Midazolam Side Effects, Abuse & Addiction Treatment Options
In This Article
What is Midazolam?
Midazolam is a drug commonly sold under the brand name Versed. It is an FDA-approved benzodiazepine that produces sedative effects on the body and central nervous system (CNS).
Midazolam is rarely used outside of hospital and clinical settings. Professionals can use Versed as:
- A premedication before surgical procedures involving anesthesia
- Treatment for seizures
- Treatment for schizophrenia combined with other drugs
- Treatment for severe agitation
Midazolam (Versed) Side Effects
Midazolam can trigger many adverse effects, which include:
- Nausea and vomiting
- Dizziness
- Drowsiness
- Headache
- Sleeping difficulty
- Trouble breathing
- Restlessness
- Uncontrollable shaking
- Aggression
- Slow or irregular heart rate
- Agitation
After administration, medical professionals will continuously monitor respiratory and heart functions until a person is stable. This should occur in a clinical or hospital setting.
When Versed is combined with other sedatives or opioids, the risk for respiratory depression, airway obstruction, and hypoventilation increases.
Serious and life-threatening reactions include:
- Airway obstruction
- Apnea
- Hyperventilation
- Hypotension
How Does Midazolam (Versed) Work?
Versed works by increasing the effect of GABA (a natural chemical) in the brain, inducing a muscle-relaxing effect that triggers sleepiness and reduces anxiety.
Midazolam can also be:
- An anticonvulsant
- A hypnotic
- An anxiolytic
- An amnestic
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Midazolam Dosage Forms
A single dose of midazolam lasts between one and six hours, so it’s not an ideal sleep aid. It comes in five dosage forms, including:
- Intravenous administration (IV midazolam)
- Intramuscular (midazolam injection)
- Intranasal (nasal spray)
- Buccally (between the gum and cheek)
- Sublingually (under the tongue)
In obese pediatric cases, doctors determine the midazolam doses based on ideal body weight. Older people should have lower doses because higher ones can trigger adverse side effects.
The World Health Organization considers midazolam one of its "essential medicines.” It is among the safest and most effective medications available when used properly.
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Midazolam Drug Interactions
A total of 451 drugs can interact with midazolam, and 32 can produce serious interactions. Serious drug interactions increase a user’s risk for severe side effects.
The most common drugs known to interact with midazolam include:
- Antidepressants (sertraline, nefazodone, and fluoxetine)
- Antiepileptic drugs (phenytoin, phenobarbital, and carbamazepine)
- Heart or blood pressure medications (diltiazem)
- Seizure medications (phenytoin)
- Certain antibiotics (clarithromycin and erythromycin)
- Tuberculosis medications (rifapentine and rifampin)
- Antifungal medications (ketoconazole and itraconazole)
- Protease inhibitors, antiviral medications taken for HIV/AIDS or hepatitis C
- Grapefruit juice
- Antihistamines
- St. John's Wort
- CNS depressants
Toxicity with midazolam can also occur when combined with CNS depressants like opioids (e.g., fentanyl, codeine, and morphine), alcohol, and other tricyclic antidepressants.
Before taking midazolam, discuss any allergies and tell your doctor if you are taking other benzodiazepines, such as diazepam.
Midazolam Abuse and Addiction
Midazolam is a benzodiazepine, and like other medications in this class, it has a high risk of abuse and addiction.
Midazolam, like Versed, is relatively safe when used under a doctor’s supervision. However, they can be dangerous when abused. Abuse doesn’t always mean a person is addicted, but it increases the likelihood of addiction.
Midazolam Abuse Symptoms
Abuse occurs when someone takes higher doses of a drug than prescribed. Abuse also includes taking a medication longer than prescribed or combining it with other drugs, including alcohol.
Midazolam abuse symptoms might include:
- Drowsiness
- Lack of coordination
- Slurred speech
- Problems with concentration
- Difficulty remembering things
- Confusion
- Dizziness
Midazolam Addiction Symptoms
Ongoing midazolam abuse alters the brain’s chemistry by changing neural pathways. In addition, when midazolam is used long-term in an intensive care unit (ICU) or clinical setting, the risk for addiction increases.
Physical dependence can happen within just a few weeks of using Versed. Some estimates show benzodiazepine dependence occurs in a third of those using these drugs for over a month.
Addiction is a DSM-5 diagnosed disease characterized by behavioral issues. Dependence refers to a physical reliance on a substance. Addiction and dependence often occur simultaneously, but a person can depend on a substance without being addicted.
Symptoms of a midazolam addiction are similar to those of other drugs, especially benzodiazepines, and include:
- Intense cravings
- Poor judgment and decision-making
- Practicing drug-seeking behaviors
- Compulsive use of the drug
- Inability to stop using the drug
- Developing tolerance and dependence
- Continuing to use the drug even with negative consequences
- Prioritizing using the drug over everything else
- Lying or stealing to cover up using or to get more of the drug
- Financial and legal problems
It is also more likely that a person with a midazolam addiction will become addicted to other substances. Or, they may already be abusing other substances before midazolam use begins.
Multiple-substance abuse can create challenges for recovery; it is common for someone addicted to midazolam to have a mental health disorder.
Midazolam Withdrawal Symptoms
Abruptly stopping the ongoing use of midazolam can trigger withdrawal symptoms. This is common when a person is abusing benzodiazepines.
Someone with an addiction tends to have a better chance of recovery if they gradually taper their medication dosage with a doctor’s supervision. Medical detox helps treat withdrawal symptoms and reduce the intensity of symptoms.
Withdrawal symptoms associated with midazolam dependence are similar to other benzodiazepines and include:
- Problems sleeping
- Runny nose
- Anxiety
- Irritability
- Panic attacks
- Tremors
- Shaking
- Sweating
- Problems with concentration
- Confusion and memory problems
- Cognitive impairment
- Nausea and vomiting
- Headache
- Muscle pain
Severe cases of midazolam withdrawal can trigger:
- Seizures
- Hallucinations
- Psychosis
- Suicidal thoughts and/or behaviors
Midazolam Overdose
Symptoms of midazolam overdose can include:
- Impaired motor coordination and reflexes
- Slurred speech
- Involuntary eye movements
- Difficulty staying awake
- Dizziness and/or drowsiness
- Extreme confusion
- Hypotension
- Respiratory arrest
- Blurred vision
- Hallucinations
- Coma and death
Call emergency services or the Poison Help line at 1-800-222-1222 if you suspect an overdose is occurring. An overdose is rare if the drug administration was in a clinical setting or an intensive care unit.
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Treatment for Midazolam Addiction
Treatment is available for people who abuse or are addicted to midazolam. Benzodiazepine addiction is a common reason people enter treatment programs.
Sometimes, these people require treatment for multiple substance addictions. Some might also have co-occurring mental health disorders.
The most effective treatment programs for midazolam addiction and dependence include:
- Inpatient treatment
- Outpatient treatment
- A combination of the two
These treatment options address a person's medical, social, and psychological issues, which can result in addiction and dependence.
Someone who abuses midazolam short-term might only require outpatient treatment. However, ongoing abuse that has led to addiction or physical dependence will likely require inpatient treatment followed by ongoing outpatient support.
The goal of addiction treatment is to help the affected person detox from the drug and, if necessary, learn about his or her addiction, deal with cravings, and prevent relapse.
Frequently Asked Questions (FAQs)
Is midazolam stronger than diazepam?
Midazolam and diazepam are both benzodiazepine medications. However, midazolam is 3 to 4 times as potent per mg as diazepam. It is also faster acting and causes deeper levels of amnesia than diazepam.
Is midazolam given to patients at end of life?
Midazolam is one of the most common drugs administered to cancer patients near their ‘end of life,’ along with morphine and haloperidol.
Terminally ill cancer patients often experience refractory symptoms. Sedative medications are used to alleviate these symptoms (palliative sedation therapy).
How long does midazolam take to work?
A midazolam injection takes up to 15 minutes to work. An intravenous (IV) drug dose begins working in five minutes or less.
How long does Versed stay in your blood?
Benzodiazepines like Versed are detectable in blood tests for 12 to 24 hours after use.
What are the side effects of Versed sedation?
The side effects of Versed-induced sedation include headache, nausea, and drowsiness. These usually go away quickly. Medical professionals monitor people when sedated to ensure they don’t experience complications.
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Related Articles
- “Midazolam: MedlinePlus Drug Information.” MedlinePlus, National Library of Medicine, 2017.
- “WHO model list of essential medicines, 2021.” WHO, 2021.
- Lingamchetty et al. “Midazolam.” National Library of Medicine, National Center for Biotechnology Information, 2022.
- Prommer, E. “Midazolam: an essential palliative care drug.” Palliative Care & Social Practice, 2020.
- Manso et al. “Efficacy of oral midazolam for minimal and moderate sedation in pediatric patients: A systematic review.” Pediatric Anesthesia, 2019.
- Makkar et al. “Alcohol and Midazolam Dependence Syndrome.” The International Journal of Indian Psychology, 2021.
