미다졸람
Midazolam
Midazolam hydrochloride
다른 이름: Versed · Dormicum · Dormonid · Fulsed · Hypnovel · Midaselect · Zolamid · Buccolam · Epistatus · Midazolam HCl · Ro-21-3981/003 · Midazolamum · Midazolam hydrochloride
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
감사 완료 v13 용량 근거
검토된 비계산 근거검토된 비계산 근거 (1)
근거 표시 전용 — 자동 계산 불가
Preanesthetic agent (extra-label)
Preanesthetic agent (extra-label): 0.5 – 5 mg/kg IM or IV
반드시 함께 고려할 임상 맥락 (2)
- NOTE: There are many potential combinations that have been suggested; the following are examples and not inclusive. For additional information, refer to other anesthesia-specific references. 25
- Store midazolam injection at room temperature (15°C-30°C [59°F-86°F]) and protected from light. After being frozen for 3 days and allowed to thaw at room temperature, the injectable product is physically stable. Midazolam is stable at a pH range of 3 to 3.6.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
미다졸람은 수의학에서 마취 전 진정제, 근육 이완제 및 항경련제로 널리 사용되는 속효성 주사용 벤조디아제핀계 약물입니다.
임상 요점:
- 독특한 용해도: 디아제팜과 달리 미다졸람은 바이알(pH < 4)에서는 수용성이지만 생리적 체내 pH(7.4)에서는 지용성으로 변합니다. 이로 인해 침전 없이 다른 수용성 약물(예: 오피오이드 및 케타민)과 안전하게 혼합할 수 있습니다.
- 근육 주사 흡수: 프로필렌 글리콜을 포함하지 않아 근육(IM) 주사 시 통증을 유발하지 않으며 빠르고 안정적으로 흡수되므로 IM 사용 시 디아제팜보다 우수합니다.
- 역설적 흥분: 건강하고 불안해하지 않는 개와 고양이에게 단독으로 투여할 경우, 확실한 진정 효과를 제공하지 못하고 역설적인 불쾌감이나 흥분을 유발할 수 있습니다. 다른 약물(예: 오피오이드, 케타민 또는 알파-2 작용제)과 병용할 때 가장 효과적입니다.
- 간질 중첩증: 진행 중인 발작을 멈추는 데 매우 효과적이며 정맥(IV), 근육(IM) 또는 비강(IN)으로 투여할 수 있습니다.
작용 기전
Midazolam exerts its effects by enhancing the activity of gamma-aminobutyric acid (GABA), the primary inhibitory neurotransmitter in the central nervous system.
- Target: Binds to specific allosteric benzodiazepine receptors on the GABA-A receptor complex.
- Mechanism: Binding increases the frequency of chloride channel openings → influx of chloride ions → hyperpolarization of the postsynaptic neuronal membrane → decreased neuronal excitability.
- Effects: This depression of subcortical levels (limbic, thalamic, and hypothalamic) produces anxiolytic, sedative, skeletal muscle relaxant, and anticonvulsant effects. Midazolam has approximately twice the affinity for benzodiazepine receptors compared to diazepam, making it more potent with a faster onset and shorter duration of action.
안전성·주의사항
금기사항
- Hypersensitivity to benzodiazepines
- Acute narrow-angle glaucoma
- Intra-carotid artery injection (must be avoided)
- Neonates (avoid use)
부작용
- Respiratory depression (especially when combined with opioids or other CNS depressants)
- Paradoxical excitement, dysphoria, or agitation (especially in cats and dogs when used alone)
- Hypotension and bradycardia (when combined with other anesthetics like isoflurane or ketamine)
- Pain on injection or local irritation (rare compared to diazepam)
- Severe hypotension
- Paradoxical excitement (occasionally)
주의
High-Risk Patients: Use cautiously in patients with hepatic or renal disease, and in debilitated or geriatric patients.
- Cardiovascular/Respiratory: Administer with extreme caution to patients in coma, shock, or with significant respiratory depression. Patients with congestive heart failure may eliminate the drug more slowly.
- Anesthetic Combinations: While midazolam alone has minimal cardiorespiratory effects, combining it with opioids, ketamine, or inhalants can lead to significant respiratory depression, bradycardia, or hypotension.
- Pregnancy: FDA Category D in humans. May cause congenital abnormalities if used in the first trimester. Excreted in milk and may cause CNS effects in nursing neonates.
약물 상호작용
Midazolam may decrease the dosages required for inhalant anesthetics.
May inhibit midazolam metabolism, increasing midazolam blood levels.
May increase midazolam levels.
May increase midazolam levels by inhibiting hepatic metabolism.
May increase the risk of profound sedation and respiratory depression.
May increase midazolam levels.
May increase the hypnotic effects of midazolam; hypotension has been reported when used with meperidine. Combination causes greater respiratory depression.
May decrease peak levels and AUC of midazolam via enzyme induction.
May decrease peak levels and AUC of midazolam.
Midazolam may decrease the dosages required for induction.
Potentiates effect, reducing the dose required for induction
Potentiates effect, reducing the dose required
May enhance the sedative effect
May enhance the sedative effect
May enhance the sedative effect
May increase the hypnotic and hypotensive effects of midazolam; enhances sedation
Inhibits the metabolism of midazolam
모니터링
- Level of sedation and central nervous system depression
- Respiratory rate, effort, and oxygenation (especially when combined with other drugs)
- Heart rate and blood pressure
- Respiratory rate and effort
- Heart rate and rhythm
- Level of sedation and consciousness
약동학
반감기
흡수
Following IM injection, midazolam is rapidly and nearly completely (91%) absorbed. Oral absorption is good, but bioavailability is low (31-72%) due to a rapid first-pass effect. Rectal bioavailability in dogs is very low. Intranasal administration (especially via compounded gel) provides good absorption and high peak levels.
분포
Highly protein bound (94-97%). Due to its high lipophilicity at physiologic pH, it rapidly crosses the blood-brain barrier. Changes in plasma protein concentrations can significantly alter the response to a given dose.
대사
Metabolized in the liver, principally by microsomal oxidation. Forms an active metabolite (alpha-hydroxymidazolam), which has a very short half-life and negligible clinical effects.
배설
Eliminated primarily via hepatic metabolism and subsequent excretion. The duration of activity is considerably shorter than that of diazepam.
과다투여
Accidental overdoses should be managed with supportive care (e.g., cardiovascular and respiratory support), similar to diazepam.
- Reversal Agent: Flumazenil is a specific benzodiazepine antagonist and can be used to reverse midazolam's effects.
- However, because midazolam has a very short duration of effect and flumazenil is costly, supportive therapy is usually sufficient for all but the most massive overdoses.
제품
제형
- Injection (solution)
- Oral syrup
- Injectable solution: 1 mg/ml, 2 mg/ml, 5 mg/ml
- Oromucosal solution: 5 mg/ml (in 0.5 ml, 1 ml, 1.5 ml, 2 ml pre-filled syringes)
- Oromucosal solution: 10 mg/ml pre-filled syringe
동물용의약품
- None (No veterinary-labeled products currently available)
- Buccolam
- Epistatus
- Hypnovel
인용의약품
- Midazolam HCl Injection: 1 mg/mL in 2 mL, 5 mL, 10 mL vials
- Midazolam HCl Injection: 5 mg/mL in 1 mL, 2 mL, 5 mL, 10 mL vials & 2 mL syringes
- Midazolam HCl Syrup: 2 mg/mL in 118 mL
- Buccolam
- Epistatus
- Hypnovel
규제 현황
POM
POM-V
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
Store midazolam injection at room temperature (15°-30°C) and protect from light. It is physically stable after being frozen for 3 days and thawed. Midazolam is stable at a pH from 3-3.6. Compounded oral suspensions (e.g., with Syrpalta) retain >90% potency for 56 days when stored at 7°C, 20°C, or 40°C and protected from light.
보호자 정보
참고: 미다졸람은 거의 전적으로 동물병원 내에서 또는 전문가의 직접적인 감독 하에 투여됩니다.
- 목적: 반려동물이 수술 전 긴장을 풀거나, 근육을 이완시키거나, 진행 중인 발작을 신속하게 멈추기 위해 이 약물을 투여받을 수 있습니다.
- 행동 변화: 단독으로 투여할 경우, 일부 반려동물(특히 건강한 개와 고양이)은 졸음이 오는 대신 일시적으로 불안해하거나, 낑낑거리거나, 비틀거릴 수 있습니다. 이는 알려진 반응이며 빠르게 사라집니다.
- 안전성: 다른 마취제와 함께 사용할 경우 호흡과 심박수에 영향을 줄 수 있으므로, 약효가 지속되는 동안 수의료진이 반려동물의 활력 징후를 면밀히 모니터링할 것입니다.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.