Midazolam (, marketed in English-speaking countries and Mexico under the trade names Dormicum, Hypnovel, and Versed,) is a short-acting drug in the benzodiazepine class developed by Hoffmann-La Roche in the 1970s. The drug is used for treatment of acute seizures, moderate to severe insomnia, and for inducing sedation and amnesia before medical procedures. It possesses profoundly potent anxiolytic, amnesic, hypnotic, anticonvulsant, skeletal muscle relaxant, and sedative properties. Midazolam has a fast recovery time and is the most commonly used benzodiazepine as a premedication for sedation; less commonly, it is used for induction and maintenance of anesthesia. Administration of midazolam by the intranasal or the buccal route as an alternative to rectally administered diazepam is becoming increasingly popular for the emergency treatment of seizures in children. Midazolam is also used for endoscopy procedural sedation and sedation in intensive care. The anterograde amnesia property of midazolam is useful for premedication before surgery to inhibit unpleasant memories. Midazolam, like many other benzodiazepines, has a rapid onset of action, high effectiveness, and low toxicity level. Drawbacks of midazolam include drug interactions, tolerance, and withdrawal syndrome, as well as adverse events including cognitive impairment and sedation. Paradoxical effects occasionally occur, most commonly in children and the elderly, particularly after intravenous administration. It is on the WHO Model List of Essential Medicines, the most important medications needed in a basic health system. The drug has recently been hastily introduced for use in executions by lethal injection in the USA in combination with other drugs, after pentobarbital’s manufacturer disallowed that drug’s use for this purpose. Florida used midazolam to execute William Happ in October 2013 and Ohio used it to execute Dennis McGuire in January 2014. Flumazenil, a benzodiazepine antagonist drug, can be used to treat an overdose of midazolam, as well as to reverse sedation. However, flumazenil can trigger seizures in mixed overdoses and in benzodiazepine-dependent individuals, so is not used in most cases.
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