Related Experiment Video
Updated: May 20, 2026
08:49
Assessing Changes in Volatile General Anesthetic Sensitivity of Mice after Local or Systemic Pharmacological Intervention
Published on: October 16, 2013
Significant hypotension following buccal midazolam administration
Maria Kensche1, Josemir W Sander, Sanjay M Sisodiya
1Institute of Neurology, University College London, London, UK. maria.kensche@charite.de
BMJ Case Reports
|July 18, 2012
Summary
Buccal midazolam is an effective rescue treatment for epileptic seizures. This report details a rare case of significant hypotension following its administration, highlighting a potential side effect.
Area of Science:
- Pharmacology
- Neurology
- Emergency Medicine
Background:
- Buccal midazolam is increasingly used as a first-line rescue medication for epileptic seizures, offering an alternative to rectal diazepam.
- The buccal formulation is administered off-licence, with prescribers assuming responsibility for its use.
- Common side effects include drowsiness and somnolence, with rare occurrences of respiratory depression or paradoxical reactions.
Observation:
- The study reports a case of significant hypotension in a patient receiving buccal midazolam for seizure management.
- Hypotension is considered a rare side effect of midazolam, with no previous cases documented for the buccal formulation.
Findings:
- A case of significant hypotension was observed following the administration of buccal midazolam.
- This finding contrasts with the generally accepted safety profile regarding hypotension for this specific formulation.
Implications:
- Clinicians should be aware of the potential for significant hypotension as a rare adverse event associated with buccal midazolam.
- Further monitoring and research may be warranted to fully understand the cardiovascular risks of buccal midazolam in seizure management.
- This case highlights the importance of considering all potential side effects, even rare ones, when using off-licence medications.
Related Concept Videos
01:18Drug Delivery: Enteral Route
The enteral drug administration involves three primary routes: oral, sublingual, and buccal. Oral ingestion is the most prevalent, safe, economical, and convenient method for drug administration. However, it has certain drawbacks, including limited absorption due to the drug's low water solubility or poor membrane permeability, possible emesis from GI mucosa irritation, destruction of drugs by digestive enzymes or low gastric pH, and irregular absorption along with food or other drugs.
Drugs in...
Drugs in...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:14CNS Depressants: Barbiturates and Benzodiazepines
CNS depressants include drugs from the category of barbiturates and benzodiazepines. They are valuable medications for managing anxiety disorders and insomnia. Barbiturates, once used to induce and maintain sleep, have been replaced mainly by benzodiazepines due to barbiturate's toxicity, tolerance, and overdose risks. They interact with GABAA receptors, leading to sedation at low doses and potentially coma and death at higher doses. Phenobarbital, a long-acting barbiturate, possesses...
01:19Sedatives and Hypnotics Drugs: Benzodiazepines
Benzodiazepines have both sedative and hypnotic properties. They include compounds such as diazepam (Valium) and alprazolam (Xanax). Structurally, their cores are similar, consisting of the fusion of a benzene ring and a diazepine ring, but they share a common mechanism of action in the central nervous system (CNS).
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
Benzodiazepines work by enhancing the effects of the inhibitory neurotransmitter GABA. They bind to the GABAA receptor, increasing its affinity for GABA, which opens chloride...
01:20Sedatives and Hypnotics Drugs: Barbiturates
Sedatives and hypnotics encompass a drug class that acts on the central nervous system (CNS) to alleviate anxiety, promote relaxation and induce sleep.These drugs function by amplifying the actions of the neurotransmitter γ-aminobutyric acid (GABA), resulting in reduced neuronal activity. Barbiturates, a subset of sedatives and hypnotics first synthesized in the late 1800s, are categorized into ultra-short, short, intermediate, and long-acting groups based on their duration of effect. A key...
01:29Anxiolytic Drugs: Benzodiazepines and Buspirone
Benzodiazepines are a class of anxiolytic drugs known for their rapid efficacy and high therapeutic-to-lethal dose ratio, but with a potential risk of drug dependence. These drugs are lipophilic, allowing for rapid absorption after oral administration, eventually reaching the central nervous system (CNS). Once in the CNS, benzodiazepines bind to the allosteric site of the GABAA receptor. This binding enhances the inhibitory effects of the neurotransmitter GABA. By doing so, they prevent...