Midazolam

Factual Questions
1

Does anyone have any experience with this medication (brand names Dormicum and Versed)? My doctor prescribed it to me for chronic sleeplessness, yet a quick review of RX sites on the Web leads me to believe that this is strong stuff. Any first-hand anecdotes?

Note: While it is not indicated in the U.S. for home treatment of insomnia, but rather as a clinical anesthetic and amnestic in larger doses, I am located in Mexico where it is legally indicated for such home treatment at a lower dosage.

Thanks as always…

“Where there is clarity, there is no choice. And where there is choice, there is misery. But then, why should I speak, since I know nothing?”

2

Versed is the ICU nurse’s best friend. It IS powerful stuff, though. I know some nurses who won’t give it to a patient who isn’t already on a ventilator because it can cause respiratory depression, but I’m not afraid of it in small doses. (Also, we always give it intravenously, which I doubt is what your doctor prescribed for you.) We use Versed to calm down wild-and-crazy-jumping-out-of-the- bed-delirium-tremens-type patients, and during procedures such as endoscopy and the insertion of various tubes and lines.

I can’t imagine taking Versed for insomnia, though I don’t doubt it’s effective. It’s a benzodiazepine, along the lines of Valium and Ativan, which are all highly addictive. This is NOT something you want to take regularly.

3

Geeze Louise. Your doctor prescribes this stuff and then you come here asking questions about it? See your doctor, yuh nut!

4

Nickrz, FWIW - Medical profession and pharmaceutical custom here isn’t like in the U.S., where you get consumer information, contraindications and such stuff along with your prescription. Basically, doctor says “Take this” and you take it. Hell, pharmacy packaging for heavy-duty drugs usually says only “follow doctor’s instructions.”

So whenever I or someone in my family is prescribed a medication with which I have no personal experience or knowledge, I run to Rxlist or the pharm’s web pages, to find out as much as I can. I was surprised to find that the doc’s recommended treatment for bad sleep is a strong benzodiazepine.

Along similar lines, here many physicians prescribe metamizol for pediatric fever control. Metamizol is banned in the U.S. because of severe life-threatening reactions. I think it is even forbidden for most veterinary uses; it was commonly used as an equine antipyretic.

Mother Jones once had an article called something like “If there aren’t any side effects you must be in Guatemala”… about how drugs deemed unsafe in the “developed world” are shipped elsewhere and marketed as safe. So while I do trust my doctor, I think it’s good to get as much information as possible on the stuff I’m putting into my body, from whatever sources available.

5

I administer midazolam (Versed) everyday in my practice. We give it to patients prior to surgery to relieve anxiety and to induce a state of amnesia (most people don’t want to remember their surgery). As far as using it for a sleep aid…there are better drugs out there as midazolam does not produce a “quality” sleep. It can be dangerous, like any drug, at higher doses though some people will become tolerant of its effects and require a higher dose to produce the same result.

6

The reason Versed is so popular in the US for medical procedures is how fast it wears. Hospitals cover their butts by telling patients not to drive themselves home after a procedure for which Versed was used, but it really does clear out of the body very fast.

This also make it less desirable as a sleep aid, in that it may well have you waking up after 2-4 hours bright-eyed & bushy-tailed. If you wait an hour & then take a 2nd pill, you’re probably not going to feel real good in the morning.

It is a potent sedative, but like it’s longer lasting cousins, Xanax, Ativan, & Valium, has a very strong potential for tolerance (requiring higher doses for same effect) & addiction. Alcohol increases the depth & the duration of the sedation, so do not use them in combination. I really wouldn’t recommend using the Versed at all.

Good luck!

Sue from El Paso
members.aol.com/majormd/index.html

7

Nickrz - I realize that you have to say that for legal reasons; however, it’s not really a good idea to get all of your medical information from one source. There are good doctors and there are bad doctors - you can’t really know which type you have without some external information. In the meantime a bad doctor can really screw you up.

Case(s) in point from when I was still living at home:
Mom started having severe problems with “klutziness”: dropping things, tripping, etc. So severe she talked to her doctor, he couldn’t find anything so he finally sent her to a neurologist. The neurologist determined that her problem was an overdose of a prescription that the first doctor had prescribed * and he hadn’t even realized what an overdose could do!* And he had her taking a very high dosage.

At another point, she was taking quinine and getting a fever and flulike symptoms. The nurse told her that it couldn’t be the quinine, that that wasn’t a side effect. She read later that one of the side effects of quinine is fever. (To give the nurse credit, Mom is likely to get nearly every side effect possible from a drug)

Lastly, same doctor as the first story gave her a refillable prescription for cortisone pills and told Mom to take one whenever she had a bad allergic reaction. Well, Mom had a lot of bad allergic reactions, and he didn’t tell her that it can stop her bodies own ability to produce cortisone, if taken too often. She’s been on cortisone/prednisone for twenty years now (switched to prednisone some time back) Unfortunately, prednisone (and cortisone) have really nasty side effects…
She might not have avoided these problems completely, but had she read about these prescriptions, she would have had fewer problems (especially now, with the prednisone)

This is why, at least in this area you get a complete writeup on all prescription medications.

8

Zyada-

I know lots and lots about prednisone. If there are any side effects that your mother is having particular trouble with, please let me know. I work with a group of people all of whom have taken pred, some for years. You can email me at RedQueen0916@cs.com

9

Zyada -
It should be possible for your mom to come off the steroids if someone is willing to work with her closely & she is willing to tolerate a few aches & see her doctor EVERY time she thinks she is having an allergic problem before increasing the amount of steroids.
I really would advise her to see an Endocrinologist or Internal Medicine doctor & hope that they would be willing to work with her for 6-12 months to accomplish the steroid taper gradually enough for her own steroid production to kick in.
I would also recommend she get tested for bone density & talk with her doc about various options for preserving her bones & preventing future fractures.

Good luck!

Sue from El Paso
members.aol.com/majormd/index.html

10

Nickrz has the right idea to see your doctor, but I have one better, go see a pharmacist. They love to give out info on drugs. I have found some to have more knowledge on drugs than doctors. After all they go to school specifically for that.

11

Thanks to all who answered. For your information, in case you’re wondering how midazolam is indicated for sleeplessness:

(This is from Roche Argentina, translated and edited by me)

Indications: Treatment for short-duration insomnia. Benzodiazepines should be indicated only when the problem is severe and blocks or causes an extreme degree of emotional tension for the patient.

Pharmacology: Dormicum Roche has a fast-acting and short-lasting sedative and hypnotic action. Also has anticonvulsive and myorelaxive properties.

Administration and Dosage: The treatment should be as brief as possible. Generally the duration ranges from a few days to a maximum of two weeks. The decrease of dosage should be gradual, according to the patient’s response.

Dormicum Roche tablets should be taken immediately before going to bed, and taken whole with a liquid. Habitual dosage: Adults-dosage will range from 7.5 mg to 15 mg. For elderly and weak patients the recommended dosage is 7.5 mg. The maximum dosage should not be exceeded due to the risk of adverse effects on the central nervous system.

Special dosing instructions: Dormicum Roche may be taken at any time of day, provided that the patient can ensure an interrupted sleep time of at least 7-8 hours. If the patient is simultaneously receiving cimetidine, diltiazem, verapamil, ketoconazol and itraconazol, see the section on drug interaction.

12

Zyada - I guess my next point would be - If you don’t trust the doctor who prescribed the drug(s) for you, why would you be visiting them in the first place?

Mariachi - I didn’t know that. You mean a doctor in Mexico will not answer questions about the drugs he or she is prescribing for their patient?

13

I worked in a pharmacy for many years- both retail and hospital. Ask a pharmacist for drug info- they are a wealth of information and a good one really keeps up on things. They can give you loads more info (usually) then your own doc.

I’m very lucky. The only time I was ever up shit creek, I just happened to have a paddle with me.
–George Carlin

14

Nickrz - If you’re lucky, your doctor will tell you to take your antibiotics with milk.

In the present case, I saw my doctor last week for rhinitis and as he was prescribing a course of treatment, I said hey by the way I’ve been sleeping bad for several months. He said OK, and added the Dormicum. He did tell me to finish the Klaricid/Claritin/Febrax treatment before starting. I asked what is Dormicum, he said “it regulates the sleep pattern.” I asked for more information, but didn’t get much more. Hence my web search and post…

The doc tends to be liberal with medication, but on several occasions his treatments have kept me out of invasive procedures which, according to what I’ve read, would normally be a first line of treatment in the U.S.

I think the underlying theme here is “Trust me, I’m a doctor.” People in my wife’s family have had physicians who say “Hey who went to med school?” when questioned about the propriety of a prescribed treatment. You find a lot of that in the public health system.

To be fair, I have a pretty good doctor, by Mexican and even by U.S. standards. He is a member of U.S. medical boards and associations. In general, the care that I and my family have received here has been superb, compared to the HMO/PPO crap we got when we lived in Chicago.

15

Dialogue in Japan between a doctor and a patient.

Doctor: You need to take this blue powder and this white powder.

Patient: What is it?

Doctor: Blue powder and white powder.

Patient: Oh.

Disclaimer: This is true of many doctors in Japan, but not of all. I’ve met a very informative doctor in my town and I stick with him.

My point is that even in industrialised nations, doctors are not very forward giving information about the treatments and medications they prescribe. Getting a second opinion is wise.

Only humans commit inhuman acts.

16

Nickrz - “If you don’t trust the doctor who prescribed the drug(s) for you, why would you be visiting them in the first place?”

Interesting question. Several things:

My position is not a trust issue, but an education issue. I advocate educating yourself on long term health issues; getting information from different, trusted sources is part of that education process.

Trunst is not all or nothing. There are different levels of trust, and educated trust is different that blind, unquestioning trust. If you give your car mechanic unquestioning trust, you may end up paying for unnecessary car repairs. If you do the same with doctors, you may end up with long term health problems. You can trust a doctor to give you a prescription for a problem, but if you get an unlimitied prescription or you’re going to take a prescription every day for the rest of your life, that’s a much bigger impact on your health, and a much bigger risk.

I also recognize the limitations of doctors. A doctor is responsible for the health of hundreds of people, and for knowing how hundreds(or more?) health problems affect the body, and how to diagnose and treat them, or what kind of doctor is best suited to deal with them. I, OTOH, am only responsible for my health, (and my children if I have any) and I have the option of educating myself on my problems, or leaving it in my doctor’s hands. By educating myself, I help my doctor in her job and reduce the chance that I will face the problems my Mom did. I also reduce the chance that medicines from different doctors or OTC medicines interact badly.

The science of medicine is extremely complicated and new things are being discovered every day. A doctor may keep up with changes, or may not. (This is why I always get young doctors) Many medicines that doctors prescribe are new, and the doctor may not know any more about them except what PDR says. And he or she may not remember everything PDR say. Why spend your time with doctor having him/her recite from a book, if you can check it at the local drugstore?

It also helps that I’ve had several doctors commend me on my knowledge. And that I’ve found non-medical or OTC solutions through education that worked better or in a more healthful manner than what the doctor had recommended.

It also affected me when I had a dentist look in my mouth and say “Damn, your last dentist was terrible”. That’s a frightening thing to hear.