Intranasal Midazolam for Claustrophobia in MRI

Moss, Morton L.; Buongiorno, Paul A.; Clancy, Virginia A.

doi:10.1097/00004728-199311000-00029

Cited by 20 publications

(12 citation statements)

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“…Moreover, one main difference compared to the study of Hollenhorst et al [2] is that our patients were scheduled for body MRI and not for a neuroradiological indication. In the study of Moss et al [14], the kind of examined body regions was not reported. Compared to neuroradiological MRI, body MRI is usually more time consuming and partially requires particular techniques which need the compliance and active cooperation of the patient.…”

Section: Discussionmentioning

confidence: 96%

“…However, the experience with midazolam in patients for radiological examinations and, in particular, in patients referred for MRI is limited. Several years ago, Moss et al [14] presented their preliminary results using intranasal midazolam for claustrophobic MRI patients. This route of administration reduced the necessity for i.v.…”

Section: Discussionmentioning

confidence: 99%

“…Schweizer et al [3] reported an improvement of panic disorders in 4/5 patients using a total dose of 0.5-1.0 mg of self-administrated intranasal midazolam drops. Moss et al [14] also used a total dose of 0.5-1.0 mg in claustrophobic patients scheduled for MRI, reducing dramatically the number of patients needing additional i.v. sedation.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, intranasal application of midazolam took place 15 min before MRI. In the study of Moss et al [14], patients received two drops per nostril of a midazolam solution (total 0.5 mg) prior to entering the scanner without a time definition. This dose could be repeated during the MRI procedures (total 1.0 mg).…”

Section: Discussionmentioning

confidence: 99%

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Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

Tschirch

Göpfert

Fröhlich³

et al. 2006

Eur Radiol

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The purpose of this study was to assess prospectively the potential of low-dose intranasal midazolam compared to oral midazolam in claustrophobic patients undergoing routine body magnetic resonance imaging (MRI). Seventytwo adult claustrophobic patients referred for body MRI were randomly assigned to one of two treatment groups (TG1 and TG2). The 36 patients of TG1 received 7.5 mg midazolam orally 15 min before MRI, whereas the 36 patients of TG2 received one (or, if necessary, two) pumps of a midazolam nasal spray into each nostril immediately prior to MRI (in total, 1 or 2 mg). Patients' tolerance, anxiety and sedation were assessed using a questionnaire and a visual analogue scale immediately before and after MRI. Image quality was evaluated using a five-point-scale. In TG1, 18/36 MRI examinations (50%) had to be cancelled, the reduction of anxiety was insufficient in 12/18 remaining patients (67%). In TG2, 35/36 MRI examinations (97%) were completed successfully, without relevant adverse effects. MRI image quality was rated higher among patients of TG2 compared to TG1 (p<0.001). Low-dose intranasal midazolam is an effective and patientfriendly solution to overcome anxiety in claustrophobic patients in a broad spectrum of body MRI. Its anxiolytic effect is superior to that of the orally administrated form.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

Tschirch

Göpfert

Fröhlich³

et al. 2006

Eur Radiol

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“…A limited number of studies (2,4,5) have shown the potential of nasally administrated midazolam for reduction of anxiety-related claustrophobia in patients undergoing MR imaging. However, all these studies were single-center studies with a limited number of patients.…”

mentioning

confidence: 99%

Multicenter trial: Comparison of two different formulations and application systems of low‐dose nasal midazolam for routine magnetic resonance imaging of claustrophobic patients

Tschirch

Suter

Froehlich³

et al. 2008

Magnetic Resonance Imaging

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Purpose:To prospectively assess and compare two formulations and methods of administration of low-dose nasal midazolam for the treatment of claustrophobic patients undergoing magnetic resonance imaging (MRI) as part of a multicenter Phase III trial. Materials and Methods:In all, 108 consecutive adult claustrophobic patients were randomly assigned to one of two treatment groups (multidose group: MDG, unit-dose group: UDG). MDG encompassed 55 patients who received intranasally a 0.5% midazolam formulation into each nostril (total dose, 1.0 mg), whereas the 53 patients in UDG received a 1% midazolam formulation into only one nostril (total dose, 1.0 mg). This initial dose could be repeated once. Patient tolerance and anxiety were assessed using a questionnaire and a visual analog scale immediately before and after MRI. Image quality was evaluated using a fivepoint scale.Results: In all, 53/55 MR examinations (96%) with MDG and 52/53 (98%) with UDG were completed successfully. The dose of 1 mg had to be repeated significantly less often in UDG compared to MDG (4/53, 8% vs. 13/55, 24%; P ϭ 0.003). The image quality of all MR examinations was rated good to excellent, and slightly better in UDG (P ϭ 0.045).Conclusion: Nasally applied low-dose midazolam is a patient-friendly solution to facilitate MRI of claustrophobicpatients. The nasal spray of UDG is superior to that of MDG with a necessity of additional dosing.

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Pharmacokinetics and Pharmacodynamics of Midazolam After Intranasal Administration

Burstein

Modica

Hatton

et al. 1997

The Journal of Clinical Pharma

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This study aimed to characterize the pharmacokinetics and pharmacodynamics of midazolam after intranasal administration to healthy volunteers. Eight participants were given 0.25 mg/kg intranasally and 2 mg intravenously in a randomized, crossover fashion. Blood samples for determination of plasma concentrations of midazolam and measures of cognitive function (using the digit symbol substitution test) were obtained at baseline and 5, 10, 20, 30, 45, 60, 90, 120, 180, 240, and 360 minutes after administration of study medications. Plasma samples were analyzed by gas chromatography (% coefficient of variation < 10%). Pharmacokinetic data were fitted using iterative two-stage analysis to a two-compartment model. Pharmacodynamic data were fitted by a baseline subtraction Hill-type model. The mean (SD) for total clearance, distributional clearance, volume of distribution in the central compartment, volume of distribution in the peripheral compartment, absorption rate constant, bioavailability, and half-life were 0.57 (0.26) L/hr/kg, 0.31 (0.29) L/hr/kg, 0.27 (0.14) L/kg, 0.67 (0.11) L/kg, 2.46 (1.72) hr-1, 50% (13%), and 3.1 (0.84) hours, respectively. The mean (SD) for the concentration at which the effect is half maximal (EC50) and the maximal effect or the maximal change in effect measure from baseline (Emax) were 63.1 (21.2) ng/mL and 52.8 (21.1) correct substitutions, respectively. After intranasal administration, midazolam concentrations rapidly achieve values considered sufficient to induce conscious sedation and produce predictable changes in digit symbol substitution score.

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Intranasal Midazolam for Claustrophobia in MRI

Cited by 20 publications

References 0 publications

Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

Low-dose intranasal versus oral midazolam for routine body MRI of claustrophobic patients

Multicenter trial: Comparison of two different formulations and application systems of low‐dose nasal midazolam for routine magnetic resonance imaging of claustrophobic patients

Pharmacokinetics and Pharmacodynamics of Midazolam After Intranasal Administration

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