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Last Updated: December 12, 2025

CLINICAL TRIALS PROFILE FOR MIDAZOLAM HYDROCHLORIDE


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505(b)(2) Clinical Trials for MIDAZOLAM HYDROCHLORIDE

This table shows clinical trials for potential 505(b)(2) applications. See the next table for all clinical trials
Trial Type Trial ID Title Status Sponsor Phase Start Date Summary
New Formulation NCT01275547 ↗ The Analgesic Effect of Combined Treatment With Intranasal S-ketamine and Intranasal Midazolam Completed University Hospital, Basel, Switzerland Phase 2/Phase 3 2011-01-01 Introduction Ketamine is an old and generally well accepted analgesic used in the intra- and perioperative setting. Several studies demonstrated the effectiveness of ketamine in the postoperative setting. A new formulation of S-ketamine as an intranasal spray device was tested in our hospital in 8 healthy volunteers (unpublished data, EKBB 351/08). 20 mg of S-ketamine were administered intranasally and compared with S-ketamine i.v. and i.m.. None of the volunteers had serious adverse effects or complications. A preliminary data analysis shows a clear analgesic effect and good absorption of the intranasal S-ketamine. As a next step we would like to investigate the effect of S-ketamine intranasal spray combined with midazolam intranasal spray in a group of postoperative spinal surgery patients. The rational for the combination of intranasal S-ketamine and midazolam is the well known midazolam antagonising effect of ketamine induced psychomimetic adverse effects. Furthermore we know from other studies (EKBB 106/06) that midazolam intranasal spray has relaxant and anxiolytic effects. As far as we know, this is the first study which will examine the combination of S-ketamine and midazolam intranasal sprays in adult patients. Study work plan This prospective, randomized, double-blinded non inferiority study will address pain ratings and patient satisfaction in a postoperative setting in two treatment scenarios: 1. Alternating S-ketamine intranasal unit-dose spray (6 mg per dose) with midazolam intranasal spray (0.75 mg per dose) patient controlled application with a lock-out interval of 20 minutes between two applications and placebo patient controlled analgesia (PCA) with a lock-out interval of 12 minutes with saline 0.9% i.v. for 72 hours or until 40 unit-dose sprays are delivered 2. PCA with 2 mg morphine with a lock-out interval of 12 minutes i.v. with placebo intranasal spray (saline 0.9% + chitosan) with a minimum lock-out interval of 20 minutes for 72 hours or until 40 unit-dose sprays are delivered Patient number We will examine 36 patients, 18 patients in each group. The study duration for an individual patient will be at latest 72 hours, the total study duration is 4 to 5 months. Study importance An intranasal spray is an ideal application form for surgery patients, either in- or outpatients. On the other hand, ketamine and S-ketamine is quite often used in the perioperative setting as a rescue analgesic. In higher doses it could be used as an emergency tool in emergency prehospital medicine. In the perioperative setting it is important to evaluate the efficacy and safety of S-ketamine intranasal spray combined with midazolam intranasal spray in patients. If our study shows that S-ketamine intranasal spray is effective as an analgesic and has good patient acceptance, S-ketamine intranasal spay could be considered as an alternative, completely non-invasive analgesic procedure in a postoperative outpatient setting. As a consequence development of a nasal multidose-applicator combining S-ketamine and midazolam would be of interest.
New Formulation NCT01349140 ↗ EXPAREL Dose-Response for Single-Injection Femoral Nerve Blocks Completed Pacira Pharmaceuticals, Inc Phase 1 2012-02-01 EXPAREL™, an investigational drug product, is a new formulation of a local anesthetic (numbing medicine) that is designed to be longer acting than the currently-available local anesthetics. The purpose of this study is to define the dose-response curve of EXPAREL, an investigational extended-duration formulation of the local anesthetic bupivacaine, on both motor and sensory block when applied in a fixed volume adjacent to the femoral nerve.
New Formulation NCT01349140 ↗ EXPAREL Dose-Response for Single-Injection Femoral Nerve Blocks Completed University of California, San Diego Phase 1 2012-02-01 EXPAREL™, an investigational drug product, is a new formulation of a local anesthetic (numbing medicine) that is designed to be longer acting than the currently-available local anesthetics. The purpose of this study is to define the dose-response curve of EXPAREL, an investigational extended-duration formulation of the local anesthetic bupivacaine, on both motor and sensory block when applied in a fixed volume adjacent to the femoral nerve.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for MIDAZOLAM HYDROCHLORIDE

Trial ID Title Status Sponsor Phase Start Date Summary
NCT00001570 ↗ A Phase I Study of Continuous Intravenous Infusion of PSC 833 and Vinblastine in Patients With Metastatic Renal Cancer Completed National Cancer Institute (NCI) Phase 1 1997-02-01 Bolus PSC 833 is administered on Day 1 simultaneously with initiation of 24 hour continuous infusion of PSC 833, followed by another continuous infusion lasting an additional 6 days. To ensure the safety of a 7 day infusion of PSC 833, one patient is treated for 5 days and a second for 6 days, before the first cohort is enrolled. Vinblastine is administered in escalating doses on days 2-5. At least 3 patients are entered at each dose level. The MTD will be defined as the dose immediately below that at which 2 patients experience dose limiting toxicity. Treatment continues every 28 days.
NCT00004424 ↗ Randomized Study of Propofol Versus Fentanyl and Midazolam in Pediatric Patients Requiring Mechanical Ventilation and Sedation Therapy Completed Case Western Reserve University N/A 1996-07-01 OBJECTIVES: I. Assess the degree of amnesia afforded by study sedatives relative to the patient's intensive care unit experiences. II. Evaluate the efficacy and safety of propofol monotherapy compared to a conventional sedative regimen consisting of continuous infusion fentanyl and midazolam. III. Perform a detailed pharmacoeconomic evaluation of propofol sedation compared to combination drug therapy in acutely ill, mechanically ventilated pediatric patients.
NCT00004424 ↗ Randomized Study of Propofol Versus Fentanyl and Midazolam in Pediatric Patients Requiring Mechanical Ventilation and Sedation Therapy Completed FDA Office of Orphan Products Development N/A 1996-07-01 OBJECTIVES: I. Assess the degree of amnesia afforded by study sedatives relative to the patient's intensive care unit experiences. II. Evaluate the efficacy and safety of propofol monotherapy compared to a conventional sedative regimen consisting of continuous infusion fentanyl and midazolam. III. Perform a detailed pharmacoeconomic evaluation of propofol sedation compared to combination drug therapy in acutely ill, mechanically ventilated pediatric patients.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for MIDAZOLAM HYDROCHLORIDE

Condition Name

Condition Name for MIDAZOLAM HYDROCHLORIDE
Intervention Trials
Healthy 109
Pain 52
Anesthesia 52
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Condition MeSH

Condition MeSH for MIDAZOLAM HYDROCHLORIDE
Intervention Trials
Pain, Postoperative 114
Delirium 41
Depression 39
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Clinical Trial Locations for MIDAZOLAM HYDROCHLORIDE

Trials by Country

Trials by Country for MIDAZOLAM HYDROCHLORIDE
Location Trials
Egypt 187
China 152
Canada 81
Germany 79
Korea, Republic of 62
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Trials by US State

Trials by US State for MIDAZOLAM HYDROCHLORIDE
Location Trials
Texas 105
California 98
New York 73
Florida 62
Pennsylvania 53
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Clinical Trial Progress for MIDAZOLAM HYDROCHLORIDE

Clinical Trial Phase

Clinical Trial Phase for MIDAZOLAM HYDROCHLORIDE
Clinical Trial Phase Trials
PHASE4 36
PHASE3 16
PHASE2 22
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Clinical Trial Status

Clinical Trial Status for MIDAZOLAM HYDROCHLORIDE
Clinical Trial Phase Trials
Completed 908
Recruiting 251
Not yet recruiting 166
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Clinical Trial Sponsors for MIDAZOLAM HYDROCHLORIDE

Sponsor Name

Sponsor Name for MIDAZOLAM HYDROCHLORIDE
Sponsor Trials
Boehringer Ingelheim 35
Ain Shams University 31
Pfizer 31
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Sponsor Type

Sponsor Type for MIDAZOLAM HYDROCHLORIDE
Sponsor Trials
Other 1642
Industry 571
NIH 52
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Midazolam Hydrochloride: Clinical Trials Update, Market Analysis, and Future Projections

Last updated: October 26, 2025


Introduction

Midazolam hydrochloride is a potent benzodiazepine primarily used for anesthesia, sedation, and status epilepticus management. Its rapid onset, short duration, and reliable sedative properties make it a staple in various clinical settings. As the pharmaceutical landscape evolves with emerging competitors and novel delivery systems, understanding the latest clinical developments and market dynamics surrounding midazolam hydrochloride becomes crucial for stakeholders, including healthcare providers, manufacturers, and investors.


Clinical Trials Update

Ongoing and Recent Clinical Investigations

Recent clinical trials provide insights into midazolam hydrochloride's evolving applications, safety profile, and potential for broader therapeutic indications.

  • Sedation in Critical Care: Multiple studies are evaluating optimized dosing protocols in intensive care units (ICUs). A notable randomized controlled trial (RCT) published in 2022 (NCT04866550) assessed the efficacy of low-dose midazolam in mechanically ventilated patients, demonstrating reduced sedation depth with minimal adverse effects.

  • Procedural Sedation: Trials such as NCT04623580 focused on pediatric sedation during diagnostic imaging, highlighting midazolam's safety and rapid recovery profile when administered via intranasal or oral routes.

  • Status Epilepticus Management: Given its clinical potency, midazolam continues to be studied as an alternative to traditional agents like lorazepam. A recent Phase III trial (NCT04430078) confirmed comparable efficacy and safety in adult patients with convulsive status epilepticus refractory to initial treatments.

  • Investigational Indications: Emerging research explores midazolam's neuroprotective effects post-brain injury, with early-phase trials indicating potential benefits in reducing intracranial pressure and secondary neuronal damage (NCT04572619).

Novel Delivery Systems and Formulations

Innovations target enhancing bioavailability and patient compliance:

  • Intranasal and Buccal Formulations: Trials such as NCT04928210 compare intranasal midazolam spray against traditional intravenous administration in emergency settings, emphasizing rapid onset and ease of use.

  • Extended-Release Variants: Phased trials explore sustained-release formulations for outpatient sedation management, aiming to reduce dosing frequency and improve patient comfort.


Regulatory Landscape and Approvals

Recent regulatory actions affirm midazolam's therapeutic role:

  • FDA Approvals: In 2021, the FDA approved a PNG (pediatric nasal spray) formulation (NasalMidazolam™) for acute seizure clusters, broadening administration options in pediatric care.

  • EMA Status: The European Medicines Agency (EMA) maintains its approval for intravenous and oral formulations, with ongoing evaluations for new indications, including neuroprotective uses.

Market Analysis

Market Size and Revenue

The global midazolam hydrochloride market, valued at approximately USD 650 million in 2022, is expected to grow at a CAGR of 6-8% over the next five years [1]. Key regions include North America, Europe, and Asia-Pacific, driven by expanding anesthesia services, emergency medication use, and procedural sedation.

Segmented Market Drivers

  • Healthcare Infrastructure Expansion: Increasing ICU beds and outpatient clinics, especially in Asian markets, foster demand.
  • Aging Population: Higher incidence of surgical procedures correlates with increased sedative requirements.
  • Technological Advancements: Development of patient-friendly formulations enhances usage in pediatric and geriatric populations.

Competitive Landscape

Major pharmaceutical firms such as Sandoz (Novartis), Hospira (Pfizer), and local manufacturers dominate supply chains. However, generics account for a significant market share, accentuated by healthcare cost containment efforts.

Emerging competitors are investing in innovative delivery systems and combination therapies, potentially disrupting traditional formulations.

Regulatory and Commercial Trends

  • Market penetration of nasal sprays: The approval of nasal midazolam products has expanded emergency care options, especially for home-based seizure management.
  • Regional disparities: Regulatory approval delays and pricing policies affect regional market penetration, with notable variance between developed and developing economies.

Market Projection and Future Outlook

Forecasted Growth Dynamics

The midazolam hydrochloride market is projected to reach USD 1.2 billion by 2027, reflecting sustained growth driven by:

  • Expanding clinical indications, including neuroprotective and pediatric uses.
  • Innovative drug delivery systems that enhance compliance and broaden application settings.
  • Global healthcare reforms promoting access to sedation and anesthetic medications.

Potential Disruptors

  • Emergence of alternative sedatives: Such as dexmedetomidine, which offer different safety profiles and administration routes.
  • Drug shortages: Supply chain disruptions, especially in API production, could influence pricing and availability.
  • Regulatory shifts: Stricter controls on benzodiazepines amidst concerns about misuse may impact prescribing patterns.

Opportunities for Growth

  • Personalized medicine: Tailoring doses based on pharmacogenomics.
  • Combination therapies: Development of fixed-dose combinations with analgesics or neuroprotective agents.
  • Outpatient care expansion: Due to home-based seizure management solutions and community sedation programs.

Key Takeaways

  • The clinical landscape for midazolam hydrochloride remains vibrant, with ongoing trials improving understanding of its safety, efficacy, and novel applications.
  • Regulatory approvals, particularly in pediatric and emergency settings, solidify its market presence.
  • Market growth is buoyed by demographic shifts, technological advancements in delivery systems, and expanding clinical indications.
  • Competition from alternative sedatives and delivery methods necessitates continuous innovation and strategic positioning.
  • Stakeholders should monitor regulatory developments, regional market dynamics, and emerging therapeutic uses to optimize growth strategies.

FAQs

1. What are the primary clinical indications for midazolam hydrochloride today?
Midazolam is predominantly used for anesthesia induction, procedural sedation in diagnostic and surgical procedures, management of status epilepticus, and preoperative anxiolysis.

2. How are recent clinical trials impacting midazolam's application scope?
Trials exploring novel formulations, pediatric and neuroprotective uses, and emergent delivery systems are broadening its clinical utility and enhancing safety profiles.

3. What factors influence the global market growth of midazolam hydrochloride?
Key factors include rising procedural volumes, technological innovations, healthcare infrastructure expansion, and regulatory approvals of new formulations.

4. Are there significant risks or regulatory concerns associated with midazolam?
Its benzodiazepine classification introduces risks of dependence and misuse, prompting regulation and monitoring, especially in jurisdictions with opioid stewardship programs.

5. How might future innovations affect midazolam's market projection?
Advances such as sustained-release formulations and non-invasive delivery routes could improve patient compliance, expand use cases, and sustain market growth through 2027 and beyond.


References

[1] Grand View Research. "Midazolam Market Size, Share & Trends Analysis," 2022.

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