COMPARISON OF SEDATIVE RECOVERY-TIME AFTER MIDAZOLAM VERSUS DIAZEPAM ADMINISTRATION

Objective: To compare the sedative recovery rate pharmacology of intra venous midazolam vs. diazepam when used for short-term sedation. Data Sources: English-language articles were identified through a search of the MEDLINE and InPharma databases. Bibliographies of retrieved artic les were examined for relevant articles. Study Selection: Twenty-eight studies were identified based on a priori inclusion criteria. Eight t rials had enough information to combine results for sedative recovery rate. Data Extraction: The difference in mean time to sedative recover y, weighted by sample size, was determined. Data Synthesis: Of the 28 trials, eight reported a significantly faster sedation recovery rate f rom diazepam vs. midazolam, whereas 19 trials reported no difference i n sedative recovery time, and a single trial reported that midazolam o ffered significantly faster recovery from sedation than diazepam. A co mmonly defined time to sedative recovery event was available for only eight trials. The median dosing ratio for these eight trials was 2.1:1 for diazepam over midazolam. The weighted mean time difference was 4 mins 16 sees in favor of diazepam as the agent from which patients rec over more quickly. Conclusions: These results firmly underscore the un derstanding that elimination half-lives of benzodiazepines do not nece ssarily correspond with their sedative pharmacodynamic effects, and we conclude that there are no clinically important sedative recovery rat e differences between midazolam and diazepam, while midazolam is a mor e expensive agent.