Friday, November 16, 2012

Injectable Midazolam Shortage: What To Do?

I got an absolutely giddy e-mail from one of my Versed-sufferers about the Versed/Midazolam shortage.  I agree!  Happy days for those of us who have been (permanently?) harmed by this horrible drug.  The entire article is here;  Current Drug Shortage Bulletin: Midazolam Injections

Here's an excerpt;


Alternative Agents & Management

  • During this shortage, use alternative injectable benzodiazepines.
  • Consider midazolam oral syrup for pediatric patients. Typical doses of oral midazolam range from 0.25 mg/kg to 1 mg/kg in children 6 months to 15 years old. The onset of action following oral administration is 10 to 20 minutes.8
  • Ravitskiy et al9 evaluated midazolam 2 mg/mL oral syrup for the treatment of perioperative anxiety in healthy adults undergoing Mohs surgery. Midazolam 10 mg oral syrup was safe and effective in this study.9 Data evaluating midazolam oral syrup for use in adults in other settings are lacking.
  • There are no direct dosage conversions between the benzodiazepines because each has a distinct pharmacokinetic profile dictating the agent’s therapeutic use and dosing.
  • Lorazepam and diazepam injection are also on shortage.10
  • Institutions may consider reserving injectable benzodiazepines for initial treatment of status epilepticus, as no other well established injectable therapeutic options are available for this indication. Diazepam rectal gel may be an alternative for some patients.11-15

I especially like the third suggestion.  Just imagine our relief if medical workers can't SNEAK Midazolam into the IV!  Let's see how far they get asking us drink an unknown substance...  I'm thinking that this can force them to describe for us exactly what drinking some kind of poison will do for us.  Then we can refuse to drink it and THERE'S NOTHING THEY CAN DO!  At least for now competent adults have no need to fear numerous health care workers holding them down, clamping their noses and forcing them to drink.  Can you imagine the outrage? 

The last bullet point suggests "reserving injectable benzodiazepines for initial treatment of status epilepticus..."  I'm all for that!  I italicized 'initial' just for medical workers.  INITIAL treatment, not continuous infusion.  You guys do understand what "initial" treatment means don't you?  Isn't epilepsy CAUSED by brain damage?  Do people with epilepsy get even more brain damage from Versed?  Do they care?  Wouldn't the side effects from Versed make coping with epilepsy even worse?  Lots of questions for this one, BUT, as long as they stop damaging the rest of us, I'll live with it.

What is left out is this idea;  Learn to do your job without the amnesia and patient control drug Midazolam aka Versed.  People have been having acceptable surgical interventions well before amnesia became the pain management technique.  It's a piss poor substitution for pain relief anyway.  It's well past time that our overpaid, underworked anesthesia people started actually earning their living instead of simply turning people into vegetables, from which they may or may not recover. 

This is my opinion and nothing that medical workers can say will change it.

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