2 It is used as premedication to inhibit anxiety and unpleasant memories during surgical procedures. It has powerful sedative, anticonvulsant, anxiolytic, and amnestic properties.
1 Midazolam is a safe benzodiazepine with a short half-life and rapid onset of action. Three benzodiazepines (diazepam, lorazepam, and midazolam) are frequently recommended for SE because they suppress a variety of seizures. However, benzodiazepines are less effective at terminating seizures when given 30 min or later after OP exposure or seizure onset, likely because of internalization or downregulation of synaptic, but not extrasynaptic, GABA A receptors, which can lead to diminished potency and seizure recurrence.īenzodiazepines are a first-line therapy for acute seizures and status epilepticus (SE), a life-threatening emergency characterized by persistent seizures lasting 30 min or more without regaining consciousness. In experimental models, midazolam is effective when given at the onset of seizures caused by nerve agents. Clinical studies such as the recent Rapid Anticonvulsant Medication Prior to Arrival Trial (RAMPART) trial have confirmed the anticonvulsant efficacy of midazolam in SE in prehospital settings. Due to its favorable pharmacokinetic features, midazolam is being considered as a replacement anticonvulsant for diazepam in the antidote kit for nerve agents. Midazolam is administered intravenously or intramuscularly to control acute seizures and SE. It potentiates GABAergic inhibition and thereby controls hyperexcitability and seizures.
Midazolam is a positive allosteric modulator of synaptic γ-aminobutyric acid (GABA) A receptors in the brain. Midazolam is considered the new drug of choice for persistent acute seizures and SE, including those caused by neurotoxic OPs and nerve agents. Midazolam is a benzodiazepine hypnotic with a rapid onset and short duration of action. Methodsīenzodiazepines are widely used to treat acute seizures and status epilepticus (SE), a neurologic emergency of persistent seizures that can lead to severe neuronal damage or death. This review summarizes the therapeutic potential of midazolam as an anticonvulsant antidote for organophosphate (OP) intoxication.
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