Safety and effectiveness of high-dose midazolam for severe behavioural disturbance in an emergency department with suspected psychostimulant-affected patients

Emerg Med Australas. 2008 Apr;20(2):112-20. doi: 10.1111/j.1742-6723.2008.01066.x.


Objectives: To trial high-dose midazolam sedation protocol for uncooperative patients with suspected psychostimulant-induced behavioural disorders. End-points were effectiveness and safety.

Methods: A prospective pilot study was undertaken with a convenience sample of adult, uncooperative patients with suspected psychostimulant-induced severe behavioural disorders. The protocol was midazolam in 10 mg increments, i.m. or i.v., at 10 min intervals, up to four doses and titrated to an end-point of rousable drowsiness.

Results: Sixty-two patients were enrolled. Two-thirds of the patients required only one dose of midazolam; 88% of the sample were sedated with two doses. Six and a half per cent of patients were not sedated after four doses. A Glasgow Coma Score of eight or less was prolonged in eight patients. Airway problems requiring an adjunct were present in four patients. Recent psychostimulant use was present in only 55% after full assessment.

Conclusions: High-dose midazolam protocols cannot be supported as universally safe. High-dose protocols for severe behavioural disturbance are not more effective, with failures occurring even after repeated dosing.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Emergency Service, Hospital
  • Female
  • Glasgow Coma Scale
  • Humans
  • Hypnotics and Sedatives / administration & dosage*
  • Male
  • Midazolam / administration & dosage*
  • Pilot Projects
  • Prospective Studies
  • Psychomotor Agitation / drug therapy*
  • Psychomotor Agitation / etiology
  • Safety
  • Substance-Related Disorders / complications*
  • Treatment Outcome


  • Hypnotics and Sedatives
  • Midazolam