Short answer: Midazolam is a fast, short-acting benzodiazepine used to sedate people for procedures and surgery and, as Nayzilam nasal spray, to stop seizure clusters at home. It is a Schedule IV controlled substance. In hospitals it is given with breathing monitoring, because it can slow or stop breathing.
Key takeaways
- What it is: Midazolam is a short-acting benzodiazepine and a Schedule IV controlled substance in the US.
- Main uses: Sedation for procedures; seizure emergencies.
- Timing: effects start in 3 to 5 minutes (IV); about 10 minutes (nasal) and last 1 to 4 hours.
- Most dangerous mix: Opioids (oxycodone, hydrocodone, fentanyl, heroin), which can cause profound sedation, slowed breathing, coma, death.
- Naloxone: it does not reverse this drug, but give it whenever opioids could be involved.
- Dependence risk: High with repeated use.
- Legal route: only with a prescription from a DEA-registered clinician, filled by a licensed pharmacy.
What is midazolam?
Midazolam is the most widely used sedative for procedures such as colonoscopy and for calming patients before surgery. It also causes amnesia, so people often do not remember the procedure.
Nayzilam nasal spray is approved for people 12 and older with epilepsy to treat seizure clusters outside the hospital, given by a caregiver.
Quick facts
| Fact | Midazolam |
|---|---|
| Generic name | Midazolam (hydrochloride) |
| Brand names | Versed (discontinued brand); Nayzilam nasal spray; Seizalam injection |
| Drug class | Short-acting benzodiazepine |
| US legal status | Schedule IV, prescription only |
| Approved uses | Sedation and amnesia for procedures; anesthesia; ICU sedation; seizure clusters (Nayzilam); status epilepticus (Seizalam) |
| Forms | Injection, oral syrup, nasal spray |
| Onset | 3 to 5 minutes intravenously |
| Half-life | About 2 to 6 hours |
| Broken down by | CYP3A4 |
How long does midazolam last?
- Starts working: 3 to 5 minutes (IV); about 10 minutes (nasal)
- Effects last: 1 to 4 hours
- Half-life: About 2 to 6 hours
Timing varies with the dose, the form, how it is taken, liver and kidney function, age, and other drugs taken at the same time.
What are the biggest risks of midazolam?
The FDA requires boxed warnings, its strongest, on midazolam products, including:
- Injected midazolam has been associated with slowed and stopped breathing, especially when used for sedation outside critical care settings. It must be given only where breathing and oxygen can be continuously monitored.
- Use with opioids can cause profound sedation, slowed breathing, coma, and death.
- Abuse, misuse, and addiction, which can lead to overdose and death, especially with alcohol, opioids, or other drugs.
- Physical dependence: stopping suddenly or reducing the dose quickly can cause life-threatening withdrawal reactions, including seizures.
Common side effects include drowsiness, hiccups, nasal discomfort (spray), and headache.
Breathing: slowed breathing and low oxygen are the main serious risks, especially with opioids, in older adults, and in people with lung disease.
Long-term ICU use: continuous infusions can cause dependence and withdrawal when stopped.
What should you never mix with midazolam?
| Combined with | What happens | Label guidance |
|---|---|---|
| Opioids (oxycodone, hydrocodone, fentanyl, heroin) | Profound sedation, slowed breathing, coma, death | Boxed warning; avoid unless no alternative |
| Alcohol | Deeper sedation, blackouts, slowed breathing | Avoid |
| Other sedatives (sleep medicines, gabapentinoids, muscle relaxants, antihistamines) | Additive drowsiness and impaired coordination | Use caution |
| Strong CYP3A4 inhibitors (ketoconazole, ritonavir, clarithromycin) | Prolonged, deeper sedation | Avoid or reduce dose |
| CYP3A4 inducers (rifampin, carbamazepine) | Reduced effect | Dose adjustment may be needed |
Check any combination with the DoseUses combination checker or ask a pharmacist.
What are the signs of a midazolam overdose, and what should you do?
Midazolam overdose causes deep drowsiness, confusion, poor coordination, slowed reflexes, and coma. With opioids or alcohol, breathing can stop.
If someone may have overdosed
- Call 911 if the person is unresponsive, hard to wake, or breathing slowly.
- For advice when the person is awake and stable, call Poison Help at 1-800-222-1222 (US, free, 24 hours).
- If opioids could be involved, including pills not from a pharmacy, give naloxone if you have it. Naloxone does not reverse midazolam, but it will not harm the person.
- Stay with the person and place them on their side if they are drowsy or vomiting.
What is midazolam withdrawal like, and how long does it last?
Single doses for procedures do not cause dependence. Repeated or continuous use, such as in intensive care, can cause withdrawal when stopped abruptly.
- HoursSymptoms beginAgitation, anxiety, tremor, and sweating after prolonged infusions.
- Days 1 to 3PeakConfusion, insomnia, and, rarely, seizures.
- Days to weeksResolvesSymptoms ease, often with a slow taper.
See the withdrawal timelines and the full midazolam withdrawal guide.
Is midazolam legal?
In the United States, midazolam is a Schedule IV controlled substance. The only legal way to get it is with a prescription from a clinician registered with the Drug Enforcement Administration (DEA), filled by a licensed pharmacy. Depending on state law, that can be a physician, nurse practitioner, or physician assistant.
- Refills: a Schedule IV prescription can be refilled up to five times within six months of the date it was written. After that, a new prescription is needed.
- Telehealth: federal flexibilities let DEA-registered clinicians prescribe Schedule II to V medicines after a telemedicine visit, without a prior in-person exam, through December 31, 2026. A permanent DEA rule was under final review in late 2026. State rules can be stricter.
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
Outside the United States
| Country | Status |
|---|---|
| United Kingdom | Class C; buccal midazolam (Buccolam) prescribed for seizures |
| Canada | Schedule IV of the Controlled Drugs and Substances Act |
| International | Schedule IV of the 1971 Convention on Psychotropic Substances |
Frequently asked questions about midazolam
Why don't people remember procedures with midazolam?
It causes anterograde amnesia, so memories of events after the dose are not stored.
Is midazolam used for seizures at home?
Yes. Nayzilam nasal spray lets caregivers treat seizure clusters outside the hospital.
Is Versed the same as midazolam?
Yes. Versed was the original brand name for midazolam.
Can you drive after midazolam?
No. Do not drive or make important decisions for at least 24 hours after sedation.
Is midazolam addictive?
Single doses carry little risk, but repeated use can lead to dependence.
Sources
- midazolam prescribing information, DailyMed, US National Library of Medicine.
- Nayzilam (midazolam nasal spray) prescription information, DailyMed, US National Library of Medicine.
- FDA warns about serious risks and death when combining opioid pain or cough medicines with benzodiazepines, US Food and Drug Administration, 2016.
- FDA requiring Boxed Warning updated to improve safe use of benzodiazepine drug class, US Food and Drug Administration, 2020.
- Controlled Substance Schedules, DEA Diversion Control Division.
- 21 CFR 1306.22, Refilling of prescriptions (Schedules III and IV), Electronic Code of Federal Regulations.
- Prescribing controlled substances via telehealth, US Department of Health and Human Services.
- BeSafeRx: Your Source for Online Pharmacy Information, US Food and Drug Administration.
This guide summarizes the sourced DoseUses Midazolam profile, written from FDA labels, DEA rules, and federal health agencies. It is educational and is not medical advice. Last updated October 5, 2026.
