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midazolam

✓ Approved

Rafa Laboratories Ltd · GABRA1 · Small Molecule

What is midazolam?

midazolam is a small molecule developed by Rafa Laboratories Ltd. It is approved for therapeutic indications via injectable (others) or intramuscular (im) injection.

Drug Profile

CompanyRafa Laboratories Ltd
Drug ClassSmall Molecule
Molecular TargetGABRA1, GABRA2, GABRA3, GABRA4, GABRA5
RouteInjectable (Others), Intramuscular (IM) Injection
StatusApproved
Sources: ClinicalTrials.gov, Rafa Laboratories Ltd

Mechanism of Action

Molecular Targets

midazolam acts on 5 molecular targets:

GABRA1gamma-aminobutyric acid type A receptor alpha1 subunit (DEE19, ECA4)
GABRA2gamma-aminobutyric acid type A receptor alpha2 subunit (DEE78, EIEE78)
GABRA3gamma-aminobutyric acid type A receptor alpha3 subunit (EPILX2)
GABRA4gamma-aminobutyric acid type A receptor alpha4 subunit ()
GABRA5gamma-aminobutyric acid type A receptor alpha5 subunit (EIEE79, DEE79)
Want deeper analysis?Noah AI can explain complex mechanisms and compare to similar drugs.

Therapeutic Indications

midazolam is developed for 1 unique indication across 1 therapeutic area.

Therapeutic AreaConditionPhase
Nervous system disordersStatus epilepticus✓ Approved

Related Research Articles

PubMedEpilepsy & behavior : E&B2026-07-17

Caregiver preferences and training needs in the administration of rescue medication for prolonged convulsive seizures in children and adolescents with epilepsy: Results from a multinational survey.

Vigevano Federico F, Arzimanoglou Alexis A, Auvin Stéphane S, Kaindl Angela M AM et al.

This multinational survey explored caregivers' preferences and training needs regarding the administration of rescue medication for prolonged convulsive seizures in children and adolescents with epilepsy across 7 European countries. A total of 68 caregivers of children with epilepsy (aged 6 months to 18 years) who had experienced a prolonged convulsive seizure in the past 12 months completed an anonymous survey in 2024. The survey assessed caregiver preferences and satisfaction with buccal, nasal, or rectal rescue medication, quality of life (QoL), valued medication attributes, and training experience. Intranasal formulations were not consistently available across countries during the study period. Most caregivers (80.9%) preferred buccal over rectal or nasal administration, and satisfaction was higher among users of buccal midazolam compared with rectal diazepam. This preference aligned with a positive impact on patients' and caregivers' QoL. Caregivers rated ease of administration as the most important attribute of rescue medication (mean: 4.8/5), followed by effectiveness in stopping seizures (mean: 4.1/5). Despite their critical role, 44.1% had received no specific training; among those trained, 62.2% preferred face-to-face sessions. Training satisfaction was higher among caregivers who administered buccal midazolam (mean: 8.3/10; standard deviation [SD]: 2.4) compared with those using rectal diazepam (mean: 5.3/10; SD: 3.3). This survey underscores a strong caregiver preference for buccal midazolam in pediatric out-of-hospital settings. However, caregiver training remains a substantial unmet need, and standardized programs could improve preparedness for managing prolonged seizures. These findings reinforce the importance of integrating caregiver perspectives to optimize emergency pediatric epilepsy care.

PMID 42462388
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PubMedAnaesthesia2026-07-17

Remimazolam vs. propofol anaesthesia for delirium in older patients recovering from lung resections: a randomised non-inferiority trial.

Wang Wei W, Zhang Fengping F, Ge Yi Y, Zhang Yunyun Y et al.

Remimazolam tosylate is an ultra-short-acting benzodiazepine sedative and anaesthetic. The related drug, midazolam, is associated with delirium but it remains unclear whether remimazolam also promotes delirium. We tested the primary hypothesis that remimazolam is non-inferior to propofol for delirium in patients during the initial 3 days after lung resection surgery. Secondary outcomes were the proportion of delirium-positive assessments; duration of stay in the post-anaesthesia care unit; and hospital and Mini-mental State Examination scores at 30 days. We randomly allocated patients aged ≥ 65 y to remimazolam or propofol anaesthesia for lung resection surgery. Delirium was assessed by trained assessors blinded to trial treatment using the Confusion Assessment Method in the post-anaesthesia care unit and twice daily for 3 postoperative days. Our non-inferiority margin was a 10% absolute difference in the incidence of postoperative delirium. The modified intent-to-treat population included 455 patients. Delirium occurred in 108/227 (48%) patients allocated to the remimazolam group and 71/228 (31%) in those allocated to the propofol group (risk ratio 1.53, 95%CI 1.21-1.94). The absolute risk difference was 16.5% (95%CI 7.7-25.3%) which considerably exceeded our non-inferiority margin; therefore, non-inferiority was not established. Emergence delirium was more frequent in patients allocated to remimazolam (105/227 (46%) vs. 64/228 (28%); risk ratio 1.65, 95%CI 1.28-2.12), whereas delirium after post-anaesthesia care unit discharge was uncommon and similar between groups (9/227 (4%) vs. 12/228 (5%); risk ratio 0.75, 95%CI 0.32-1.75). Delirium-positive assessments occurred in 129/1377 (9%) patients allocated to the remimazolam group and 102/1440 (7%) in those allocated to the propofol group (risk ratio 1.36, 95%CI 0.96-1.91). Remimazolam was not non-inferior to propofol for postoperative delirium in older patients having lung resection surgery and provoked more emergence delirium.

PMID 42464898
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PubMedBMC anesthesiology2026-07-16

Perioperative anesthetic management and procedural sedation in a child with type 1 congenital long QT Syndrome undergoing serial procedures: a case report.

Tu Youbing Y, Xing Dajun D, Liu Zhongjie Z

Congenital long QT syndromes (cLQTS) are inherited cardiac channelopathies that predispose pediatric patients to ventricular arrhythmias, particularly Torsades de Pointes (TdP), during the perioperative period. Data regarding repeated anesthetic and sedation exposures in this high-risk population remain limited. We present an 8-year-old boy with genetically confirmed LQT1 and multiple systemic comorbidities who underwent five general anesthetics and four procedural sedations within a four-month timeframe. Management focused on preserving hemodynamic stability, attenuating autonomic fluctuations, minimizing drug-induced prolongation of cardiac repolarization, and ensuring immediate availability of rescue resources. Anesthesia was maintained via balanced volatile or intravenous regimens, while procedural sedation employed dexmedetomidine-midazolam based anxiolysis. Across all nine interventions, no TdP, malignant ventricular tachyarrhythmia, treatment-requiring bradycardia, or cardiac arrest was documented. This single-patient experience describes repeated general anesthesia and procedural sedation in a child with LQT1 without documented adverse cardiac events.

PMID 42458257
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PubMedDrug metabolism and disposition: the biological fate of chemicals2026-07-16

A protein standard addition framework for absolute quantification of drug metabolizing enzymes.

Wu Xiaofeng X, Zhang Sam S, Obach R Scott RS, Yuan Qianying Q et al.

Accurate quantification of absorption, distribution, metabolism and elimination (ADME) proteins in complex human-derived matrices remains technically challenging. Although targeted bottom-up proteomic approaches have improved specificity and sensitivity relative to immunometric methods, peptide level absolute quantification (AQUA) remains confounded by peptide-dependent proteolytic recovery, limiting confidence in protein abundance estimates. Here, we describe AQUA-ADME, a protein level absolute quantification strategy that integrates protein standard addition with our previously described FAst Surfactant-Treated -enabled liquid chromatography-multiple reaction monitoring workflow to address peptide-dependent digestion bias. By spiking known amounts of purified recombinant human CYP3A4 into native human intestinal and hepatic microsomes prior to digestion, AQUA-ADME enforces matched proteolytic behavior between endogenous CYP3A4 and exogenously spiked recombinant human CYP3A4 within the same biological matrix, while stable isotope-labeled peptides correct for ionization variability. Using 4 structurally and spatially distinct CYP3A4 tryptic peptides, AQUA-ADME yielded highly concordant CYP3A4 abundance estimates within each microsomal pool (<2-fold variation across peptides), in contrast to the wide variability observed using conventional peptide-centric AQUA workflows. Normalization of microsomal CYP3A4-mediated midazolam 1'-hydroxylation and testosterone 6β-hydroxylation rates to AQUA-ADME-derived protein abundance collapsed apparent differences in turnover numbers and specificity constants between intestinal and hepatic microsomes, supporting enzyme abundance as the dominant driver of tissue-specific metabolic capacity. Collectively, these findings demonstrate that AQUA-ADME provides a simple, accessible, and mechanistically grounded approach for absolute protein quantification, strengthening the quantitative foundation for in vitro-in vivo extrapolation and physiologically based pharmacokinetic modeling. SIGNIFICANCE STATEMENT: Reliable absolute proteomic quantification is essential for confident interpretation of enzyme-normalized kinetic parameters and translational pharmacokinetic modeling. This study introduces AQUA-ADME, a protein standard addition approach that addresses peptide-dependent digestion bias inherent to peptide-centric proteomics. By enforcing matched digestion between endogenous and reference protein, AQUA-ADME yields coherent, protein level abundance estimates and improves confidence in derived turnover numbers. AQUA-ADME provides a mechanistically grounded framework to strengthen quantitative ADME analyses supporting in vitro-in vivo extrapolation and physiologically based pharmacokinetic applications.

PMID 42462328
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PubMedPaediatric anaesthesia2026-07-15

Comparison of Discharge Readiness in Pediatric Patients: Oral Versus Intranasal Preoperative Midazolam Administration.

Naem Mohammad M, Hossain Jobayer J, Hamideh Janna J, Szolnoki Judit J

Midazolam is commonly administered orally or intranasally to reduce preoperative anxiety in children undergoing tympanostomy. Prior studies suggest differences in recovery exist between the two routes, but their impact on post-anesthesia care unit (PACU) length of stay remains unclear. We conducted a retrospective chart review of pediatric patients aged 6 months to 10 years undergoing tympanostomy at Nemours Children's Hospital, Central Florida, between November 2023 and November 2024. Patients were grouped by midazolam route (intranasal 0.2 mg/kg IV formulation vs. oral 0.5 mg/kg syrup). The primary outcome was PACU length of stay, defined as time from PACU arrival to discharge based on standard hospital criteria. Predictors of administration route were evaluated using univariate logistic regression, and PACU length of stay was analyzed using age-adjusted ANCOVA with backward stepwise variable selection. A total of 463 patients were included: 322 received oral midazolam and 141 received intranasal midazolam. In unadjusted analysis, intranasal midazolam was associated with a shorter PACU stay (mean 39.7 vs. 42.9 min, p = 0.02). However, patients receiving intranasal midazolam were significantly younger (31.5 vs. 37.8 months, p < 0.001). After adjustment for age, age emerged as the only independent predictor of PACU length of stay, and the association between administration route and PACU duration was attenuated and no longer significant (p = 0.15). Age, rather than route of midazolam administration, primarily explained differences in PACU discharge readiness among children undergoing tympanostomy. Previously reported differences in recovery time between oral and intranasal midazolam may reflect age-related confounding rather than a true effect of route. Future prospective, age-stratified studies are needed to clarify this relationship and refine pediatric sedation practices.

PMID 42454517
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PubMedThe Journal of hospital infection2026-07-15

Updated Risk Factors for Ventilator-Associated Pneumonia: Findings from a Matched Case-Control VAPRISK Study.

Ahmed Islam I, Soliman Hanan Hasan HH, Habib Tamer T, Waheed Amani A

Although prevention bundles and surveillance systems are widely used, the incidence of ventilator-associated events rose by 13% in 2023. This study aimed to identify independent risk factors for VAP within a low-resource clinical setting to provide evidence-based targets for prevention in such environments. Ninety VAP patients were matched 1:1 with controls based on sex, age, and duration of mechanical ventilation at the time of VAP onset. Multivariate logistic regression was used to identify independent risk factors. After confounding factors were considered, recent cerebrovascular stroke (adjusted odds ratio (OR) = 6.555, 95% confidence interval (CI): 1.768-24.306, p = 0.005), sedation with midazolam (adjusted OR = 3.292, 95% CI: 1.342-8.079, p = 0.009), and prior use of corticosteroids (adjusted OR = 3.369, 95% CI: 1.335-8.505, p = 0.010) were significant risk factors. Regarding the items of the VAP bundle, both "No sedation holiday" (adjusted OR = 6.774, 95% CI: 2.751-16.682, p < 0.001) and "Oral care with chlorhexidine" (adjusted OR = 8.544, 95% CI: 3.334-21.891, p < 0.001) were independently associated with higher odds of VAP. In a patient cohort matched for age, sex, and duration of MV, multivariate analysis revealed that recent cerebrovascular stroke, midazolam sedation, a lack of sedation holidays, prior corticosteroid use, and chlorhexidine oral care were independently associated with VAP.

PMID 42448182
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