Midazolam

Registered South African indications:

1mg/ml

• Basal sedation before diagnostic or surgical interventions carried out under local anaesthesia
• Pre-medication before induction of anaesthesia
• Induction of anaesthesia, as an induction medicine in inhalation anaesthesia or a sleep-inducing component in combined anaesthesia, including total intravenous anaesthesia
• Maintenance of anaesthesia where subsequent ICU administration with ventilation is envisaged for the purpose of recovery and stabilisation
• Long-term sedation in intensive care units

5mg/ml

• Conscious (basal) sedation before diagnostic or therapeutic procedures with, or without, local anaesthesia
• Anaesthesia
  - Premedication before induction of anaesthesia, as part of a balanced technique
  - Induction and maintenance of anaesthesia
  - As an induction agent in adults in inhalation anaesthesia or a sedative component in combined anaesthesia, including total intravenous anaesthesia
• Sedation in intensive care units
  - Long-term sedation in intensive care units

Contraindications

South African recommendations

1mg/ml injection

• Hypersensitivity to midazolam, benzodiazepines or to any of the excipients
• Conscious sedation in patients with severe respiratory insufficiency or acute respiratory depression
• Pregnancy
• Breastfeeding

5mg/ml injection & infusion

• Known hypersensitivity to midazolam or any medicine from the benzodiazepines group or to any excipient within the medicine
• Myasthenia gravis
• Severe hepatic impairment
• Respiratory insufficiency
• Sleep apnoea syndrome
• Pregnancy
• Lactation

Recommendations in other jurisdictions

• Hypersensitivity to benzodiazepines or to any of the excipients
• Conscious sedation in patients with severe respiratory failure or acute respiratory depression

Cautions

• Pregnancy (Recommendations in other jurisdictions)
• Breastfeeding (Recommendations in other jurisdictions)
• Renal impairment
• Hepatic impairment (1mg/ml) (South African recommendations)
• Mild to moderate hepatic impairment (5mg/ml) (South African recommendations)
• Mild to moderate hepatic impairment (Recommendations in other jurisdictions)
• Elderly
• Inexperienced physician
• Rapid IV injection
• High dosages
• Long-term sedation
• Chronically ill or debilitated patients
• Chronic respiratory insufficiency
• Impaired cardiac function
• Low cardiac output
• Myasthenia gravis
• History of alcohol or drug abuse
• Abrupt withdrawal
• Paediatric patients younger than 6 months
• Paediatric patients especially those with cardiovascular instability
• Preterm and former preterm non intubated patients
• May impair ability to drive and operate machinery

Forms avail. in SA and covered in this monograph: inj, inf

Dosages below include:

• South African registered indications and dosages

South African registered indications and dosages

1mg/ml

Basal sedation

• IV: 1mg, given as a slow injection over 30sec; Takes effect 2min post injection

Basal sedation in diagnostic or surgical interventions carried out under local anaesthesia

• IV: Initial: 2.5mg (0.04mg/kg), 5-10min before the beginning of the procedure; Further doses of 1mg, may be given when necessary; A total dose >5mg is not usually necessary to reach the desired endpoint

Pre-medication before induction of anaesthesia (before an operation)

• IM: 0.07-0.1mg/kg body weight, according to the general condition of the patient, administered into a large muscle mass 30-60min before induction of anaesthesia; Usual dose: 5mg

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Premedication with midazolam shortly before a procedure produces sedation (induction of sleepiness or drowsiness and relief of apprehension), and pre-operative impairment of memory

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Induction of anaesthesia

• IV: Approx. 2.5mg, given as a slow injection over 10sec for induction of anaesthesia; Desired level of anaesthesia is reached by stepwise titration; Titrate by ≤5mg, given as a slow injection over 20-30sec at intervals of 2min between successive increments; In pre-medicated patients: Dose range: 10-15mg (0.15-0.2mg/kg); Sufficiently deep level of sleep is generally achieved after 2-3 min; In non-pre-medicated patients: Dose requirement may be higher: 0.3-0.35mg/kg body weight

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In pre-medicated patients a total dose greater than 15mg is usually not necessary. In non-pre-medicated patients a total dose greater than 20mg is usually not necessary

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Maintenance of anaesthesia (Additional agent(s) required)

• IV: 0.03-0.1mg/kg/hr, given as an infusion when used in combination with narcotics or ketamine

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In high-risk surgical patients, lower maintenance doses will be required

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Midazolam is a potent sedative medicine, requiring slow administration and individualised dosing. The dose should be individualised and titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication

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Sedation in intensive care units (ICU)

• IV: Individualised dosages; Loading dose: 0.03-0.3mg/kg, given slowly in increments; For each increment: Titrate by 1-2.5mg, given over 20-30sec at intervals of 2min between successive increments; Maintenance dose range: 0.03-0.2mg/kg/hr

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The desired level of sedation is reached by stepwise titration of midazolam, followed by either continuous infusion, or intermittent bolus

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For sedation in ICU, the dosage should be individualised and midazolam 1mg/ml titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication

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A total dose greater than 15mg is usually not necessary. The loading dose should be reduced or omitted in hypovolaemic, vasoconstricted or hypothermic patients

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In hypovolaemic, vasoconstricted or hypothermic patients, the maintenance dose should be reduced, at times to as low as 25% of the usual dose. The level of sedation should be assessed regularly if permitted by the patient's condition

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5mg/ml

Conscious (basal) sedation before diagnostic or therapeutic procedures with, or without, local anaesthesia

• IV: Initial: 2.5mg, given as a slow injection at a rate of 1mg/30sec, 5-10min before the beginning of the procedure; Further doses of 1mg, may be given when necessary; Takes effect in about 2min after the injection has been given; Mean time to maximum effect is 2.4min; Total dose: 3.5-7.5mg

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A total dose >5mg is not usually necessary to reach the desired endpoint

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Midazolam requires slow administration and individualisation of dosage. The dose should be titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication

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Anaesthesia premedication before induction of anaesthesia, as part of a balanced technique (Additional agent may be required)

• IM: 0.07-0.1mg/kg bodyweight, according to general condition of the patient 20-60min before induction of anaesthesia; Usual dose: 5mg

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Premedication with midazolam given shortly before a procedure produces sedation (induction of sleepiness or drowsiness and relief of apprehension), and pre-operative impairment of memory. Midazolam may be administered in combination with anticholinergics

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Induction of anaesthesia (Additional agents may be required)

• IV: Desired level of anaesthesia is reached by stepwise titration; Titrate by ≤5mg, given as a slow injection over 20-30sec at intervals of 2min between successive increments; In non-pre-medicated patients: Dose requirement may be higher: 0.3-0.35mg/kg body weight given as a slow injection over 20-30sec allowing 2min for effect; To complete induction if needed: Titrate by approx. 25% of the patient’s initial dose OR Induction may instead be completed with volatile liquid inhalation anaesthetics; In resistant patients: Total dose of up to 0.6mg/kg may be used for induction

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Large doses of up to 0.6mg/kg may prolong recovery

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If midazolam is used for induction of anaesthesia before other anaesthetic agents have been administered, the individual response is variable. The dose of all the agents should be titrated to the desired effect, at times as low as 25% of the usual initial dose of the individual agents

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Maintenance of anaesthesia

• IV: 0.03-0.1mg/kg, given as intermittent small IV doses OR 0.03-0.1mg/kg/hr, given as a continuous infusion typically in combination with analgesics; Dose and the interval between doses vary according to the patient's individual reaction

Sedation in intensive care units (ICU)

• IV: Loading dose: 0.03-0.3mg/kg, given slowly in increments; For each increment: Titrate by 1-2.5mg, given over 20-30sec at intervals of 2min between successive increments; Maintenance dose range: 0.03-0.2mg/kg/hr

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The IV loading dose can range from 0.03-0.3mg/kg, but a total dose greater than 15mg is usually not necessary. The loading dose should be reduced or omitted in hypovolaemic, vasoconstricted or hypothermic patients

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When midazolam is given with potent analgesics, the latter should be administered first so that sedative effects of midazolam can safely be titrated on top of any sedation caused by the analgesic

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In hypovolaemic, vasoconstricted or hypothermic patients the maintenance dose should be reduced, at times to as low as 25% of the usual dose. The level of sedation should be assessed regularly if the patient's condition permits

Paed. forms avail. in SA and covered in this monograph: inj, inf

Dosages below include:

• South African registered indications and dosages

South African registered indications and dosages

1mg/ml

Pre-medication before induction of anaesthesia (before an operation)

• Younger than 1 year: No information available
• Between 1-15 years: IM: 0.08-0.2mg/kg body weight, into a large muscle mass 30-60min before induction of anaesthesia

---

Premedication with midazolam shortly before a procedure produces sedation (induction of sleepiness or drowsiness and relief of apprehension), and pre-operative impairment of memory

---

Proportionately higher doses are required than in adults in relation to bodyweight

---

5mg/ml

Conscious (basal) sedation before diagnostic or therapeutic procedures with, or without, local anaesthesia

IV

• Younger than 6 months*: Limited information is available in non-intubated paediatric patients less than 6 months of age
• Between 6 months - 5 years: Initial dose: 0.05-0.1mg/kg, given slowly over 2-3min; Wait an additional 2-3min to fully evaluate the sedative effect before initiating a procedure or repeating dose; If further sedation is necessary, continue to titrate with small increments until the appropriate level of sedation is achieved; Total dose up to 0.6mg/kg may be necessary to reach the desired endpoint; Total dose: ≤6mg
• Between 6-12 years: Initial dose: 0.025-0.05mg/kg, given slowly over 2-3min; Wait an additional 2-3min to fully evaluate the sedative effect before initiating a procedure or repeating dose; If further sedation is necessary, continue to titrate with small increments until the appropriate level of sedation is achieved; Total dose of up to 0.4mg/kg; Total dose: <10mg
• Between 12-16 years: See adult dosage

IM

• Between 1-15 years: 0.1-0.15mg/kg, given 5-10 min before the start of the procedure; For more anxious patients: Up to 0.5mg/kg may be given; A total dose greater than 10mg is not usually necessary

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*Limited information is available in non-intubated paediatric patients less than 6 months of age. These patients are particularly vulnerable to airway obstruction and hypoventilation, therefore titration with small increments to the clinical effect and careful monitoring are essential

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For conscious sedation prior to diagnostic or surgical intervention, midazolam is administered IV. The dose must be individualised and titrated, and should not be administered by rapid or single bolus injection. If necessary, subsequent doses may be administered according to the individual need

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Midazolam should be titrated slowly to the desired clinical effect. Infants and young children <5 years of age may require substantially higher doses (mg/kg) than older children and adolescents

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IV administration in paediatric patients less than 6 months of age is not recommended with exception in ICU as they are vulnerable to airway obstruction and hypoventilation

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Pre-medication before induction of anaesthesia (before an operation)

• Younger than 1 year: No information available
• Between 1-15 years: IM: 0.08-0.2mg/kg, administered into a large muscle mass 30-60min before induction of anaesthesia

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Premedication with midazolam shortly before a procedure produces sedation (induction of sleepiness or drowsiness and relief of apprehension), and pre-operative impairment of memory

---

Proportionally higher doses are required than in adults in relation to bodyweight

---

Midazolam is not recommended for the induction of anaesthesia in children, as experience is limited

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Maintenance of anaesthesia (Additional agent required)

• IM: 0.15-0.2mg/kg, when receiving ketamine for anaesthesia (ataralgesia); A sufficiently deep level of sleep is generally achieved after 2-3min

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Midazolam is a potent sedative medicine, requiring slow administration and individualised dosing. The dose should be individualised and titrated to the desired state of sedation according to the clinical need, physical status, age and concomitant medication

---

In high-risk surgical patients, lower maintenance doses will be required

---

Sedation in intensive care units (ICU)

• Neonates younger than 32 weeks gestational age: IV: 0.03mg/kg/hr (0.5µg/kg/min), given as a continuous infusion
• Neonates older than 32 weeks gestational age - 6 months: 0.06mg/kg/hr (1µg/kg/min), given as a continuous infusion

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Intravenous loading doses should not be used in neonates, rather the infusion may be run more rapidly for the first several hours to establish therapeutic plasma levels. The rate of infusion should be carefully and frequently reassessed, particularly after the first 24 hours so as to administer the lowest possible effective dose and reduce the potential for medicine accumulation

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Careful monitoring of respiratory rate and oxygen saturation is required

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• Older than 6 months: Loading dose: 0.05-0.2mg/kg, given slowly over ≥2-3min to establish the desired clinical effect; Followed by: 0.06-0.12mg/kg/hr (1-2µg/kg/min), given as a continuous infusion; Rate of infusion can be increased or decreased (generally by 25% of the initial or subsequent infusion rate) as required OR supplemental IV doses of midazolam can be administered to increase or maintain the desired effect

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When initiating an infusion with midazolam in haemodynamically compromised patients, the usual loading dose should be titrated in small increments and the patient monitored for haemodynamic instability, e.g., hypotension. These patients are also vulnerable to the respiratory depressant effects of midazolam and require careful monitoring of respiratory rate and oxygen saturation

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In preterm newborn infants, and paediatrics less than 15kg of body weight, midazolam solutions with concentrations higher than 1mg/ml are not recommended. Higher concentrations should be diluted to 1mg/ml

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IV administration in paediatric patients less than 6 months of age is not recommended with exception in ICU as they are vulnerable to airway obstruction and hypoventilation. Midazolam is not indicated in children in induction of anaesthesia and as a sedative component in combined anaesthesia as limited data is available

Pregnancy

South African recommendations

1mg/ml

• Contraindicated
• Safety in pregnancy has not been established. Midazolam has been shown to cross the placenta and enter foetal circulation
• Insufficient data are available on midazolam to assess its safety during pregnancy
• Animal studies do not indicate a teratogenic effect, but fetotoxicity was observed as with other benzodiazepines. No data on exposed pregnancies are available for the first two trimesters of pregnancy
• The administration of high doses of midazolam in the last trimester of pregnancy, during labour or when used as an induction medicine of anaesthesia for caesarean section has been reported to produce maternal or foetal adverse effects (inhalation risk in mother, irregularities in the foetal heart rate, hypotonia, poor sucking, hypothermia and respiratory depression in the neonate)
• Infants born from mothers who received benzodiazepines chronically during the latter stage of pregnancy may have developed physical dependence and may be at some risk of developing withdrawal symptoms in the postnatal period. The risk for neonates should be considered in case of administration of midazolam for any surgery near the term

5mg/ml

• Contraindicated
• Midazolam has been shown to cross the placenta and to enter foetal circulation. Insufficient data is available on midazolam to assess its safety during pregnancy
• Benzodiazepines, including midazolam, should be avoided in pregnancy unless there is no safer alternative. An increased risk of congenital malformation associated with the use of midazolam during the first trimester of pregnancy may occur
• If administered during the last three months of pregnancy, or during labour, effects on the neonate such as irregularities in the foetal heart rate, hypothermia, hypotonia, poor sucking and moderate respiratory depression can be expected
• Infants born to mothers who took benzodiazepines chronically during the latter stages of pregnancy may have developed physical dependence and may be at some risk of developing withdrawal symptoms in the postnatal period

Recommendations in other jurisdictions

• Caution; not recommended
• Insufficient data are available on midazolam to assess its safety during pregnancy. Animal studies do not indicate a teratogenic effect, but foetotoxicity was observed as with other benzodiazepines
• No data on exposed pregnancies are available for the first two trimesters of pregnancy. It has been suggested that the use of benzodiazepines during the first trimester of pregnancy is associated with an increased risk of congenital abnormalities
• The administration of high doses of midazolam in the last trimester of pregnancy, during labour or when used as an induction agent of anaesthesia for caesarean section has been reported to produce maternal or foetal adverse effects (inhalation risk in mother, irregularities in the foetal heart rate, hypotonia, poor sucking, hypothermia and respiratory depression in the neonate)
• Moreover, infants born from mothers who received benzodiazepines chronically during the latter stage of pregnancy may have developed physical dependence and may be at some risk of developing withdrawal symptoms in the postnatal period
• Consequently, midazolam should not be used during pregnancy unless clearly necessary. It is preferable to avoid using it for caesarean
• The risk for neonate should be taken into account in case of administration of midazolam for any surgery near the term

Breastfeeding

South African recommendations

1mg/ml

• Contraindicated
• Midazolam passes in low quantities into breast milk. Breastfeeding mothers should be advised to discontinue breastfeeding for 24 hours following administration of midazolam

5mg/ml

• Contraindicated
• Midazolam is excreted in breast milk. Do not use during lactation

Recommendations in other jurisdictions

• Caution; not recommended
• Midazolam passes in low quantities into breast milk. Breastfeeding mothers should be advised to discontinue breastfeeding for 24 hours following administration of midazolam

Fertility

• Animal studies did not show an impairment of fertility

Renal Impairment

• Caution; no dose adjustment recommended
• In severe renal impairment (CrCl <30ml/min) midazolam may be accompanied by more pronounced and prolonged sedation including clinically relevant respiratory and cardiovascular depression. Midazolam should therefore be dosed carefully in this patient population and titrated for the desired effect

Hepatic Impairment

South African recommendations

1mg/ml

• Caution; no dose adjustment recommended
  The elimination half-life in patients with cirrhosis can be prolonged, and the clearance, shorter than in healthy test subjects

5mg/ml

• Mild to moderate: Caution; dose adjustment recommended
  Hepatic impairment reduces the clearance of IV midazolam with a subsequent increase in terminal half-life
  The clinical effects in patients with hepatic impairment may be stronger and prolonged. In patients with mild to moderate hepatic impairment the dose of midazolam may have to be reduced and vital signs should be monitored
• Severe: Contraindicated
  Patients with severe hepatic impairment should not be treated with midazolam

Recommendations in other jurisdictions

• Caution; dose adjustment recommended
  Hepatic impairment reduces the clearance of IV midazolam with a subsequent increase in terminal half-life
  Therefore the clinical effects in patients with hepatic impairment may be stronger and prolonged. The required dose of midazolam may have to be reduced and proper monitoring of vital signs should be established
  Benzodiazepines may precipitate or exacerbate encephalopathy in patients with severe hepatic impairment

Elderly

South African recommendations

• >60 years: Caution; dose adjustment recommended
  
  1mg/ml
  For basal sedation in diagnostic or surgical interventions carried out under local anaesthesia: Initial: 1-1.5mg, given over 5-10min before the beginning of a procedure;  Further doses of 0.5-1mg, may be given when necessary; Total doses greater than 3.5mg are not usually necessary
  Pre-medication before an operation: IM: 0.025 – 0.05mg/kg body weight; Usual dose: 2-3mg
  Induction of anaesthesia: Lower doses will be required
  Maintenance of anaesthesia: Lower maintenance doses will be requires
  
  5mg/ml
  Conscious (basal) sedation before diagnostic or therapeutic procedures with, or without, local anaesthesia (IV administration): Initial and further doses must be halved; Additional midazolam should be titrated very slowly and carefully; Total dose of >3.5mg is not usually necessary
  Anaesthesia induction: IV: Non-premedicated: Initial: 0.3mg/kg; Non-premedicated patients with severe systemic disease or other debilitation: 0.2-0.25mg/kg will usually suffice; In some cases: 0.15mg/kg may suffice
  In adults over 60 years of age, debilitated and chronically ill patients: Lower doses will be required
  Anaesthesia maintenance: IV: Lower doses than recommended for adults <60 years
  Sedation in ICU: No dose adjustment recommended

Recommendations in other jurisdictions

• Caution; dose adjustment recommended
  Conscious sedation: IV: Initial dose: 0.5-1mg; Titration doses: 0.5-1mg, given 5-10min before the beginning of the procedure. Further doses of 0.5-1mg may be given as necessary. Since in these patients the peak effect may be reached less rapidly, additional midazolam should be titrated very slowly and carefully. Total dose: <3.5mg (A total dose >3.5mg is usually not necessary)
  Anaesthesia premedication: IV: Initial dose: 0.5mg; Slow up-titration as needed OR IM: 0.025-0.05mg/kg; In case of concomitant administration of narcotics the midazolam dose should be reduced. The usual dose is 2-3mg
  Anaesthesia induction: IV: In premedicated patients: 0.05-0.15mg/kg, given over 20-30secs and allowing 2min for effect; In non-premedicated patients: Initial: 0.15-0.3mg/kg; Non-premedicated patients with severe systemic disease or other debilitation usually require less midazolam for induction: 0.15-0.25mg/kg will usually suffice
  Sedative component in combined anaesthesia: IV: Lower doses than recommended for adults <60 years
  Sedation in ICU: No dose adjustment recommended

Debilitated or chronically ill patients

• See elderly

Porphyria Information

• Probably not porphyrinogenic (PNP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Confusion
• Disorientation
• Emotional
• Libido disorder
• Mood disturbances
• Physical drug dependence and withdrawal syndrome
• Abuse
• Involuntary movements (including tonic/clonic movements and muscle tremor)
• Hyperactivity
• Sedation (prolonged and postoperative)
• Decreased alertness
• Headache
• Somnolence
• Dizziness
• Ataxia
• Anterograde amnesia
• Seizures (premature infants and neonates)
• Drug withdrawal seizures
• Depression
• Fatigue
• Paradoxical reactions
  - Restlessness
  - Agitation
  - Irritability
  - Nervousness
  - Hostility
  - Anger
  - Aggressiveness
  - Anxiety
  - Nightmares
  - Abnormal dreams
  - Hallucinations
  - Psychoses
  - Inappropriate behaviour
  - Paroxysmal excitement

Cardiovascular Disorders

• Cardiac arrest
• Bradycardia
• Hypotension
• Vasodilation
• Thrombophlebitis
• Thrombosis

Respiratory Disorders

• Respiratory depression
• Respiratory arrest
• Apnoea
• Dyspnoea
• Laryngospasm
• Hiccups

Gastrointestinal Disorders

• Nausea and vomiting
• Constipation
• Dry mouth

Musculoskeletal Disorders

• Falls
• Fractures

Skin and Subcutaneous Tissue Disorders

• Rash
• Urticaria
• Pruritis
• Injection site erythema
• Injection site pain

Immune, Blood and Lymphatic System Disorders

• Hypersensitivity
• Angioedema
• Anaphylactic shock

• CYP3A4 inhibitors
• CYP3A4 inducers
• Central nervous system depressants
• Centrally acting antihypertensives
• Inhalational anaesthetics
• Azole antifungals
• Ketoconazole
• Voriconazole
• Fluconazole
• Itraconazole
• Posaconazole
• Macrolide antibiotics
• Erythromycin
• Clarithromycin
• Telithromycin
• Roxithromycin
• Propofol
• Protease inhibitors
• Saquinavir 
• Ritonavir-boosted lopinavir
• Boceprevir
• Telaprevir
• Calcium-channel blockers
• Diltiazem
• Verapamil
• Atorvastatin
• Fentanyl
• Nefazodone
• Aprepitant
• Ticagrelor
• Valproic acid
• Analgesics
• Antitussives
• Antipsychotics
• Other benzodiazepines
• Anxiolytics
• Hypnotics
• Barbiturates
• Ketamine
• Etomidate
• Sedative antidepressants
• Non-recent H1-antihistamines
• St John's wort
• Quercetin
• Ginkgo biloba
• Panax ginseng
• Alcohol

• Respiratory function
• Pulse oximetry
• Vital signs
• Heart rate
• Blood pressure

The central actions of benzodiazepines are mediated through an enhancement of the GABAergic neurotransmission at inhibitory synapses. In the presence of benzodiazepines the affinity of the GABA receptor for the neurotransmitter is enhanced through positive allosteric modulation resulting in an increased action of released GABA on the postsynaptic transmembrane chloride ion flux. Chemically midazolam is a derivative of the imidazobenzodiazepine group. Although the free base is a lipophilic substance with low solubility in water, the basic nitrogen in position 2 of the imidazobenzodiazepine ring system enables the active ingredient of midazolam to form water-soluble salts with acids, producing a stable and well tolerated injection solution. This together with rapid metabolic transformation is the reason for rapid onset and short duration of effects. Due to its low toxicity, midazolam has a wide therapeutic range. 

Injection (per ml) 5mg

• Midacum (Sandoz)

Injection (per 5ml) 5mg

• Accord midazolam (Accord)
• Dormicum (Roche) originator
• Midanium (Pharmacare)
• Midacum (Sandoz)
• Midazoject (Thebe)
• Pharma-Q midazolam (Pharma-Q)
• Sabax midazolam (Adcock Ingram) originator

Injection (per 3ml) 15mg

• Accord midazolam (Accord)
• Dormicum (Roche) originator
• Micro-midazolam (Micro)
• Midanium (Pharmacare)
• Midacum (Sandoz)
• Midazoject (Thebe)
• Midazolam Specpharm (Specpharm)
• Pharma-Q midazolam (Pharma-Q)
• Sabax midazolam (Adcock Ingram) originator

Injection (per 10ml) 50mg

• Accord midazolam (Accord)
• Aspen midazolam (Pharmacare)
• Dormicum (Roche) originator
• Midazoject (Thebe)
• Midazolam PharmC (Pharmacorp)
• Midazolam Specpharm (Specpharm)
• Pharma-Q midazolam (Pharma-Q)
• Sabax midazolam (Adcock Ingram) originator