Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review
Midazolam is a benzodiazepine with rapid onset of action and short duration of effect. In healthy neonates the half-life (t1/2) and the clearance (Cl) are 3.3-fold longer and 3.7-fold smaller, respectively, than in adults. The volume of distribution (Vd) is 1.1 L/kg both in neonates and adults. Mida...
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Wiley
2014-01-01
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| Series: | International Journal of Pediatrics |
| Online Access: | http://dx.doi.org/10.1155/2014/309342 |
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| author | Gian Maria Pacifici |
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| description | Midazolam is a benzodiazepine with rapid onset of action and short duration of effect. In healthy neonates the half-life (t1/2) and the clearance (Cl) are 3.3-fold longer and 3.7-fold smaller, respectively, than in adults. The volume of distribution (Vd) is 1.1 L/kg both in neonates and adults. Midazolam is hydroxylated by CYP3A4 and CYP3A5; the activities of these enzymes surge in the liver in the first weeks of life and thus the metabolic rate of midazolam is lower in neonates than in adults. Midazolam acts as a sedative, as an antiepileptic, for those infants who are refractory to standard antiepileptic therapy, and as an anaesthetic. Information of midazolam as an anaesthetic in infants are very little. Midazolam is usually administered intravenously; when minimal sedation is required, intranasal administration of midazolam is employed. Disease affects the pharmacokinetics of midazolam in neonates; multiple organ failure reduces the Cl of midazolam and mechanical ventilation prolongs the t1/2 of this drug. ECMO therapy increases t1/2, Cl, and Vd of midazolam several times. The adverse effects of midazolam in neonates are scarce: pain, tenderness, and thrombophlebitis may occur. Respiratory depression and hypotension appear in a limited percentage of infants following intravenous infusion of midazolam. In conclusion, midazolam is a safe and effective drug which is employed as a sedative, as antiepileptic agent, for infants who are refractory to standard antiepileptic therapy, and as an anaesthetic. |
| format | Article |
| id | doaj-art-7c19eb50f831416a90056d6f95f52203 |
| institution | OA Journals |
| issn | 1687-9740 1687-9759 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
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| series | International Journal of Pediatrics |
| spelling | doaj-art-7c19eb50f831416a90056d6f95f522032025-08-20T02:06:54ZengWileyInternational Journal of Pediatrics1687-97401687-97592014-01-01201410.1155/2014/309342309342Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A ReviewGian Maria Pacifici0Section of Pharmacology, Department of Translational Research and New Technologies in Medicine and Surgery, Medical School, University of Pisa, 56126 Pisa, ItalyMidazolam is a benzodiazepine with rapid onset of action and short duration of effect. In healthy neonates the half-life (t1/2) and the clearance (Cl) are 3.3-fold longer and 3.7-fold smaller, respectively, than in adults. The volume of distribution (Vd) is 1.1 L/kg both in neonates and adults. Midazolam is hydroxylated by CYP3A4 and CYP3A5; the activities of these enzymes surge in the liver in the first weeks of life and thus the metabolic rate of midazolam is lower in neonates than in adults. Midazolam acts as a sedative, as an antiepileptic, for those infants who are refractory to standard antiepileptic therapy, and as an anaesthetic. Information of midazolam as an anaesthetic in infants are very little. Midazolam is usually administered intravenously; when minimal sedation is required, intranasal administration of midazolam is employed. Disease affects the pharmacokinetics of midazolam in neonates; multiple organ failure reduces the Cl of midazolam and mechanical ventilation prolongs the t1/2 of this drug. ECMO therapy increases t1/2, Cl, and Vd of midazolam several times. The adverse effects of midazolam in neonates are scarce: pain, tenderness, and thrombophlebitis may occur. Respiratory depression and hypotension appear in a limited percentage of infants following intravenous infusion of midazolam. In conclusion, midazolam is a safe and effective drug which is employed as a sedative, as antiepileptic agent, for infants who are refractory to standard antiepileptic therapy, and as an anaesthetic.http://dx.doi.org/10.1155/2014/309342 |
| spellingShingle | Gian Maria Pacifici Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review International Journal of Pediatrics |
| title | Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review |
| title_full | Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review |
| title_fullStr | Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review |
| title_full_unstemmed | Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review |
| title_short | Clinical Pharmacology of Midazolam in Neonates and Children: Effect of Disease—A Review |
| title_sort | clinical pharmacology of midazolam in neonates and children effect of disease a review |
| url | http://dx.doi.org/10.1155/2014/309342 |
| work_keys_str_mv | AT gianmariapacifici clinicalpharmacologyofmidazolaminneonatesandchildreneffectofdiseaseareview |