Very few people have serious side effects from midazolam. It is important to be aware of possible reactions and what to do if they happen.
- Read the package insert for more information.
- Call your provider's office right away if any of these problems occur.
Heart and breathing problems: These have happened rarely after midazolam has been used. These include:
- Slowed breathing, blocking of the airway, low oxygen levels, change in breathing patterns, heart attack or respiratory (breathing) arrest. Of note: cardiac or respiratory arrest was not seen during clinical drug trials of midazolam.
- Rarely, periods of low blood pressure have been seen when midazolam was given for tests, surgery, or in people with other medical problems. Low blood pressure may happen more often in people who have been given a narcotic pain killer at the same time.
- The risk of breathing problems is greater in older adults, people with other chronic health problems, and people with other breathing problems.
Central nervous system (CNS) depression: Drugs like midazolam can potentially depress or affect the CNS (the brain and spinal cord) causing too much sedation or sleepiness, slowed breathing, coma, or even death. The risk of this is increased if midazolam is used with:
- Other medications that can depress or affect brain function.
- Medicines that inhibit or affect how some medicines work can also cause this risk. One group of these medicines is called CYP3A4 Inhibitors – these drugs can increase side effects of midazolam.
- Alcohol or other substances that can affect the brain. Opioids (a group of medicines used to treat severe pain) can cause severe sedation or sleepiness, slowed breathing, coma, and death if used with midazolam.
- Before using midazolam, talk to your health care provider about any use of an opioid medicine. Keep close follow-up with your health care team if these medicines are used together.
Allergic reactions: Allergic reactions happen rarely, but can cause symptoms such as low blood pressure, hives, rash, breathing difficulties, and swelling. It can happen after the first dose or any time when taking the medicine. Since this can be life-threatening, if these symptoms occur, get immediate medical help
Suicidal thoughts and behavior: Since 2008, the Food and Drug Administration (FDA) has placed a warning on seizure medications or antiepileptic drugs (AEDs) used for any reason. The FDA alert states that some AEDs may increase a person’s risk for suicidal thoughts or behavior. Together, these thoughts and behaviors are called suicidality. According to the FDA’s Alert, among the patients with epilepsy in these drug studies, more had symptoms of suicidality than people taking a placebo or inactive substance — 3.5 of 1,000 people taking a seizure medicine had suicidality compared to 1 of 1,000 people taking a placebo.
- Since nasal midazolam is being used intermittently for cluster seizures, the risk for suicidality would likely be rare.
- People taking any AED should talk to their provider about the following recommendations:
- Taking seizure medicines may increase the risk of having suicidal thoughts or actions.
- Do not make any changes to the medicines without first talking to the prescribing health care provider.
- Pay close attention to any day-to-day changes in mood, behavior, and actions. These changes can happen very quickly, so it is important to be aware of any sudden differences.
- Know common warning signs that might be a signal for risk of suicide. Some of these are:
- Talking or thinking about wanting to hurt yourself or end your life
- Withdrawing from friends and family
- Becoming depressed or having your depression get worse
- Becoming preoccupied with death and dying
- Giving away prized possessions
- Contact your health care provider before stopping any seizure medicine. This could possibly lead to worsening of seizure and mood.
Changes in cognitive function: Problems with thinking, memory, or attention are examples of cognitive function. Midazolam has a high risk for causing temporary loss of memory, either partially or completely, for several hours after using this medicine.
- People should not use dangerous machinery or drive (if they have a valid driver’s license) until the medicine effects have gone away.
- Children should be watched to make sure they can walk safely alone after using the medicine.
Change in vision – Glaucoma: Medicines like midazolam can raise pressure in an eye in people who have glaucoma.
- People who have glaucoma should talk to their health care provider and eye doctor before using midazolam. They may need to have eye tests done more often.
- People who have a form of glaucoma called narrow-angle glaucoma should not use midazolam.
Other potentially serious side effects: When midazolam was used for other reasons, such as sedation, some changes in behavior have been reported, i.e. agitation, involuntary movements or tremors, hyperactivity, and combativeness.