Buccal midazolam for agitation on psychiatric intensive care wards

Midazolam is a benzodiazepine known to be effective as a treatment for status epilepticus and for rapid tranquillisation. Buccal midazolam has recently become available in the UK. We introduced it as a treatment option for rapid tranquillisation on our intensive care wards. Buccal midazolam was found to be effective and well tolerated. Target levels of sedation were achieved in nearly 70% of subjects within half an hour. Activity was evident within 15 minutes. Over-sedation occurred in only one patient at one time point. There were no cases of respiratory depression. Buccal midazolam deserves further investigation as a non-invasive treatment option in rapid tranquillisation.