Intranasal Midazolam Administration

Uses

Handling

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Uses

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

Step 1:

(Do not dispose blunt needle cover)

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Cap the blunt needle once the required volume has been withdrawn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:

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.

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