Midazolam: What It Is And How It Works

Very short-acting benzodiazepine, midazolam is an anxiolytic that is also useful as a sedative. Its excessive use can generate dependency.

Midazolam is a drug that belongs to the extensive family of benzodiazepines. At present, these types of drugs are used to treat anxiety states as they have anxiolytic, sedative and muscle relaxant actions.

Benzodiazepines act on receptors for GABA, an inhibitory neurotransmitter in the central nervous system. GABA is characterized by having a calming effect on the body, reducing stress and activating it.

What are the characteristics of midazolam?

Midazolam is a benzodiazepine with a very short half-life. This means that the time it remains in the body fulfilling its functions is short (less than 6 hours). For this reason it is used many times to induce anesthesia but intravenously.

In these cases, it is important to administer midazolam carefully and slowly to avoid the appearance of adverse effects. They must be taken into account:

• Clinical needs.
• The physical state of the patient.
• Age.
• Other drugs the patient may be taking.

Like the rest of the benzodiazepines, it has a strong anxiolytic action that is useful for the management of anxiety. Midazolam reduces the time of onset of sleep, increases its duration and decreases the number of nighttime interruptions (wakefulness).

In addition, it is also a valuable option in various therapies as it has hypnotic, anticonvulsant and muscle relaxant effects.

Adverse reactions of midazolam

In general, benzodiazepines are well-tolerated and safe drugs. Problems appear when they are taken for periods of time that exceed three months.

Thus, midazolam is a drug that should always be used with care. It is capable of crossing the placental barrier and part of it can be excreted in breast milk, so special care should be taken in pregnant women. Some of the side effects that appear more frequently after the administration of midazolam are the following:

• Nausea, vomiting, and rashes.
• Agitation and restlessness.
• Tremors or stiffness
• Aggressiveness.
• Drowsiness, confusion, amnesia, and impaired coordination.

Tolerance and dependence on benzodiazepines

Midazolam, like the rest of the benzodiazepines, leads to tolerance and dependence. This means that each time it is necessary to administer a higher dose of the drug to achieve the desired effect.

In addition, the strong dependence that appears means that over time the patient is not able to fall asleep without the use of this drug. It is recommended to gradually withdraw benzodiazepines, gradually decreasing the dose.

Abrupt cessation of midazolam treatment after weeks or months causes a rebound effect of anxiety, tremors and even dizziness and sleep disturbances. This is why you should always notify your doctor when you want to stop taking this drug.

How to stop benzodiazepine treatment?

Before reducing or suspending the administration of this type of medication, you should first discuss it with your doctor. This step is very important because he will be the one to help you choose the way to carry it out or the alternatives that you can use to achieve it. Once agreed with your doctor, some of the points to take into account are the following:

• Seek appropriate psychological support.

• You must be confident that you are going to succeed, trying to maintain a positive frame of mind.

• Always carry out a slow and gradual withdrawal of the medicine. This aspect varies completely from one person to another.

• Switch to a long-acting benzodiazepine like diazepam. This fact will allow the reduction of the drug in the body to be much more gradual.

• Once the process is advanced, a gradual replacement by other substances that cause less dependence such as valerian or melatonin can be tried.