Seizalam (midazolam intramuscular) / Pfizer - LARVOL DELTA

What is the best approach for parenteral sedation to manage severe acute behavioral disturbance in the emergency department? (PubMed, Clin Toxicol (Phila)) - "We recommend droperidol, or olanzapine where droperidol is unavailable, as the preferred first-line parenteral agent, due to strong evidence of effectiveness and safety...We do not routinely recommend benzodiazepines, such as midazolam, except for treating specific causes of agitation which respond well to benzodiazepines, such as alcohol withdrawal or stimulant intoxication...We do not routinely recommend benzodiazepines as first-line therapy, unless specifically treating a condition likely to benefit from benzodiazepines, such as alcohol (or sedative hypnotic) withdrawal or stimulant intoxication. We do not recommend combination therapy (antipsychotic and benzodiazepines)."

Journal • Anesthesia • CNS Disorders • Mental Retardation

Evaluation of a Multimodal Anesthetic Protocol for Immobilization in Black Vultures (Coragyps atratus) and Turkey Vultures (Cathartes aura). (PubMed, Vet Sci) - "Vultures were anesthetized with intramuscular dexmedetomidine (5 μg/kg), midazolam (0.2 mg/kg), butorphanol (0.2 mg/kg), and ketamine (5 mg/kg) (DMBK), followed by isoflurane induction and maintenance. The DMBK protocol provided profound sedation in both species, maintained key cardiorespiratory parameters, including heart rate and arterial blood pressure, within a clinically acceptable range throughout isoflurane maintenance, and enabled uneventful rapid recovery. These findings support DMBK with the cardiorespiratory monitoring system as a safe and effective regimen for anesthetizing vultures and likely other similarly sized raptors requiring non-invasive immobilization."

Journal • Anesthesia

Midazolam Needle-Free Auto Injector: Demonstration of Intramuscular Injection by MRI and of no Impact of Subcutaneous Fraction on Midazolam Exposure (AES 2025) - "ZENEO® is expected to deliver midazolam IM in most patients, in emergency situation, on thigh either on bare skin or through clothing. While the IM injection has been demonstrated, a mixed IM/SC dosing has negligible impact on midazolam pharmacokinetics.This analysis indicates that ZEPIZURE® features are consistent with its use in SE in emergency situation, with benefits of midazolam intramuscular injection while variations in the IM/SC fraction are very unlikely to be associated with a clinically relevant impact on safety or efficacy."

Epilepsy

Impact of atropine and hydroxyzine pretreatment in contemporary bronchoscopy. (PubMed, Respir Investig) - "Anticholinergic pretreatment may reduce procedural discomfort, particularly that associated with secretions and airway reflexes, without evident adverse effects. Further randomized controlled trials are required to validate the role of pretreatment in contemporary bronchoscopy."

Journal • Cough • Respiratory Diseases

Unilateral damage to anterior cingulate cortex and amygdala differentially disrupts socioemotional responses in macaque monkeys (Neuroscience 2025) - "Prior to pairing, the affective state of the "demonstrator" monkey is pharmacologically manipulated via intramuscular injection of an anxiolytic drug (midazolam, 0.4 - 0.8 mg/kg), anxiogenic drug (β-CCE, 0.4 - 0.8 mg/kg), or saline (0.9%)...We conclude that the EAPP is a valuable tool for studying the neural underpinnings of socioemotional functioning and empathy in nonhuman primates. This type of information would inform both basic research and translational applications."

Late-breaking abstract • CNS Disorders • Vascular Neurology

An Unexpected Culprit: Cephaloithin-Induced Perioperative Anaphylaxis (ACAAI 2025) - "Immediately after induction, signs of anaphylaxis were reported following administration of cephalothin, along with exposure to midazolam, fentanyl, propofol, cisatracurium, and morphine. Intramuscular epinephrine, diphenhydramine, hydrocortisone, and dexamethasone were promptly administered to control the event...Cephalosporin allergy is difficult to predict, especially in patients without prior exposure or known risk factors and skin testing for allergies can help with planning anesthesia for future procedures. This case highlights the importance of perioperative allergy evaluation and raises awareness about cephalothin as a potential, though uncommon, trigger of anaphylaxis."

Anesthesia • Gastroenterology • Gynecology • Immunology

A RARE CASE OF HALOPERIDOL-INDUCED ANGIOEDEMA PRESENTING AS QUINCKE'S DISEASE (CHEST 2025) - "The idiopathic group encompasses agents causing angioedema with no known mechanism and is associated with a wide range of drugs and herbal supplements, most notably calcium channel blockers, sirolimus, everolimus, risperidone, and certain biologics like etanercept. CASE PRESENTATION: 40 y.o. male with a history of schizophrenia, opioid dependence on methadone, polysubstance use, brought in by EMS for violent and erratic behavior. In the ED, he was alert but disoriented and again combative, so he was given midazolam 4 mg, diphenhydramine 25 mg, and haloperidol 5 mg...He was treated with a dexamethasone taper, as well as diphenhydramine and famotidine, and eventually was extubated... Prompt identification and management of haloperidol associated angioedema is critical. Discontinuation of the offending agent is the first step, followed by supportive care, including antihistamines, corticosteroids, and epinephrine if anaphylaxis is suspected. In cases where airway compromise..."

Clinical • Addiction (Opioid and Alcohol) • Cardiovascular • CNS Disorders • Dermatology • Hereditary Angioedema • Immunology • Psychiatry • Pulmonary Disease • Schizophrenia • Tetanus • Urticaria

Assessment of Intramuscular Verapamil as Pharmacological Countermeasure in a Rat Model of Organophosphate DFP-induced Status Epilepticus. (PubMed, Neurotox Res) - "One minute later, SOC treatment consisting of atropine (0.5 mg/kg, i.m.) and pralidoxime chloride (2-PAM; 25 mg/kg, i.m.) were administered, and at 1-hour post-SE, midazolam (1.78 mg/kg, i.m.) was given. Neuroinflammatory markers and long-term behavioral outcomes were not included in this study. Our studies provide evidence that the i.m. route is an effective method for delivering VPM following SE, producing significant neuroprotective outcomes compared to treatment with the standard-of-care alone in OP-SE."

Journal • Preclinical • Epilepsy • Inflammation

Non-Injectable Ketamine for Pediatric Sedation in the Emergency Department: A Systematic Review. (PubMed, Acad Emerg Med) - "Sedation with oral ketamine might have a desirable depth, faster OA, and shorter DA relative to the oral comparators. Furthermore, NIK probably showed no SAE during PSA. Nevertheless, the limited number of heterogeneous studies leaves uncertainty, highlighting the need for further research."

Journal • Review • Anesthesia • Pain • Pediatrics

Effects of Intraparietal Gastric Botulinum Toxin-A Injection on Weight Loss: A Retrospective Study of 500 Patients. (PubMed, Diabetes Metab Syndr Obes) - "Patients were injected intramuscularly with 1000 U of botulinum toxin-A in the antrum and fundus regions of the stomach via endoscopy under sedation anesthesia (midazolam and propofol)...Intraparietal gastric botulinum toxin-A injection can lead to significant weight loss and may contribute to the development of effective, minimally invasive approaches for the management of obesity. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings."

Journal • Retrospective data • Anesthesia • Genetic Disorders • Obesity

Eight days of darkness: a case of severe gamma-hydroxybutyrate withdrawal (ECNP 2025) - "Treatment involved high-dose anxiolytics and antipsychotics: intramuscular diazepam (up to 80 mg/day), oral midazolam (15 mg/day), olanzapine (5 mg/day), and eventually, valproate titrated to 1000 mg/day. This case contributes to the sparse literature on GHB withdrawal and underscores the necessity of developing evidence-based treatment protocols. The prolonged symptom course and high pharmacologic demands challenge conventional detox models. Given the growing incidence of GHB use in specific populations (MSM), clinicians must be equipped to recognize and manage these complex presentations."

Clinical • Addiction (Opioid and Alcohol) • CNS Disorders • Insomnia • Mood Disorders • Psychiatry • Psychomotor Agitation • Sleep Disorder

RETROSPECTIVE REVIEW OF DEXMEDETOMIDINEBUTORPHANOL-MIDAZOLAM OR MEDETOMIDINEBUTORPHANOL-MIDAZOLAM FOR ANESTHESIA OF SEA OTTERS (ENHYDRA LUTRIS ) UNDER PROFESSIONAL CARE. (PubMed, J Zoo Wildl Med) - "Included induction protocols involved IM injection of DBM or MBM, and injectable agents were reversed with IM atipamezole and naltrexone ± flumazenil. Anesthetic events were compared from a subset of sea otters anesthetized with both MBM and fentanyl-midazolam (FM) on separate occasions...DBM and MBM appear to be safe, reliable protocols with smooth induction and recovery; clinically acceptable physiologic values across various age classes, sexes, and subspecies; and a low rate of complications. Furthermore, MBM appears to be a reliable alternative to FM with more favorable respiratory values."

Journal • Retrospective data • Aesthetic Medicine • Anesthesia

DESCRIPTION OF TRANSCOELOMIC AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN HEALTHY HUMBOLDT PENGUINS (SPHENISCUS HUMBOLDTI). (PubMed, J Zoo Wildl Med) - "The use of IM midazolam and butorphanol provided an inadequate level of sedation, so only images from awake and anesthetized exams were evaluated. Left ventricular end systolic volume (LVESV) values were significantly higher using TCE than TEE regardless of consciousness state (p < 0.05), but the opposite was true for left ventricular ejection fraction (LVEF) (p < 0.05). Based on these results, TCE is an adequate imaging modality for basic cardiac assessment in awake and anesthetized penguins, whereas TEE is the preferred modality for more detailed cardiac assessments."

Journal • Anesthesia

Comparison of two immobilisation protocols (medetomidine-midazolam and alfaxalone-midazolam) for restraint of urban red foxes (Vulpes vulpes): A pilot study. (PubMed, Vet Anaesth Analg) - "Both protocols provided sufficient sedation for intended procedures. MM resulted in higher sedation scores and faster recovery after antagonist administration, while AM provided higher SpO2 and heart rates and lower rectal temperature values."

Journal • Anesthesia

Randomised clinical trial comparing intramuscular alfaxalone and butorphanol sedation with or without midazolam in hyperthyroid cats. (PubMed, J Feline Med Surg) - "Thyroxine concentrations, gabapentin treatment and assessors were recorded. In group BA3, additional alfaxalone was required significantly earlier (P = 0.043). Although sedated, muscle twitching was a commonly observed adverse effect in all groups, but head pawing was significantly increased in BA3 (P = 0.014).Conclusions and relevanceSedation and recovery quality were satisfactory with all protocols but the addition of midazolam prolonged sedation."

Clinical • Journal • Anesthesia • Endocrine Disorders

Comparison of Three Different Balanced Sedative-Anaesthetic Protocols in Captive Baboons (Papio hamadryas). (PubMed, Vet Sci) - "Animals were assigned to TZD_G (n = 17; tiletamine/zolazepam 3 mg/kg + dexmedetomidine 20 μg/kg), KDM_G (n = 23; ketamine 6 mg/kg + dexmedetomidine 30 μg/kg + methadone 0.2 mg/kg), or MDM_G (n = 9; midazolam 2 mg/kg + dexmedetomidine 60 μg/kg + methadone 0.2 mg/kg). TZD_G showed the longest recovery (minutes: 19, 11.5-30; KDM_G: 6, 4-12; MDM_G: 4, 2.5-5; p < 0.001), while MDM_G the best recovery (0, 0-0; TZD_G: 9, 6-12; KDM_G: 0, 0-6; p < 0.001). TZD produced deepest sedation but bad recovery; KDM offered optimal sedation and recovery, and cardiopulmonary stability; MDM provided lighter sedation and excellent recovery."

Journal • Anesthesia

Efficacy and Safety of Different Preoperative Sedative Regimens in Alleviating Pediatric Preoperative Anxiety: A Systematic Review and Network Meta-Analysis. (PubMed, J Evid Based Med) - "ID significantly alleviated PPA with minimal adverse effects in single-drug regimens (optimal dose: 1-2 µg/kg). OK, OM or IM served as potential alternative options for clinical application. While combination regimens (notably OM+OK) demonstrated superior efficacy across outcomes, small sample sizes necessitate cautious interpretation, underscoring the need for future comparative studies."

Journal • Retrospective data • CNS Disorders • Mood Disorders • Pediatrics • Psychiatry

Comparison of Intramuscular and Intranasal Midazolam in Great Horned Owls (Bubo virginianus). (PubMed, J Avian Med Surg) - "These data indicate that IN midazolam sedation at the same dose used IM is a viable option for sedation of GHOWs. Further research is needed for other species of raptors."

Journal • Anesthesia

Antidepressant Efficacy of Ketamine Plus Naltrexone for Major Depression Comorbid with Alcohol Use Disorder: A Randomized Controlled Trial. (PubMed, Int J Neuropsychopharmacol) - "This study found similar antidepressant and anti-alcohol effects across 3 groups. Compared to midazolam, the ketamine groups showed longer-lasting antidepressant effects and greater improvements in anxiety and quality of life. Comparable outcomes between the two ketamine groups suggest opioid receptor antagonism did not alter ketamine's therapeutic effects."

Clinical • Journal • Addiction (Opioid and Alcohol) • CNS Disorders • Depression • Major Depressive Disorder • Mood Disorders • Psychiatry

Repeated balanced anesthesia in a juvenile sable antelope (Hippotragus niger) for diagnostic imaging and orthopedic interventions in a hospital setting. (PubMed, Vet Anaesth Analg) - "For the nine additional anesthetics (days 35-50), intravenous premedication [midazolam (0.1-0.2 mg kg-1), combined with butorphanol (0.17 mg kg-1) for the second anesthetic] and anesthetic induction [ketamine (1.7-3.0 mg kg-1) and propofol (0.7-2.7 mg kg-1)] were followed by sevoflurane for maintenance (Fe'Sevo 1.22-2.17% for 40-90 minutes), delivered through an endotracheal tube (8.0-8.5 mm internal diameter)...Morphine (0.1-0.2 mg kg-1) and saline (6-10 mL) were injected once daily through an epidural catheter (days 38-47)...Postmortem findings included chronic-active fibrinosuppurative polyarthritis of the right femoropatellar and metacarpophalangeal joints, necrosuppurative pyelitis and laryngeal petechiation. This case is described as a resource for anesthesia of juvenile antelopes in a hospital setting."

Journal • Anesthesia • Hypoglycemia • Hypotension • Immunology • Nephrology • Orthopedics

Alfaxalone as a Total Intravenous Anesthesia Protocol in New Zealand White Rabbits (Oryctolagus cuniculus) Improves Cardiovascular Stability Compared to Isoflurane. (PubMed, J Am Assoc Lab Anim Sci) - "Twenty-four male New Zealand White rabbits were assigned to 1 of 3 treatment groups: isoflurane alone, alfaxalone with buprenorphine, or alfaxalone with midazolam. There were no significant differences noted between alfaxalone treatment groups. The results confirmed that CRI alfaxalone (total intravenous anesthesia) should be considered as a potential anesthetic alternative to isoflurane anesthesia in rabbits, although special attention to respiratory monitoring and management is warranted."

Journal • Preclinical • Anesthesia • Cardiovascular

Assessment of pharmacokinetics, safety, and neuroprotective efficacy of an adjunct intramuscular verapamil therapy in a rat model of organophosphate DFP-induced status epilepticus. (PubMed, bioRxiv) - "One minute later, atropine (0.5 mg/kg, i.m.) and 2-PAM (25 mg/kg, i.m.) were injected, and at 1-hour post-SE, midazolam (1.78 mg/kg, i.m.) was administered. VPM therapy did not cause significant muscle pathology and produced a robust neuroprotective response. Our studies provide evidence that the i.m. route is an effective method for delivering VPM following SE producing significant neuroprotective outcomes compared to treatment with the standard-of-care alone in OP-SE."

Journal • PK/PD data • Preclinical • Epilepsy • Inflammation

Methadone-fluconazole formulations provide superior clinical efficacy compared to buprenorphine injection in dogs undergoing soft tissue surgery. (PubMed, Am J Vet Res) - "To determine the perioperative efficacy and safety of methadone-fluconazole injection followed by oral methadone-fluconazole-naltrexone (methadone-fluconazole) compared to IM buprenorphine followed by oral codeine (buprenorphine)...Preoperative sedation included acepromazine; anesthetic induction included ketamine-midazolam and isoflurane anesthesia...Methadone-fluconazole formulations provided superior clinical efficacy compared to buprenorphine. Methadone-fluconazole formulations provide effective analgesia with twice-daily administration."

Journal • Anesthesia • Gynecology • Hypotension • Pain

KOMET-001: First in Human Study of Ziftomenib in Relapsed or Refractory Acute Myeloid Leukemia (clinicaltrials.gov) - P1/2 | N=263 | Recruiting | Sponsor: Kura Oncology, Inc. | N=199 ➔ 263

Enrollment change • Acute Lymphocytic Leukemia • Acute Myelogenous Leukemia • Hematological Malignancies • Leukemia • Oncology • KMT2A • NPM1

Use of Intramuscular Midazolam, Diphenhydramine, and Haloperidol in Acute Agitation Management in a Psychiatric Emergency Department. (PubMed, J Clin Psychopharmacol) - "This is the first study to examine coadministration of intramuscular midazolam with haloperidol and diphenhydramine. Midazolam+ was effective at managing agitation and may be an alternative to lorazepam+."

Journal • Anesthesia • Psychiatry