Remimazolam
BYFAVO
What it isUltra-short IV benzodiazepine GABA-A modulator for induction and maintenance of procedural sedation in adults.
Why this oneRapid tissue-esterase metabolism gives predictable offset and less dependence on hepatic or renal clearance than midazolam.
What limits itStill causes hypoventilation, apnea, hypotension, and bradycardia; continuous monitoring, rescue equipment, and flumazenil must be immediately available.
FDA-approved for
- procedural sedation (2020)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Procedural sedation | Adults | 5 mg IV push over 1 min | Supplemental 2.5 mg IV over 15 sec as needed | Titrate to effect |
| Procedural sedation | ASA III-IV | 2.5-5 mg IV over 1 min | Supplemental 1.25-2.5 mg IV over 15 sec as needed | Titrate to effect |
Renal Undefined
Hepatic Severe impairment: titrate carefully; reduced doses may be indicated
At least 2 min must elapse between supplemental doses
Instructions
- Individualize and titrate to desired effect
- Wait >=2 min before each supplemental dose
- Continuously monitor vitals (capnography, pulse oximetry) during sedation and recovery
Contraindications
- History of severe hypersensitivity reaction to dextran 40 or dextran 40-containing products
Cautions
- Hypersensitivity/anaphylaxis
- Neonatal sedation and withdrawal syndrome
- Pediatric neurotoxicity with exposures >3 h in developing animals
Adverse reactions
- Hypotension
- Hypertension
- Hypoxia
Pregnancy Benzodiazepine use late in pregnancy may cause neonatal sedation/withdrawal
Lactation No human data; pump and discard milk for ~5 h after administration
⚠ BOXED WARNINGS
- Risk from concomitant use with opioids
- Abuse, misuse and addiction
- Dependence and withdrawal reactions
Cost, est. cash$50–$300/procedure
Generic entry2034 est.
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilityApnea, hypotension and loss of protective reflexes require continuous monitoring and airway capability.
Mechanism of action: Remimazolam ballicule
Open Remimazolam in the interactive console ↗
Memory aids: mascots and interaction avatars
hot pink → benzo theme
repurposing of midazolam’s Midis mascot