When midazolam is administered in combination with fentanyl, the incidence of hypoxemia or apnea becomes more likely.Although the incidence of respiratory depression/arrest is low (0.1–0.5%) when midazolam is administered alone at normal doses, the concomitant use with CNS acting drugs, mainly analgesic opiates, may increase the possibility of hypotension, respiratory depression, respiratory arrest, and death, even at therapeutic doses. Potential drug interactions involving at least one CNS depressant were observed for 84% of midazolam users who were subsequently required to receive the benzodiazepine antagonist flumazenil. Therefore, efforts directed toward monitoring drug interactions and preventing injuries from midazolam administration are expected to have a substantial impact on the safe use of this drug. Pregnancy and breastfeeding
Midazolam, when taken during the third trimester of pregnancy, may cause risk to the neonate, including benzodiazepine withdrawal syndrome, with possible symptoms including hypotonia, apnoeic spells, cyanosis, and impaired metabolic responses to cold stress. Symptoms of hypotonia and the neonatal benzodiazepine withdrawal syndrome have been reported to persist from hours to months after birth. Other neonatal withdrawal symptoms include hyperexcitability, tremor, and gastrointestinal upset (diarrhea or vomiting). Breastfeeding by mothers using midazolam is not recommended. Elderly
Additional caution is required in the elderly, as they are more sensitive to the pharmacological effects of benzodiazepines, metabolise them more slowly, and are more prone to adverse effects, including drowsiness, amnesia (especially anterograde amnesia), ataxia, hangover effects, confusion, and falls.
It is not a life-threatening disease, and it is not contagious.Dermographism may occur in mastocytosis (systemic mast cell proliferation). Diagnosis
This condition is diagnosed by a health care provider writing or drawing on the patients skin with a tongue depressor or other implement, to see whether a red wheal appears soon afterwards. Treatment
Dermographism can be treated by substances which prevent histamine from causing the reaction (i.e. an antihistamine). These may need to be given as a combination of H1 antagonists, or possibly with an H2-receptor antagonist such as cimetidine. Over-the-counter vitamin C, 1000 mg daily, increases histamine degradation and removal.Refraining from taking hot baths or showers may help if the condition is generalized (i.e. all over), as well as possibly for localized cases (i.e. in a specific area). If taking hot showers helps, it may be a condition called shower eczema. If it affects mainly the head, it may be psoriasis. In rare cases, allergy tests may uncover substances the patient is allergic to.While cromoglycate, which prevents histamine from being released from mast cells, is used topically in rhinitis and asthma, it is not effective orally for treating chronic urticaria. See also
Triple response of Lewis

References


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