Talk:Midazolam

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Fuzzform (talk · contribs) requested cleanup, but I don't think that is necessary. This article does need to be expanded though. JFW | T@lk 08:20, 7 November 2005 (UTC)

Cleanup is very necessary; I started it by correcting at least some of the atrocious spelling/grammar, sentence structure, lack of citation, POV, etc. etc.

Contents

[edit] Anticonvulsant

Midazolam most certainly is used as an anticonvulsant, in the treatment of status epilepticus. It is an important new development for the treatment of status by non medical staff. Prior to this, the only option in the UK is rectal diazepam, with all the social problems of that method of delivery!

"Buccal midazolam is currently not licensed for the treatment of epilepsy in the UK although there is an increasing trend for doctors to prescribe it as an emergency treatment for prolonged seizures" - Epilepsy Action UK

  • BNF 50. Indications: ..., status epilepticus [unlicensed use]; ...
  • McIntyre J, Robertson S, Norris E, Appleton R, Whitehouse WP, Phillips B, Martland T, Berry K, Collier J, Smith S, Choonara I (2005). "Safety and efficacy of buccal midazolam versus rectal diazepam for emergency treatment of seizures in children: a randomised controlled trial". Lancet 366 (9481): 205-10. PMID 16023510. 
  • ICL Institute of Child Health: Buccal Midazolam (Great Ormond Street Hospital for Children Factsheet).
  • A Google for midazolam and status will find loads more.

Whilst I'm not much of a fan of the big {{Anticonvulsants}} table (which was removed from this article), I think this usage should be added to the article. --Colin 22:08, 15 February 2006 (UTC)

Yes, what's the beef with this? I've added some stuff; the above references and anticonvulsant table can/should be added too. -ikkyu2 (talk) 07:55, 17 February 2006 (UTC)
The "beef" was just the removal of the {{Anticonvulsants}} table with the history comment "this drug is not used as an anticonvulsant.". I didn't want to make the change if Fuzzform was still in the middle of working on the article --Colin 09:14, 17 February 2006 (UTC)

Yes, I apologize for that. I'm not really a fan of the huge anticonvulsants template either. All of the benzodiazepines can be used for treatment of epilepsy (as they all share similar inhibitory properties), so I didn't think it necessary to have this template as well. Also, the benzodiazepine template is a sub-template of the anticonvulsants template. It seems silly to use both templates, but midazolam is first and foremost a benzodiazepine, and I think it would be improper not to include the benzodiazepine template.

I think that all the benzo pages should use the same templates, but it would be unnecessary (not to mention messy-looking) to have the anticonvulsant template on every benzo page. The more I think about this, the more I'm unsure about what to do. Any ideas for a compromise? Fuzzform 20:02, 18 February 2006 (UTC)

I'm glad you've asked this because I've been tidying the benzo listing on anticonvulsant. Whilst I agree that these drugs (like the barbiturates) probably all have some anticonvulsant effect, they are not all used / indicated / licensed for treating epilepsy or acute seizures. I think the current list on anticonvulsant is a subset of benzodiazepines that I am happy with classifying as anticonvulsants based on their clinical use. If someone more experienced than me wants to correct that listing, then I'd welcome their input. You can get the UK drug usage situation from the BNF - it is free to register for access.
As I said on the anticonvulsant page, the benzodiazepines share a lot of properties but these vary in usefuless/strength from drug to drug. Some might be too weak an anticonvulsant to be useful at non-toxic doses, or at non-hypnotic doses. I think that in your upgrade-drive for these drugs, you should try to differentiate them so the reader knows clearly why certain benzodiazepines are chosen over another.
Re: the anticonvulsant template - I don't think it should contain the benzodiazepines template. Instead, a new template should be created "benzodiazepine anticonvulsants", which is in keeping with most of the other templates inside anticonvulsant. The same is true of the barbiturates template. I don't have the time to do this over the weekend so go ahead if you like.
Just done it --Colin 22:50, 18 February 2006 (UTC)
Re: "midazolam for intramuscular buccal injection" - I half-laughed and half-squirmed when I read this. I had visions of a mad dentist missing my gum and stabbing his needle through my cheek. If you read the GOSH leaflet, it has kinder instructions. You just squirt the liquid slowy between the gum and the cheeks. I'll correct the wording. --Colin 21:53, 18 February 2006 (UTC)


[edit] Abuse and Side Effects

The section on side effects should not be used for discussion of abuse. I did not have time to separate into two sections, so I just retitled the existing section while I focused on doing some serious cleanup work. At the very least, abuse should not be intermingled with medical side effects (such as you'd read on literature accompanying prescription) but perhaps have its own distinct paragraph if it was going to be kept in the side effect section.

[edit] Pop culture mention

Apparently the Duran Duran album Medazzaland was named after this drug. Probably not worth a mention in the article, but you learn something new every day, and look what I wasted today on! :) — Catherine\talk 01:47, 14 April 2006 (UTC)

The article states that midazolam was first synthesized in 1976. But in the "Indications" section, it states that midazolam was used as a truth serum during the Vietnam War. Since the Vietnam War ended in 1973, before the stated first-synthesis date of 1976, how is this possible? 68.7.45.142 15:56, 31 August 2006 (UTC)

Well spotted, thank-you. There are plenty sources to back up the synthesis date but none can be found about the Vietnam stuff. The Vietnam paragraph was added along with other unsourced, speculative and just plain wrong stuff by user 24.63.58.100. Some of that has been removed already and I've now removed the rest. Colin°Talk 17:56, 31 August 2006 (UTC)

[edit] Dosage

Under dosage info it says Versed is often paired with 50mg of Fentanyl. This can't possibly be right. Unless it's rewritten as "Endoscopy: if 3-5mg (rarely 10mg) is not enough to adequately sedate the patient, the only viable option is a super-massive overdose of opiods, preferrably inserted directly into the jugular. Be prepared with naloxone syringe. Repeat as necessary with problem patients."—The preceding unsigned comment was added by 63.165.238.2 (talk • contribs) 17:11, 14 June 2006. --Legomancer 15:52, 19 June 2006 (UTC)

Please remove any text that you think is erroneous. This is preferable to adding "citation needed" - especially for important facts. See WP:VERIFY, especially policy point 3. Colin°Talk 21:56, 14 June 2006 (UTC)

Done. Reference to fentanyl now says a more reasonable 2.5-5 micrograms. Would a digression about benzo/opiod interaction be appropriate for this page? --Legomancer 15:52, 19 June 2006 (UTC) —The preceding unsigned comment was added by 63.165.238.2 (talk • contribs) 12:09, 15 June 2006.

Unless specific to Midazolam, then perhaps the benzodiazepine page would be better. Although if this combination is used for a specific medical treatment/procedure then maybe that would indicate a more suitable place. You could ask on Wikipedia talk:WikiProject Drugs or Wikipedia talk:WikiProject Clinical medicine?

Please consider getting an account. It takes only a few seconds and makes discussion much easier. Colin°Talk 12:41, 15 June 2006 (UTC)

Oops, thought I was signed in. I've added my sig behind the anonymous. It looks like this: --Legomancer 15:52, 19 June 2006 (UTC)


I'm still not happy with the Dosage section. Looking at the reference Clinical Use of Midazolam by John Shu or the RxList link, I think that dosing is a very complex issue. IMO this section should either be removed or else totally revised by somebody with the skills to do a good (well referenced) job. Colin°Talk 18:51, 31 August 2006 (UTC)


As a side note: Midasolam is also marketed in Europe under the brand name Dormicum® (La Roche) as a sleep aid. Two dosages are available 7.5mg (white colored tablets) and 15mg (blue). ...thought it's worth mentioning.

[edit] Possible redirect?

I heard the drug name midazolan used on the show Prison Break and wanted to know what it was. Wikipedia has no mention of the drug so I am wondering if midazolam is the same drug, and should there be a redirect here? 70.48.129.107 23:12, 22 November 2006 (UTC)strideranne

[edit] Ring opening in acidic aqueous solution

The imidazoline ring will not open in acidic aqueous solution, because it is too stable, due to its aromaticity; instead, the diazepine ring opens upon protonisation and hydrolysis:
http://img144.imageshack.us/img144/6521/midazolamringopeningob4.png
I therefore change the remark in the article.--84.163.87.66 11:39, 28 April 2007 (UTC)