Versed (Midazolam) at a glance: schedule, half-life, and class
- 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
Versed uses: what midazolam is prescribed for
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.[1]
Nayzilam nasal spray is approved for people 12 and older with epilepsy to treat seizure clusters outside the hospital, given by a caregiver.[2]
Versed dosage: how midazolam is usually prescribed
The figures below come from the FDA-approved label and describe how prescribers typically use midazolam. They are not personal dosing advice. A prescriber sets the dose for each person and adjusts it over time.[1]
| Product | Typical adult dose | Notes from the label |
|---|---|---|
| Nayzilam nasal spray (seizure clusters) | 5 mg (one spray) in one nostril | A second 5 mg dose may be given after 10 minutes |
| Nayzilam limits | No more than 2 doses per episode | Treat no more than 1 episode every 3 days and 5 a month |
| Injection for procedures | Dosed by weight and response | Only with breathing monitoring and resuscitation equipment |
Versed (midazolam) side effects and risks
FDA boxed warnings
- 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.[1]
- Use with opioids can cause profound sedation, slowed breathing, coma, and death.[3]
- Abuse, misuse, and addiction, which can lead to overdose and death, especially with alcohol, opioids, or other drugs.[4]
- 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.[1]
Breathing: slowed breathing and low oxygen are the main serious risks, especially with opioids, in older adults, and in people with lung disease.[1]
Long-term ICU use: continuous infusions can cause dependence and withdrawal when stopped.
Versed interactions: what not to mix with midazolam
Choose what it would be combined with:
| 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 |
This is not a full list. A pharmacist can check a complete medication list, including supplements and over-the-counter products.[1]
Versed overdose: signs of midazolam overdose and what to do
Midazolam overdose causes deep drowsiness, confusion, poor coordination, slowed reflexes, and coma. With opioids or alcohol, breathing can stop.[1]
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.
Versed withdrawal timeline: how long midazolam withdrawal lasts
Single doses for procedures do not cause dependence. Repeated or continuous use, such as in intensive care, can cause withdrawal when stopped abruptly.[1]
- 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.
Hospitals usually taper long infusions gradually or switch to a longer-acting medicine.
How to get prescribed Versed (midazolam) legally in the US
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.[5]
- 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.[6]
- 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.[7]
- Monitoring: prescribers and pharmacists in most states check a prescription drug monitoring program, a database of controlled-substance prescriptions, before prescribing or dispensing.
- Pharmacies: a legitimate pharmacy always requires a valid prescription, has a licensed pharmacist available, and is licensed in the state it ships to. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm a pharmacy is real.[8][9]
- Cost: nayzilam is a brand-only product and can be costly without insurance; hospital midazolam is billed as part of care.
Traveling: keep the medicine in its original pharmacy container and carry a copy of the prescription. Check the rules of the destination country before travel, because many countries restrict controlled medicines or require a permit.
Can you order Versed (midazolam) online legally?
Yes, but only with a valid prescription and only from a pharmacy licensed in your state. Many licensed pharmacies, including mail-order pharmacies run by insurers, fill midazolam prescriptions online and ship them. Buying midazolam from a website that does not require a prescription is illegal, and the product is often fake.[8][10]
- See a licensed clinicianA clinician evaluates you in person or by telemedicine and decides whether midazolam is appropriate.
- The prescription goes to a pharmacyPrescriptions are usually sent electronically, straight from the prescriber to the pharmacy you choose.
- The pharmacy checks and fills itA pharmacist verifies the prescription and your identity, then dispenses the medicine in person or by mail.
Signs that an online seller is illegal:
- It sells midazolam with no prescription, or after only a short online questionnaire.
- It takes orders through social media, messaging apps, or email.
- It asks for payment in cryptocurrency, gift cards, or money transfers.
- It has no US street address, no state pharmacy license, and no pharmacist to speak to.
- Its prices are far below those of ordinary pharmacies, or it ships from another country.
The FDA's BeSafeRx tool links to each state's license lookup, and the National Association of Boards of Pharmacy lists verified online pharmacies.[8][9]
Versed price: how much does Versed (midazolam) cost without insurance?
Nayzilam is a brand-only product and can be costly without insurance; hospital midazolam is billed as part of care.
What you pay depends on the strength, the number of doses, your insurance plan, and the pharmacy. Cash prices for the same prescription can differ several times over between pharmacies in the same town, so check current prices before you fill it.
Ways to pay less, legally:
- Ask the prescriber whether a generic midazolam is available. FDA-approved generics work the same way as the brand and usually cost much less.
- Compare cash prices between pharmacies before you fill the prescription.
- Use a free prescription discount card, such as GoodRx or SingleCare, when you pay cash. These cards cannot be combined with insurance on the same fill.
- For brand-name medicines, check the manufacturer's savings program or patient assistance program.
- Ask about a 90-day supply or your insurer's mail-order pharmacy, which often lowers the cost per dose when your prescriber agrees it is appropriate.
Warning: A price far below what licensed pharmacies charge, especially with no prescription required, is a strong sign of an illegal seller and counterfeit medicine.[8]
Is Versed legal? Midazolam legal status in other countries
| 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 |
Laws change and differ in detail. Check current rules before carrying any controlled medicine across a border.[11]
Common questions about Versed (midazolam)
Why don't people remember procedures with Versed (midazolam)?
It causes anterograde amnesia, so memories of events after the dose are not stored.
Is Versed (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 Versed (midazolam)?
No. Do not drive or make important decisions for at least 24 hours after sedation.
Is Versed (midazolam) addictive?
Single doses carry little risk, but repeated use can lead to dependence.
Can you buy Versed (midazolam) without a prescription?
No. Versed (midazolam) is a Schedule IV controlled substance in the US, so it is illegal to buy or possess it without a valid prescription. Websites and social media sellers that offer it without one are not legal pharmacies, and the DEA warns that pills sold this way are often counterfeit and can contain fentanyl. The legal route is a visit with a licensed clinician, in person or by telehealth, and a prescription filled at a state-licensed pharmacy. The FDA's BeSafeRx tool and the NABP's safe pharmacy list help confirm an online pharmacy is real.
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.
- Safe Pharmacy. National Association of Boards of Pharmacy.
- One Pill Can Kill. US Drug Enforcement Administration.
- International drug control conventions. United Nations Office on Drugs and Crime.
