Infusion: Midazolam and Morphine combined
MIXING OF MIDAZOLAM AND MORPHINE INTO THE SAME 50ML SYRINGE:
Morphine and Midazolam Combined Infusion
Caution: Mixing of midazolam and morphine into the same syringe is frowned upon by some healthcare professionals, but the mixture is inherently stable and safe, and is used within the intensive care units of many academic hospitals throughout the world. Ketamine and midazolam are also routinely mixed in the same syringe.
Check that local or institutional policy is accepting of this practice before implementation.
Combined Infusions:
“Normal strength” combined infusion for adults (50ml syringe driver):
- Add 50mg midazolam and 20mg morphine into 50ml total volume.
- Run at 5 to 15ml/hr.
“Normal strength” combined infusion for adults (100ml ml infusion pump):
- Add 100mg midazolam and 40mg morphine into 100ml total volume.
- Run at 5 to 15ml/hr.
- Or add 100mg midazolam and 40mg morphine into 200ml total volume.
- Run at 10 to 30ml/hr.
“High dose” combined infusion for adults:
- Add 50mg midazolam and 40mg morphine to a total volume of 50ml.
- Run at 5 to 15ml/hr.
Australian Royal Flying Doctor Service (Western Operations):
- Syringe driver: 50mg midazolam + 50mg morphine in 50ml total volume.
- Mix 30ml volumes (1mg/ml) for shorter flights.
- Run at 2.5 to 15ml/hr.
- Infusion pump: 50mg midazolam + 50mg morphine in 500ml total volume.
- Run at 25 to 150ml/hr.
Normal strength combined infusion for paediatrics:
- Caution: this regime not applicable to neonates:
- Add 3mg/kg midazolam and 1mg/kg morphine into a total volume of 50ml.
- Run at 1 to 4ml/hr.
Normal strength combined infusion for neonates:
- Add 3mg/kg midazolam and 0.5mg/kg morphine into a total volume of 50ml.
- Run at 1 to 3ml/hr.
Morphine and Midazolam combined infusion
| Trade names: | Presentation and strength: |
Morphine and Dormicum | Midazolam: 5mg/5ml and 15mg/3ml ampoules. Morphine: 10mg/1ml and 15mg/1ml ampoules. |
| Cautions: See SAMF | |
| Loading dose: | |
| Adult: Midazolam: 0.1 to 0.2mg/kg IV. Morphine: 0.1 to 0.2mg/kg. | Paediatric: Midazolam: 0.2 to 0.5mg/kg IV or IM. Administer 0.2mg/kg and repeat after 10 minutes if necessary. Morphine: 0.1 to 0.2mg/kg. |
| Commonly for 70kg adult: Midazolam: 1 to 4mcg/kg/min. 60 to 240mcg/kg/hr. For 70kg adult: 4.2mg/hr to 16.8mg/hr. Morphine: 7 to 14mg for a 70kg patient. Usually 5 to 10mg, but may be up to 15mg. | Neonatal: Midazolam:As above. |
| Constant infusion: | |
| Adult dosage range: Midazolam: 1 to 4mcg/kg/min = 60 to 240mcg/kg/hr. For 70kg adult: 4.2mg/hr to 16.8mg/hr. Morphine: 20 to 80mcg/kg/hr. | Paediatric dosage range: Midazolam: 1 to 4mcg/kg/min. Morphine: 20 to 80mcg/kg/hr. |
| Neonatal dosage range: Midazolam: as above. Morphine: 0.5 to 1.5ml/hr (10 to 30mcg/kg/hr). | |
| Regime for 70kg adult: | Regime for paediatrics: |
| Mixture: Add 50mg midazolam and 20mg morphine to a total volume of 50ml. | Mixture: Add 3mg/kg midazolam and 1mg/kg morphine into a total volume of 50ml. |
| Rate: Run at 5 to 15ml/hr. | Rate: Run at 1 to 4ml/hr. |
| Alternative adult regime: | Neonatal regime: |
| Mixture:(higher-dose morphine infusion): Add 50mg midazolam and 40mg morphine into 50ml total volume. | Mixture: Add 3mg/kg midazolam and 0.5mg/kg morphine into a total volume of 50ml. |
| Rate: Run at 5 to 15ml/hr. | Rate: Run at 1 to 3ml/hr. |
| Additional notes: To mix solution for infusion pump, double strength for 100ml IV bag and quadruple strength for 200ml IV bag. Keep rate the same. Australian Royal Flying Doctor Service (Western Operations): Syringe driver: 50mg midazolam + 50mg morphine in 50ml total volume. Mix 30ml volumes (1mg/ml) for shorter flights. Run at 2.5 to 15ml/hr. Infusion pump: 50mg midazolam + 50mg morphine in 500ml total volume. Run at 25 to 150ml/hr. | |