Midazolam: Uses And Side Effects Of This Anxiolytic
Anxiety is one of the most common problems today. In fact, a large majority of the Western population has had or will have some episode of anxiety or a panic attack throughout their lives. And while for some it may be something that has happened at a specific time, for others it may become common and may require some type of treatment.
In this sense, at a pharmacological level we have substances that allow us to reduce anxiety levels in specific situations. This is the most used and widespread group of psychotropic drugs among the population: anxiolytics. And within these, benzodiazepines stand out, with applications not only for anxiety itself but also for other conditions.
An example of this type of drug is midazolam which we are going to talk about throughout this article.
Midazolam is an anxiolytic drug, that is, a drug that, through its action on the brain neurotransmission systems can treat conditions such as anxiety, agitation and extreme nervousness
Among anxiolytics, it is part of the benzodiazepines, the most popular group of anxiolytics used in anxiety and whose appearance allowed it to displace barbiturates (effective but much more dangerous and addictive) in addition to having multiple applications in different types of disorders.
Is about a hypnotic-sedative drug and also has an anticonvulsant effect Although it is not considered an anesthetic, it has a slight effect at this level that, together with sedation, means that it is often applied as a preparation for anesthesia and together with other drugs.
Midazolam is a short-lived benzodiazepine, which means that its effects take a short time to disappear (on average 2.3 hours, although it can range between 2.2 and 6.8 depending on body mass), although On the other hand, its effects are almost immediate (it begins to have sedative effects after two minutes). It is metabolized in the liver and is excreted mainly through the kidneys.
On the other hand, midazolam is a highly known product with multiple applications, and is available in various presentations for oral administration (the most common in the form of tablets or tablets), intravenous or intramuscular (presentation as an injection), intranasal or even rectal. It can be used in children over 6 months, although it requires very controlled doses prescribed by the doctor In the case of children under that age, there is a risk of respiratory depression.
Unfortunately it is also famous for a controversial application in the United States: it is one of the drugs with a sedative effect that is applied to prisoners sentenced to capital punishment before subjecting them to lethal injection, in order to render them unconscious (they are used high doses) before other substances that will cause death are applied.
Even so, the drug has a weak anesthetic effect and is not approved as such, and in fact there have been legal disputes to stop it being applied in this way, since there have been cases of prisoners in which it did not work.
Mechanism of action: how does it work?
Like many other benzodiazepines, midazolam acts on our body through a mechanism based on the alteration of the GABAergic system Specifically, midazolam is an indirect agonist of gamma-aminobutyric acid or GABA, which is one of the main inhibitory neurotransmitters in the brain.
This mechanism implies that the drug acts by activating the GABAergic receptors of the nervous system, something that has the effect of inhibiting the system and reducing the level of brain activation This action is especially relevant in the limbic system, which is linked to emotional responses, including anxiety.
Indications in pharmacological treatments
As we have seen, there are various different indications for this substance. Since it is a short-lived anxiolytic, it is especially indicated in those situations in which a sudden attack of anxiety and agitation appears, such as an anxiety crisis. It can also be used to induce sleep in people with sleep insomnia (that is, they have problems falling asleep).
Another of its main indications and uses is at a medical level, as a sedative drug to relax patients. before any type of surgical intervention or in a situation of being in the intensive care unit.
It is also applied at the level of anesthesia, mainly as a prior drug or for induction to the administration of other anesthetics. In addition, it is used as initial antiepileptic treatment in seizures, or in problems linked to muscle spasticity since it can help relax the muscles.
Side effects
As with the rest of the drugs, midazolam also may cause side or adverse effects and undesirable. Among them is the presence of prolonged sedation, headaches, nausea and vomiting, erythema, fatigue, involuntary movements, tremors, euphoria, agitation, confusion, incoordination, hallucinations, constipation, dry mouth or allergic reactions.
As it is sedative, it can cause falls and fractures, especially in the elderly. Also hypotension and vasodilation, respiratory disorders may appear which can lead to depression and respiratory arrest, decreased level of consciousness, tremors and aggressive behavior (a possible paradoxical effect).
In some cases, seizures have also been observed (especially in children or as an effect of withdrawal syndrome). Possible hypotension and slowing of heart and respiratory rates are especially relevant.
Last but not least, this and other benzodiazepines They can generate dependency and be linked to abusive uses (in the case of midazolam it is easier due to its rapid and short action) and even overdoses that can lead to coma and even death, as well as withdrawal syndromes (something that means that its withdrawal must be gradual).
Although the effects of this drug can be very useful, the truth is that midazolam may be contraindicated for some population groups due to the risk that its effects on the body may pose.
Among them are all those people who are allergic or hypersensitive to this drug or any of its components. They also have it contraindicated people who suffer from respiratory failure or depression, as well as those who suffer from heart problems sleep apnea or have a serious chronic illness.
It is not recommended or people with kidney or liver failure should exercise great caution. It should also not be used by people with myasthenia or glaucoma, people in a coma or those who are under the influence of alcohol or other depressant substances.
Concomitant use with other drugs should also be avoided, and the suitability should be consulted with the doctor since in some cases it may interact and its effects may be enhanced or diminished. Among them we can find some antidepressants, antihypertensives, antihistamines, antiretrovirals (as in the case of some of the protease inhibitors used in HIV), ketoconazole, fluconazole, diltiazem or some antibiotics.
Pregnant and lactating women should not use it unless necessary, since it can cause effects on the fetus and even cause dependence.
Although it is applicable in children, its use must be carried out with special caution with this sector of the population (it should be avoided as far as possible in children under six months of age unless necessary, and always with control and monitoring).
