Midazolam

What is this medication for?

• Preanesthetic/anesthetic adjunct, status epilepticus

How is it given?

This medication is normally given by your veterinary team (in clinic or hospital).

• Alone, midazolam does not reliably sedate animals — often causes dysphoria/excitement, especially in cats; always combine with an opioid or dissociative for predictable drowsiness.
• Unlike diazepam, midazolam can be given into a muscle effectively (water-soluble) and mixed in the same syringe with ketamine — a major practical advantage for premed/induction combos.

What if I miss a dose?

• Give it as soon as you remember — unless it is almost time for the next dose (then skip the missed one; never double up).
• Call your clinic if you miss more than one dose in a row.

Side effects — what should I watch for?

Effects listed as common in this handout

• Paradoxical excitement/dysphoria (Can occur alone, especially in cats)
• Pain on injection, local irritation (Reported (human data))

Worth a phone call to your veterinarian

• Any new symptom that worries you.

⚠️ Contact your veterinarian or an emergency clinic IMMEDIATELY if you notice

• Respiratory depression (Primary concern, esp. combined with opioids)

Before starting (or refilling), tell your veterinarian if your pet:

• has or has had: Hypersensitivity to benzodiazepines; acute narrow-angle glaucoma
• has or has had: Hepatic/renal disease, debilitated/geriatric, CHF (slower elimination), coma/shock/respiratory depression; avoid intra-carotid injection

• is pregnant, nursing, or used for breeding
• is taking any other medications, supplements, or flea/tick products, including:
  • Azole antifungals (keto/itra/fluconazole)
  • Calcium channel blockers (diltiazem, verapamil)
  • Macrolides (erythromycin, clarithromycin)
  • Phenobarbital, rifampin
  • Opiates

Storage and handling

Room temperature, protect from light. Stable after freeze/thaw. Water-soluble — unlike diazepam, compatible with aqueous fluids and can be mixed with ketamine/other water-soluble agents in the same syringe.

Good to know

• Alone, midazolam does not reliably sedate animals — often causes dysphoria/excitement, especially in cats; always combine with an opioid or dissociative for predictable drowsiness.
• Unlike diazepam, midazolam can be given into a muscle effectively (water-soluble) and mixed in the same syringe with ketamine — a major practical advantage for premed/induction combos.
• Much shorter half-life than diazepam — better suited to short procedures or as a CRI component, not as a maintenance anticonvulsant.