What You Should Know About Versed (Midazolam)

Versed: What It Is and Why It Is Used

Anesthetist adjusting intravenous drip during open heart operating
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What Is Versed?

Versed is a benzodiazepine, a type of drug that causes relaxation, sleepiness and can cause a partial or complete loss of memory during the use of the drug. It is commonly used to help a patient better tolerate a medical procedure. It is also used in intensive care for patients who are on a ventilator and may not be tolerating the breathing machine well. 

Why Versed Is Used

Versed is typically used for sedation during procedures that do not require general anesthesia, but do require the patient to remain calm and relaxed, such as a colonoscopy.

Versed may also be used after surgery for sedation, or to help keep the patient calm while on the ventilator.

Versed can be used in combination with pain medications or other types of sedation. While it is commonly combined with Fentanyl, a powerful pain medication, it can also be combined with Propofol and other medications.

Forms of Versed

Versed is available as an injection, as an IV infusion and as a syrup taken orally.  It is typically given through an IV, so that it can take effect quickly, the syrup takes longer to be effective and it is harder to predict when it will take effect. 

Syrup is often used for individuals who have a feeding tube, whether it is permanent or temporarily inserted, and usually for patients who need sedation for an extended period of time rather than just a few minutes or a few hours.

Versed and Fentanyl

Versed is often combined with Fentanyl, a powerful pain reliever, to provide “conscious sedation." It is also known as “twilight sleep” or “monitored anesthesia care (MAC)”.

 This type of anesthesia does not require the patient to be on a ventilator during the procedure. 

The two drugs, working together, provide pain relief, relaxation, and amnesia. The purpose is to prevent pain and anxiety during the procedure, and if there is any discomfort or stress, the patient is not likely to remember it.

The combination of Versed and Fentanyl is also used in the ICU setting, typically through an IV. It can be given to medically induce a type of “coma,” keeping the patient unaware of their surroundings. This can be necessary if a patient cannot be calmed, is in danger of injuring themselves, is resisting the ventilator, or has an illness that causes significant pain (such as a burn). 

Side Effects of Versed

  • Versed frequently causes a loss of memory during the time while the drug is being administered and the time immediately following. This is a normal side effect of Versed and should be expected.
  • Versed can slow breathing, so close monitoring is essential when the drug is being used.
  • A small minority of patients feel agitated, hyperactive or combative when taking Versed, rather than the anxiety relief and relaxation that is intended.
  • Versed causes drowsiness and driving after receiving the medication is not recommended.
  • Versed can cause or increase coughing.

Versed Home Use

Versed is not appropriate for home use, it is used during procedures or inpatient care. Constant monitoring is required with the use of Versed, so it is rarely used in the hospital in areas outside of surgery, procedure rooms and intensive care.

Versed Warnings

Versed can cause respiratory depression, meaning that the urge to breathe is decreased in people receiving the medication.  Due to this side effect, patients should be closely monitored in a healthcare facility when taking Versed. Versed can also increase the respiratory depression effects of other medications, including opioids.  

Due to this respiratory depression effect, patients with respiratory conditions such as COPD may not be good candidates for Versed.  

Patients on a ventilator, who may or may not have a respiratory disease, may be given Versed to help them tolerate having a breathing tube in place.

Versed can decrease blood pressure and should be used with caution when a patient has low blood pressure, whether it is caused by shock, sepsis or a normal state health for the patient.

Versed should be used with caution in breastfeeding and pregnant women. Versed has been shown to cross the placental barrier, meaning that the fetus will receive some of the drug when it is given to a pregnant woman.

Versed is excreted more slowly in patients with diminished kidney function and may have longer lasting effects in those patients.  Lower doses and/or longer recovery periods may be necessary.

Versed Dosages

Unlike most drugs, Versed dosages should be based upon the effect of the drug, rather than the weight of the patient. The dose should be adjusted based on the result of the initial dose, meaning that the patient should be given more or less of the drug based on how effective it is. 

A patient's ability to tolerate alcohol consumption often gives a hint of their likely tolerance for Versed.  Individuals who are a "lightweight" and become intoxicated easily may require less medication than someone who can "hold their liquor."

A Word From Very Well

Versed is a very useful drug for sedation during procedures, but it must be used in the appropriate setting: with trained staff present and electronic monitoring in use for safety.  This medication can cause a decrease in breathing and memory loss, so it is essential that a trained professional is present to monitor the effects the patient experiences. 

Sources:

Versed Monograph. RxMed Pharmaceutical. Accessed July 2009. http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20(General%20Monographs-%20V)/VERSED.html

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