However, for long-term sedation, lorazepam is preferred due to its long duration of action, Midazolam is sometimes used in neonatal intensive care units.
When used, additional caution is required in newborns; midazolam should not be used for longer than 72 hours due to risks of tachyphylaxis, and the possibility of development of a benzodiazepine withdrawal syndrome, as well as neurological complications.
which typically results in tolerance and benzodiazepine withdrawal syndrome when the dose is reduced too rapidly.
Midazolam infusions may induce tolerance and a withdrawal syndrome in a matter of days.
Paradoxical behavior is often not recalled by the patient due to the amnesia-producing properties of the drug.
Therefore, preventing a withdrawal syndrome requires that a prolonged infusion be gradually withdrawn, and sometimes, continued tapering of dose with an oral long-acting benzodiazepine such as clorazepate dipotassium.Tolerance develops rapidly to the anticonvulsant effect, and the dose may need to be increased by several times to maintain anticonvulsant therapeutic effects.With prolonged use, tolerance and tachyphylaxis can occur and the elimination half-life may increase, up to days.Withdrawal symptoms can sometimes resemble a person’s underlying condition.Gradual reduction of midazolam after regular use can minimise withdrawal and rebound effects.