Pediatrics and Neonates : In pediatric patients aged 1 year and older, the pharmacokinetic properties following a single dose of midazolam reported in 10 separate studies of midazolam are similar to those in adults. Weight-normalized clearance is similar or higher ( to L/hr/kg) than in adults and the terminal elimination half-life ( to hours) is similar to or shorter than in adults. The pharmacokinetic properties during and following continuous intravenous infusion in pediatric patients in the operating room as an adjunct to general anesthesia and in the intensive care environment are similar to those in adults.
Diazepam and other benzodiazepines should be administered cautiously in patients with CNS depression. Ambulatory patients receiving diazepam should be warned of the hazards of driving or operating machinery, and should avoid engaging in these activities until the full effect of the drug has dissipated. There is a potential for synergistic CNS-depressant effects if benzodiazepines are administered concomitantly with alcohol, barbiturates, or other CNS depressants. If opiate agonists are used concomitantly, the dose of the opiate should be reduced by at least one-third. Except as indicated for acute alcohol withdrawal, diazepam should not be administered parenterally to patients with acute ethanol intoxication, shock, or coma because the drug can worsen CNS depression.
Withdrawal symptoms , similar in character to those noted with barbiturates and alcohol (., convulsions, psychosis, hallucinations, behavioral disorder, mood changes, tremor, abdominal and muscle cramps) have occurred following abrupt discontinuance of clonazepam. The more severe withdrawal symptoms have usually been limited to those patients who received excessive doses over an extended period of time. Generally milder withdrawal symptoms (., dysphoria and insomnia) have been reported following abrupt discontinuance of benzodiazepines taken continuously at therapeutic levels for several months. Consequently, after extended therapy, abrupt discontinuation should generally be avoided and a gradual dosage tapering schedule followed (see DOSAGE AND ADMINISTRATION ). Addiction- prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving clonazepam or other psychotropic agents because of the predisposition of such patients to habituation and dependence.