Midazolam: Safety of use in palliative care: A systematic critical review

Biomed Pharmacother. 2019 Jun:114:108838. doi: 10.1016/j.biopha.2019.108838. Epub 2019 Apr 10.


Purpose: The undesired effects of midazolam can be life-threatening. This paper delineates the findings related to the pharmacokinetics, adverse effects and drug-drug interactions as well as associated therapeutic implications for safe midazolam use.

Methods: A systematic review of literature was conducted.

Results: The pharmacokinetics of midazolam depends on hepatic and renal functions, fat tissue mass, route and duration of administration, as well as potential drug-drug interactions. Palliative care patients constitute a high-risk group prone to side effects of drugs, due to polytherapy and multi-organ failure.

Conclusion: Midazolam is one of three most frequently administered drugs in palliative care. The indications for its use include anxiety, dyspnea, seizures, vomiting refractory to treatment, agitation, myoclonus, status epilepticus, restlessness, delirium, pruritus, hiccups, insomnia, analgosedation, palliative sedation and preventing or counteracting undesired effects of ketamine.

Keywords: Context-sensitive half-life; Drug-drug interactions; Midazolam; Palliative care; Palliative sedation; Pharmacokinetics.

Publication types

  • Systematic Review

MeSH terms

  • Drug Interactions / physiology
  • Humans
  • Hypnotics and Sedatives / adverse effects*
  • Hypnotics and Sedatives / pharmacokinetics
  • Ketamine / therapeutic use
  • Kidney / drug effects
  • Liver / drug effects
  • Midazolam / adverse effects*
  • Midazolam / pharmacokinetics
  • Palliative Care / methods


  • Hypnotics and Sedatives
  • Ketamine
  • Midazolam