Summary
Midazolam is a Schedule IV controlled substance in the United States and a prescription-only medication in most countries. It should never be combined with other depressants due to extreme risk of fatal respiratory depression. Users with liver or kidney impairment may experience prolonged effects and should avoid use or reduce doses significantly. The sudden discontinuation after prolonged use can be dangerous or life-threatening and requires medical supervision with gradual tapering. Midazolam causes anterograde amnesia, meaning users will not remember events during peak effects.
Dose Information
| ROA | Light | Common | Strong | Heavy |
|---|---|---|---|---|
| Oral | 2.5-5mg | 5-15mg | 15-30mg | 30mg+ |
| Intranasal | 3-7mg | 7-15mg | 15-25mg | 25mg+ |
| Intramuscular | 3-5mg | 5-12mg | 12-25mg | 25mg+ |
| Intravenous | 1-2mg | 2-4mg | 4-5mg | 5mg+ |
| Insufflated | 3-7mg | 7-15mg | 15-25mg | 25mg+ |
| Rectal | 3-7mg | 7-15mg | - | - |
Light
Common
Strong
Heavy
Onset, Duration & After-effects
| ROA | Onset | Comeup | Peak | Offset | After Effects | Total |
|---|---|---|---|---|---|---|
| Oral | 30-60 min | 30-60 min | 1-2 hrs | 1-2 hrs | 6 hrs | 240-0 min |
| Intranasal | 5-15 min | - | 10-30 min | 1-2 hrs | 4 hrs | 240-0 min |
| Intramuscular | 2-30 min | - | 30-60 min | 1-2 hrs | 6 hrs | 240-0 min |
| Intravenous | 1-5 min | - | 5-15 min | 30-90 min | 4 hrs | 240-0 min |
| Insufflated | 1-5 min | - | 4.0-8.0 hrs | - | 1.0-12.0 hrs | 240-0 min |
| Rectal | 15-25 min | - | 4.0-8.0 hrs | - | 1.0-12.0 hrs | 240-0 min |
Tolerance
Build-up
develops over 1–4 weeks of daily use; hypnotic tolerance faster than anxiolytic tolerance
Reset
weeks to months depending on half-life and duration of use; taper recommended
Cross-tolerance
Effects
Positive
- Muscle Relaxation
- Anxiolytic
- Muscle Relaxant
Negative
- Respiratory Depression
- Nausea or vomiting
- Tremor
- Sedation
- Sedative
- Dystaxia
- Hypnotic
Positive
- Anxiety Suppression
- Euphoria
Negative
- Anterograde Amnesia
- Motor Control Loss
- Cognitive Impairment
- Dream Suppression
- Delusions of Sobriety
- Amnesia
- Anxiety or panic
- Abrupt return of consciousness
Positive
- Tracers
- Increased Music Appreciation
Negative
- Disinhibition
- Acuity Suppression
- Appetite suppression
- Dulled perception
- Metallic Taste
- Visual Drifting
- External Hallucinations
- Auditory Hallucinations