Hiccups midazolam

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

The safety of midazolam in very low birth-weight neonates is being questioned. In 200 children weighing 3-15 kg premedicated with rectal midazolam 0.5 or 1.0 mg/ kg before minor surgery, the incidence of hiccups was 22% and 26% respectively (28). The mean age of children with hiccups was 6 months and of children without hiccups 20 months. Intranasal ethyl chloride spray was 100% successful in treating the hiccups. The incidence of hiccups was related to age but not dose. The effectiveness of... 

There was a variety of significant nervous system adverse effects in six of 104 patients who underwent transesophageal echocardiography, including aggression, euphoria, depression, and intense hiccups (42). These effects occurred despite careful titration and relatively low doses of intravenous midazolam (mean 4.8 mg), and were generally reversible with intravenous flumazenil 0.25-0.5 mg. 

Marhofer P, Glaser C, Krenn CG, Grabner CM, Semsroth M. Incidence and therapy of midazolam induced hiccups in paediatric anaesthesia. Paediatr Anaesth 1999 9(4) 295-8. 

Observational studies In a prospective study of 516 children undergoing CT scans, who received midazolam 0.212 mg/kg, there was adequate sedation in 5.9 minutes and only a few patients required additional boluses [22 ]. There were adverse effects in 9.1% of patients, including desaturation in 6.9%, all of whom were treated successfully with oxygen, hiccups in 1.4%, and agitation in 0.79%. All the adverse effects were self-limitmg. 

In a double-blind, crossover, randomized trial in 10 healthy volunteers midazolam 0.2 mg/kg was given by nebulizer and liquid instillation nasally 5 days apart [30 ]. Plasma concentrations were greater after intranasal midazolam. Nasal instillation caused increased sedation but no difference in the time to sedation. There were no respiratory adverse events. Blood pressure and oxygen saturation fell in both groups (peak reduction at 15 minutes) but none required extra oxygen. Mean heart rate and diastolic pressure were increased. The incidence of unpleasant adverse effects was greater after intranasal midazolam, and nasal stinging, eye irritation, hiccups, and excessive secretions were common. One patient with asthma became wheezy after intranasal administration. 

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