Although it's a short-acting benzodiazepine, triazolam is considered one of the more potent benzodiazepines. Interestingly, triazolam does not have an established Food and Drug Administration Maximum Recommended Drug (MRD) dosage for unmonitored home use.16 Triazolam was initially intended for less than 10 days of use to treat insomnia, and is often used for patients with sedation needs scores ranging from 3-6 with short dental procedures. Triazolam: Dosage and administration mode for dental anxiety 37,38 Dosage Administration route Onset of sedation 0.125-0.5mg Oral 0.75-2 hours Midazolam Midazolam was synthesized for the first time by Fryer and Walser in 1976.17 It represents a different form of benzodiazepines than triazolam and quickly gained popularity for sedation. Midazolam offers a more pronounced amnestic effect than other benzodiazepines, and has a rapid onset and short duration of action. The stability of midazolam allows it to be prepared and easily administered orally, intranasally, intramuscularly and intravenously. Oral and intranasal dosing of midazolam is typically provided to the pediatric population in dentistry and for patients less than 40 kilograms; therefore, those routes will not be covered here. Intramuscular (IM) and intravenous (IV) administration of midazolam can provide sedation with a hypnotic-like effect for dental procedures. The onset of action of the IM route is approximately 15 minutes with a peak effect occurring in 30-60 minutes. The IV route onset of action ranges from 3 to 6 minutes. The onset of action for IV sedation is both dose-dependent and dependent on concurrent opioid medication administration. Caution and appropriate patient monitoring are key factors in sedation safety with the administration of midazolam because of its ability to induce anesthesia and result in respiratory compromise. Dental practitioners are encouraged to refamiliarize themselves with the FDA monograph on midazolam administration because of safety considerations.18 Dental providers should consider that midazolam is short-acting and considered three to four times more potent than diazepam. The manufacturer's drug monograph states that dosing of midazolam should not be based solely on the pharmacokinetics of the medication but rather on the clinical effects. The FDA monograph for MRDs for IM and IV dosing provide ranges for ASA I and II patients who are 60 or younger without significant comorbidities. IM midazolam MRDs are 0.07-0.08mg/kg and the IV MRDs range from 1-2.5mg with conservative administration and patient monitoring. Maintenance dosages of IV midazolam are recommended to be 25% or less of the initial dose.18 Literature suggests that patients well-suited for the administration of midazolam have sedation needs scores of 5-6. Midazolam: Dosage and administration mode for dental anxiety 23-25 Dosage Administration route Onset of sedation 0.5mg/kg Intramuscular 15 minutes 1mg/2min Intravenous 3-6 minutes dentaltown.com \\ JANUARY 2020 81http://www.dentaltown.com