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Intranasal Midazolam Administration

Drug Class: Commonly Known As: Category:
Benzodiazepines Adult, Children

Intranasal Midazolam Administration - What is it for

Intranasal Midazolam Administration - Side Effects, Precautions, and Contraindications

What side effects can Intranasal Midazolam Administration cause?

Before taking Intranasal Midazolam Administration, what precautions must I follow?

What food or medicine must I avoid when I take Intranasal Midazolam Administration?

Intranasal Midazolam Administration - Dosage and How to Use

How should Intranasal Midazolam Administration be used?

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  • Cap the blunt needle once the required volume has been withdrawn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

WeightDose* Volume (5mg/ml)
​1 month to 5 months old​6 kg​1.2 mg0.3 ml​
​6 month old and older ​6.1 to 8 kg ​1.6 mg0.4 ml​
8.1 to 10 kg​2 mg​0.5 ml​
​10.1 to 14 kg3 mg​​0.7 ml
​14.1 to 20 kg4.2 mg​​0.9 ml
​20.1 to 28 kg6 mg​​1.3 ml
​28.1 to 35 kg8.4 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.

What should I do if I miss a dose?

What should I do if I overdose?

Intranasal Midazolam Administration - Handling and Storage

How should I handle Intranasal Midazolam Administration safely?

How should I store Intranasal Midazolam Administration?

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

How should I dispose of Intranasal Midazolam Administration safely?

Intranasal Midazolam Administration - Additional Information

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

  • Updated on Wednesday, August 16, 2017
  • This article is contributed by Department of Pharmacy KK Women's and Children's Hospital

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