Depending on its dose, midazolam can cause any stage of a cardiovascular and respiratory depression. High i.v. doses have caused cardiac and respiratory arrest with lethal consequences. Usual doses normally cause a minor decrease of the blood pressure and oxygen saturation. The amnesia desired, e.g. for endoscopies, can last much longer than the intervention, sometimes for hours (semiconsciousness). Occasionally daydreams with sexual content occur. In addition to a multitude of central nervous symptoms (vertigo, dizziness, headaches, rarely hallucinations, etc.), midazolam can also cause visual disturbances and nausea. Repeated administration (e.g. as a sleeping aid) leads to tolerance and dependence within weeks; withdrawal syndrome often occurs if the drug is discontinued abruptly.

Midazolam: Interactions

A dangerous central nervous sedation can develop if midazolam is combined with alcohol or other centrally sedative drugs (e.g. opioids). Cimetidine and ranitidine cause higher midazolam levels.

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