Nurses Compass
Drug Guide
Remimazolam Besylate
Classification
Therapeutic: Sedative, Anesthetic adjunct
Pharmacological: Benzodiazepine
FDA Approved Indications
- Induction and maintenance of procedural sedation in adults
Mechanism of Action
Remimazolam enhances the effect of gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, amnestic, and hypnotic effects.
Dosage and Administration
Adult: Initial dose of 5 mg IV, may be repeated or titrated based on response; infusion rate up to 1 mg/min for maintenance.
Pediatric: Not approved for pediatric use.
Geriatric: Starting dose of 2.5 mg IV recommended due to increased sensitivity.
Renal Impairment: Adjustments not specifically required, but careful titration advised.
Hepatic Impairment: Use with caution, dosage adjustments may be necessary.
Pharmacokinetics
Absorption: Administered via IV; absorption is not applicable.
Distribution: Widely distributed; volume of distribution approximately 70 L.
Metabolism: Metabolized rapidly by tissue esterases to an inactive metabolite.
Excretion: Excreted primarily via urine; very little unchanged drug recovered.
Half Life: Approximately 0.75 hours, allowing for rapid recovery after infusion cessation.
Contraindications
- Known hypersensitivity to remimazolam or benzodiazepines.
Precautions
- Use with caution in patients with respiratory depression, elevated intracranial pressure, or hepatic impairment. Monitor vital signs closely.
Adverse Reactions - Common
- Hypotension (Uncommon)
- Respiratory depression (Uncommon)
- Nausea (Common)
Adverse Reactions - Serious
- Hypoxia, Respiratory arrest (Rare)
- Anaphylaxis (Very rare)
Drug-Drug Interactions
- Other CNS depressants, opioids, CYP3A4 inhibitors or inducers.
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor sedation levels, respiratory and cardiovascular status.
Diagnoses:
- Risk for respiratory depression
- Altered mental status
Implementation: Administer slowly, titrate carefully, and monitor patient continuously.
Evaluation: Ensure patient maintains airway, stable vital signs, and appropriate sedation level.
Patient/Family Teaching
- Inform patient about possible drowsiness and respiratory effects.
- Advise against operating heavy machinery post-administration.
Special Considerations
Black Box Warnings:
- Potential for respiratory depression, especially when combined with other CNS depressants.
Genetic Factors: None specific.
Lab Test Interference: Minimal; does not interfere with typical lab results.
Overdose Management
Signs/Symptoms: Excessive sedation, respiratory depression, hypotension.
Treatment: Supportive care, airway management, and ventilatory support if needed. Flumazenil may be considered for benzodiazepine reversal under careful monitoring.
Storage and Handling
Storage: Store at room temperature, away from light and moisture.
Stability: Stable until expiration date on packaging.