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Use of midazolam in palliative care

Sir Michael Sobell House, Churchill Hospital, Oxford

Michael Minton

Sir Michael Sobell House, Churchill Hospital, Oxford

Robert G Twycross

Sir Michael Sobell House, Churchill Hospital, Oxford

Objective: To review the use of midazolam (a water-soluble benzodiazepine) in terminally ill patients.

Design: A retrospective study of 104 patients.

Results: Midazolam was used intravenously as sedation before minor procedures in three patients. Because of prolonged sedation in two patients, the following regimen is now used: 1 mg intravenously stat, followed by 1 mg/min, or 0.5mg/min in those over 65. In other situations, midazolam was used subcutaneously (SC), usually via a syringe driver. For muscle relaxation the median dose was 30mg SC/24h (27 patients; range 10-60mg). When treating terminal agitated delirium the median dose was 35mg SC/24h (61 patients; range 10-240mg). For multifocal myoclonus or as prophylaxis against fits the median dose was 30mg SC/24h (12 patients; range 15-80mg).

Key Words: benzodiazepines • epilepsy • myoclonus • palliative treatment • psychomotor agitation • subcutaneous injections • terminal care

Palliative Medicine, Vol. 5, No. 3, 244-249 (1991)
DOI: 10.1177/026921639100500310


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