BACK

How is Midazolam being used for COVID-19? Is it dangerous?

This article was published on
June 9, 2021

This explainer is more than 90 days old. Some of the information might be out of date or no longer relevant. Browse our homepage for up to date content or request information about a specific topic from our team of scientists.

Midazolam is a sedative primarily given to patients before a surgery or medical procedure, to help with seizures, and to critically ill patients in hospital settings. The medication has not been linked to premature deaths in patients that were purposely mislabeled as deaths caused by COVID-19.

Midazolam is a sedative primarily given to patients before a surgery or medical procedure, to help with seizures, and to critically ill patients in hospital settings. The medication has not been linked to premature deaths in patients that were purposely mislabeled as deaths caused by COVID-19.

Publication

What our experts say

Midazolam is also known under the brand name Versed. It is most frequently used before surgeries or procedures to decrease anxiety, cause drowsiness, and help with anesthesia in patients who need tubes or machines to help them breathe.

Less frequent uses of the medication are for epileptic patients' seizure clusters. Midazolam is also used in palliative care for patients in chronic pain or with terminal illnesses to promote a sense of calm and ease discomfort. The medication can also help people forget some memories associated with medical procedures like colonoscopies or resetting dislocated joints.

The medication was first used in a medicine in 1982. Now it is listed on the World Health Organization's List of Essential Medicines. Midazolam has been used in COVID-19 medical care, in people who have been sedated while they are on ventilators.

The drug works by slowing down brain activity, which helps with relaxation and sleep. It is a benzodiazepine, which is a group of medicines that slow down the central nervous system. The medication is most frequently given in hospitals, dental offices, or in other medical settings. It is more potent, shorter lasting, and can cause less injection site pain than other benzodiazepines. Unlike other benzodiazepines it needs to be administered by a medical professional.

Midazolam has a United States Food and Drug Administration black box warning, which notes that the medication has been associated with respiratory depression and arrest because it can slow or stop breathing. Black box warnings are issued to consumers when medications or products may have serious or life-threatening side effects that could lead to severe illness, hospitalizations, and death. This is why it is vital that medical professionals administer the medication in specific dosages and monitor patients after they have received the shot.

In recent years, Midazolam has been used as one of three medications which, when combined, are given to prisoners as part of death penalty executions. This usage has been highly controversial and subject to several lawsuits due to problems that have arisen as part of executions, including one man's death taking over two hours to complete.

Midazolam's use as an end-of-life care medication and as a drug used in executions should not be confused with the implication that the drug is being used to end the lives of COVID-19 patients in hospitals. There is no data to suggest this event has occurred in these circumstances. Patients with terminal diagnoses who have received the drug have been given the medication to ease their suffering, not to end their lives.

Context and background

In seven states in the United States, Midazolam has been used along with two other medications as a lethal injection drug in cases where the death penalty has been issued. However, the use of Midazolam in this context is very rare. It is primarily used as a sedative before medical procedures or to aid palliative care patients with pain management and anxiety, prevent seizures, and treat insomnia over the short-term.

Recent articles from website like The Daily Expose suggest that Midazolam has been used in the United Kingdom to "prematurely end the lives of thousands upon thousands of people" whom the public was told died from COVID-19. There is no evidence to suggest that the drug was used to end the life of any patients. Rather, Midazolam was most likely used on ventilated patients with COVID-19. It is one of the two most commonly used benzodiazepine medications for sedation in the ICU. This medication is frequently used in critically ill patients to keep them calm, allow their bodies to recover through rest, and ease discomfort and other physical symptoms.

This drug has been used frequently due to the virus' impact on patients admitted to the hospital, so it is currently listed as part a medication shortage caused by COVID-19. This is not due to Midazolam's very rare use in state-mandated executions. It is due to the coronavirus' spread and symptoms on hundreds of millions of people around the world.

Resources

  1. Sedation in the intensive care setting (The Journal of Clinical Pharmacology)
  2. Challenges in Sedation Management in Critically Ill Patients with COVID-19: a Brief Review (Current Anesthesiology Reports)
  3. Midazolam - Medical Countermeasures Database (United States National Institutes of Health Chemical Hazards Emergency Medical Management)
  4. Midazolam (Injection Route) (Mayo Clinic)
  5. Drugs@FDA: FDA-Approved Drugs (United States Food & Drug Administration)
  6. Midazolam (PubChem)
  7. Midazolam Nasal (Epilepsy Foundation)
  8. Overview of Lethal Injection Protocols (Death Penalty Information Center)
  9. midazolam (oral) (Michigan Medicine)
  10. How Does Execution Drug Midazolam Work? (Live Science)
  11. When a Common Sedative Becomes an Execution Drug (The New York Times)
  12. What is Midazolam? (GoodRx)
  13. After a Prolonged Execution in Ohio, Questions Over ‘Cruel and Unusual’ (The New York Times)
  14. We need to talk about Midazolam… (The Daily Expose)
  15. WeNeedToTalkAboutMidazolam (Twitter)

Media briefing

Media Release

Expert Comments: 

No items found.

Q&A

No items found.