The Basics
What is Midazolam?
Used before medical procedures and surgery to cause drowsiness, relieve anxiety, and prevent any memory of the event.
Brand names for Midazolam
Midazolam Injection
How Midazolam is classified
Hypnotics and Sedatives, Anti-Anxiety Agents
Midazolam During Pregnancy
Midazolam pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Midazolam while pregnant
An increased risk of congenital malformations associated with the use of benzodiazepine drugs (diazepam and chlordiazepoxide) has been suggested in several studies. If this drug is used during pregnancy, the patient should be apprised of the potential hazard to the fetus. Withdrawal symptoms of the barbiturate type have occurred after the discontinuation of benzodiazepines
Taking Midazolam While Breastfeeding
What are recommendations for lactation if you're taking Midazolam?
The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing.[1][2] However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age. After general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse.[3][4][5] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. With prolonged use (days) of intravenous therapy, an active metabolite can accumulate in the mother and might affect the infant, but data in breastfeeding are lacking.
Maternal / infant drug levels
The small amounts of midazolam excreted into breastmilk would not be expected to cause adverse effects in most breastfed infants. Two expert panels advocates waiting for at least 4 hours after a single intravenous dose of midazolam (e.g., for endoscopy) before resuming nursing.[1][2] However, no waiting period or discarding of milk might be necessary before resuming breastfeeding after a single dose of midazolam in the mothers of infants over 2 months of age. After general anesthesia, breastfeeding can be resumed as soon as the mother has recovered sufficiently from general anesthesia to nurse.[3][4][5] When a combination of anesthetic agents is used for a procedure, follow the recommendations for the most problematic medication used during the procedure. With prolonged use (days) of intravenous therapy, an active metabolite can accumulate in the mother and might affect the infant, but data in breastfeeding are lacking.
Possible effects of Midazolam on milk supply
Relevant published information was not found as of the revision date.
Possible alternatives to Midazolam
(Intravenous Sedation) Dexmedetomidine, Etomidate, Methohexital, Propofol; (Oral for Sleep) Zaleplon, Zolpidem.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Shergill AK, Ben-Menachem T, Chandrasekhara V et al. Guidelines for endoscopy in pregnant and lactating women. Gastrointest Endosc. 2012;76:18-24. PMID: 22579258
2. Vargo JJ, Delegge MH, Feld AD et al. Multisociety sedation curriculum for gastrointestinal endoscopy. Gastroenterology. 2012;143:e18-41. PMID: 22624720
3. Lee JJ, Rubin AP. Breast feeding and anaesthesia. Anaesthesia. 1993;48:616-25. PMID: 8346780
4. Spigset O. Anaesthetic agents and excretion in breast milk. Acta Anaesthesiol Scand. 1994;38:94-103. PMID: 8171959
5. Nitsun M, Szokol JW, Saleh HJ et al. Pharmacokinetics of midazolam, propofol, and fentanyl transfer to human breast milk. Clin Pharmacol Ther. 2006;79:549-57. PMID: 16765143
6. Matheson I, Lunde PKM, Bredesen JE. Midazolam and nitrazepam in the maternity ward: milk concentrations and clinical effects. Br J Clin Pharmacol. 1990;30:787-93. PMID: 2288825
7. Koitabashi T, Satoh N, Takino Y. Intravenous midazolam passage into breast milk. J Anesth. 1997;11:242-3.
8. Avram MJ, Nitsun M et al. Midazolam elimination in human breast milk. Clin Pharmacol Ther. 2006;79 (Suppl S) :P7. Abstract OII-C DOI: doi:10.1016/j.clpt.2005.12.021
9. Kelly LE, Poon S, Madadi P, Koren G. Neonatal benzodiazepines exposure during breastfeeding. J Pediatr. 2012;161:448-51. PMID: 22504099
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
