The two benzodiazepines used for sedation and their reversal agent, side by side, as their own monographs state them. IV figures shown; midazolam and diazepam monographs also give IM and oral timings.
| Agent | Route | Onset | Peak | Duration | Adult dose (as stated) | Reversal |
|---|---|---|---|---|---|---|
| Midazolam (Versed) | IV (also IM, oral) | 1–2 minutes | 3–5 minutes | 10–30 minutes | 1–2 mg IV over 2 minutes, then titrate to effect; in general do not exceed 3 mg total | Flumazenil (Romazicon) |
| Diazepam (Valium) | IV (also oral) | 2–5 minutes | 3–5 minutes | 30–90 minutes | 1–2 mg increments every 2 minutes IV to effect; generally 10–20 mg in 60 minutes | Flumazenil (Romazicon) |
| Flumazenil (Romazicon) | IV bolus or infusion | 1–2 minutes | 6–10 minutes (80% of maximum response within 3 minutes) | 45–90 minutes | 0.2 mg IV over 15 seconds to 1 minute; repeat at 1-minute intervals to a cumulative 1 mg | Is the reversal agent; monitor up to 120 minutes for resedation |
Every figure above is taken from the linked monograph on this site; a dash means the monograph does not state it. Verify all doses against the current package insert and your facility protocols before clinical use.
Benzodiazepines
Specific Agents:
Midazolam (Versed)
Diazepam (Valium)
- Most widely used drugs for Sedation.
- Probably work in the limbic system and amygdala of the brain, where fear, anxiety and apprehension arise.
- Attach to receptor sites in the cerebral cortex, enhancing gamma-aminobutyric acid (GABA) and inhibiting excitatory impulses: anxiolysis…reduction of anxiety, amnesiac…reduces ability to recall events surrounding administration, anti-convulsive …stops seizures, skeletal muscle relaxation, sedative …hypnotic in large doses.
- Patients who chronically take cimetidine (Tagamet) or ranitidine (Zantac) are especially susceptible to benzodiazepine overdose…these H-2 blocking drugs may dramatically increase the sedative effect of even small doses of benzodiazepines.
- Narcotics (when given in conjunction with benzodiazepines are great potentiators of respiratory depression (great synergistic effect).
Reversal
Educational reference for sedation providers, relocated from the previous version of this site — not a substitute for the current package insert, your facility protocols, or clinical judgment. Verify all doses against current references before clinical use.