.1 to 14 kg	3 mg	0.7 ml
	14.1 to 20 kg	4.2 mg	0.9 ml
	20.1 to 28 kg	6 mg	1.3 ml
	28.1 to 35 kg	8.4 mg	1.8 ml
Teenager or adult	35.1 kg or more	10 mg	2 ml

* Volume is based on the calculated dose plus 0.10 ml dead space in the device

For children 1 month to 5months old, intranasal midazolam is dosed at 0.2mg/kg/dose.

For children of 6 month old to adults, intranasal midazolam is dosed at 0.2 – 0.3mg/kg/dose. Max of 10mg/dose.

Handling

How should I store Intranasal Midazolam Administration?

Keep away from children
Keep in a cool, dry place, away from direct sunlight

For more information

What else should I know about Intranasal Midazolam Administration?

Maintenance of accessories:

To flush accessories (atomizer, blunt needle and syringe) with water after use
Dry them thoroughly
Store them together with the midazolam ampoules (15mg/3mL) in a cool dry place, away from sunlight

Note: Accessories are only available for purchase at outpatient pharmacy during office hours only

Other Languages

Intranasal Midazolam Administration in English

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Disclaimers

Please take note that the above is not a complete list of all possible side effects. If you have any concerns about your medication or if you have other side effects that you think are caused by this medication, please consult your doctor or pharmacist.

If you take more than the recommended dose, please seek medical advice immediately. The information provided on this page does not replace information from your healthcare professional. Please consult your healthcare professional for more information.

This article is jointly developed by members of the National Medication Information workgroup. The workgroup consists of cluster partners (National Healthcare Group, National University Health System, and SingHealth), community pharmacies (Guardian, Unity, and Watsons), and the Pharmaceutical Society of Singapore. The content does not reflect drug availability and supply information in pharmacies and healthcare institutions. You are advised to check with the respective institutions for such information.