Significant hypotension following buccal midazolam administration

Abstract

Buccal midazolam is a rescue medication to reduce the duration of or stop an epileptic seizure, and is used to prevent status epilepticus. It is available in various forms, including a buccal preparation with a strength of 10 mg/1 ml. Midazolam is a licensed medication, but the buccal formulation is currently used off-licence. The prescriber takes ultimate responsibility for its use in this way. Administered by a trained person, it is receiving widespread acceptance as an alternative and effective treatment to rectally-administered diazepam in the community. The commonest side effects of midazolam are drowsiness and somnolence, although respiratory depression and paradoxical reactions, for example, agitation, restlessness and disorientation, may also occur. Hypotension is said to be a rare side effect, but with no reported cases in people administered buccal midazolam. The authors report a case of significant hypotension associated with administration of buccal midazolam for seizure management.

Buccal midazolam for pediatric convulsive seizures: efficacy, safety, and patient acceptability

“…Both Kutlu et al29 and Melendez et al30 reported no adverse cardiorespiratory effects in their series of patients. There is a single case report of an episode of hypotension following administration of buccal midazolam 31. An online report of a search of the UK National Health Service National Reporting and Learning System following a signal generated by a event involving respiratory depression in the community attributed to buccal midazolam administration revealed 132 reported medication incidents 32.…”