Canterbury DHB


Intranasal Midazolam Information Sheet

The main clinical indication for intranasal midazolam is anxiety-related dyspnoea - a common and distressing symptom in palliative care.

Midazolam is a short acting benzodiazepine which can be administered as an intranasal spray. It is rapidly absorbed by the highly vascular nasal mucosa. It has a half-life of two to five hours, is metabolised in the liver and excreted in the urine.

Intranasal midazolam can be used as an alternative to clonazepam drops with the advantage of less sedation and more frequent administration, if needed.

Intranasal midazolam has also been used for:

It is not advisable to use intranasal midazolam for treatment of seizures or for situations where profound sedation is required.


Adverse reactions

Irritation of mucosa, eye watering, and sedation (although in such small doses sedation should be minimal).

Instructions for use

Note: Contents of the bottle expires one month after the date of preparation.

The nasal spray can be left at the patient’s bedside for immediate use but ensure the environment is appropriate so there is no danger of the spray being uplifted inadvertently by others. Keep it in a cool, dry place, but not in the fridge.

Patients must be assessed as being capable of self-administration and should be advised to inform nursing staff when they have used a dose. Patients in the community should be asked to document their usage.



Quinn, B., Allan, S., 2007 Intranasal Midazolam as an adjunct to management of breathlessness in palliative care. Conference presentation Wermeling DP et al. (2006). Pharmacokinetics and pharmacodynamics of a new intransal midazolam formulation in healthy volunteers. Anaesthetic Analg. 103:344-349.

More information and advice is available

For more information and advice within working hours, contact either the Christchurch Hospital Palliative Care Service on (03) 364 1473 or the Nurse Maude Hospice on (03) 375 4274. After hours, contact the Christchurch Hospital operator on (03) 364 0640 and ask for the palliative care clinician on call.

About this Canterbury DHB document (58015):

Document Owner:

Kate Grundy (see Who's Who)

Issue Date:

March 2016

Next Review:

March 2018


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 58015