Formulary
Remimazolam: Indications, Dosing, Side Effects and Interactions
Remimazolam clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Remimazolam: Indications, Dosing, Side Effects and Interactions
Remimazolam clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Conscious sedation**
- **Adult** (By Intravenous Injection): for procedures (consult product literature).
Cautions
Avoid prolonged use (and abrupt withdrawal thereafter); debilitated patients (reduce dose); elderly (reduce dose); history of alcohol dependence or abuse; history of drug dependence or abuse; myasthenia gravis; personality disorder (within the fearful group-dependent, avoidant, obsessive-compulsive) may increase risk of dependence; respiratory disease Cautions, further information Paradoxical effects A paradoxical increase in hostility and aggression may be reported by patients taking benzodiazepines. The effects range from talkativeness and excitement to aggressive and antisocial acts. Adjustment of the dose (up or down) sometimes attenuates the impulses. Increased anxiety and perceptual disorders are other paradoxical effects. Elderly Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) criteria to aid medication reviews (see Prescribing in the elderly for information). Potentially inappropriate: for a duration of 4 weeks or longer (no indication for longer treatment; risk of adverse events; all benzodiazepines should be withdrawn gradually if taken for more than 2 weeks as there is a risk of causing a benzodiazepine withdrawal syndrome if stopped abruptly) with acute or chronic respiratory failure i.e. PaO 2 < 8 kPa with or without PaCO 2 > 6.5 kPa (risk of exacerbation of respiratory failure) in patients prone to falls (sedative, may cause reduced sensorium and impair balance) Cautions For remimazolam Cardiac disease Cautions, further information Recovery when used for sedation Remimazolam has a fast onset of action, recovery is faster than for other benzodiazepines such as diazepam, but may be significantly longer in the elderly, in patients with severe hepatic impairment, or with body weight less than 50 kg.
Contraindications
Acute pulmonary insufficiency; marked neuromuscular respiratory weakness; not for use alone to treat chronic psychosis; not for use alone to treat depression (or anxiety associated with depression); obsessional states; phobic states; sleep apnoea syndrome; unstable myasthenia gravis
Side effects
Common or very common Alertness decreased; anxiety; ataxia (more common in elderly); confusion (more common in elderly); depression; dizziness; drowsiness; dysarthria; fatigue; headache; hypotension; mood altered; muscle weakness; nausea; respiratory depression (particularly with high dose and intravenous use-facilities for its treatment are essential); sleep disorders; tremor; vision disorders; withdrawal syndrome Uncommon Agitation (more common in children and elderly); anterograde amnesia; behaviour abnormal; hallucination; libido disorder; rash Rare or very rare Aggression (more common in children and elderly); blood disorder; delusions; jaundice; paradoxical drug reaction; restlessness (with sedative and peri-operative use); urinary retention Frequency not known Drug dependence Overdose Benzodiazepines taken alone cause drowsiness, ataxia, dysarthria, nystagmus, and occasionally respiratory depression, and coma. For details on the management of poisoning, see Benzodiazepines, under Emergency treatment of poisoning . Side-effects For remimazolam Common or very common Arrhythmias; dyspnoea; gas exchange abnormal; respiratory disorders; vomiting Uncommon Chills; feeling cold; hiccups
Pregnancy
Risk of neonatal withdrawal symptoms when used during pregnancy. Avoid regular use and use only if there is a clear indication such as seizure control. High doses administered during late pregnancy or labour may cause neonatal hypothermia, hypotonia, and respiratory depression. Pregnancy For remimazolam Avoid-limited information available. M
Breast feeding
Avoid breast feeding for 24 hours after administration-present in milk in animal studies. M
Hepatic impairment
In general, manufacturers advise caution in mild to moderate impairment; avoid in severe impairment. Benzodiazepines with a shorter half-life are considered safer. Dose adjustments In general, manufacturers advise dose reduction in mild to moderate impairment, adjust dose according to response. Hepatic impairment For remimazolam Caution in severe impairment (more pronounced and prolonged effects). M Dose adjustments Titrate doses with caution in severe impairment. M
Renal impairment
In general, manufacturers advise caution (risk of increased cerebral sensitivity to benzodiazepines). Dose adjustments In general, manufacturers advise to consider dose reduction.
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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