Remimazolam - drug evaluations: expert opinion on pharmacotherapy

Remimazolam is a novel, ultra-short-acting benzodiazepine that enhances inhibitory transmission at the GABA-A receptor to produce sedation, anxiolysis, and amnesia. Its organ-independent metabolism by nonspecific tissue esterases enables rapid onset and offset. These characteristics make it particularly suited to high-risk populations where hemodynamic stability and predictable recovery are particularly important.

The review evaluates the pharmacological properties, clinical efficacy, and safety of remimazolam, drawing on data from Phase I - III clinical trials and major comparative trials. A systematic literature search was conducted using PubMed for English-language articles published between January 2015 and September 2025, incorporating both MeSH and non-MeSH terms. Key studies comparing remimazolam with midazolam, propofol, dexmedetomidine, and etomidate were analyzed, with a focus on pharmacokinetics, pharmacodynamics, pharmacoeconomic developments, and clinical outcomes.

Remimazolam offers a favorable balance between efficacy and safety, with advantages in hemodynamic stability, reduced respiratory depression, and rapid recovery. While higher acquisition costs may limit widespread adoption, potential efficiencies in procedural throughput and patient safety support its growing role in modern anesthetic practice. Although higher acquisition cost and limited availability remain barriers, its procedural efficiency and safety profile support its growing role in anesthesia and sedation practice.