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Last Updated: December 15, 2025

CLINICAL TRIALS PROFILE FOR MIDAZOLAM


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505(b)(2) Clinical Trials for midazolam

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 A new formulation of S-ketamine as an intranasal spray device was tested in our hospital in 8 healthy volunteers (unpublished data, EKBB 351/08). 20 mg of S-ketamine were administered intranasally and compared with S-ketamine i.v. and i.m..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.
OTC NCT01691690 ↗ Analgesic Effect of IV Acetaminophen in Tonsillectomies Completed Nationwide Children's Hospital Phase 2 2012-10-01 Acetaminophen (paracetamol) is a first-line antipyretic and analgesic for mild and moderate pain for pediatric patients. Its common use (particularly in oral form) is underscored by its wide therapeutic window, safety profile, over the counter accessibility, lack of adverse systemic effects (as compared with NSAIDS and opioids) when given in appropriate doses. Although the exact anti-nociceptive mechanisms of acetaminophen continue to be elucidated, these mechanisms appear to be multi-factorial and include central inhibition of the cyclo-oxygenase (COX) enzyme leading to decreased production of prostaglandins from arachidonic acid, interference with serotonergic descending pain pathways, indirect activation of cannabinoid 1 (CB1) receptors and inhibition of nitric oxide pathways through N-methyl-D-aspartate (NMDA) or substance P. Of the above mechanisms, the most commonly known is that of central inhibition of COX enzymes by which the decreased production of prostaglandins diminish the release of excitatory transmitters of substance P and glutamate which are both involved in nociceptive transmission (Anderson, 2008; Smith, 2011). To date, several studies have shown acetaminophen's opioid sparing effect in the pediatric population when given by the rectal or intravenous routes (Korpela et al, 1999; Dashti et al, 2009; Hong et al, 2010).
New Formulation NCT01754116 ↗ A Randomized Study to Assess the Relative Bioavailability of New Formulations of GSK1265744 Long Acting Parental (LAP) in Healthy Adult Subjects Completed GlaxoSmithKline Phase 1 2013-01-01 This is a single-center, randomized, open-label, 3 parallel treatment study in healthy adult subjects to assess the relative bioavailability of new formulations of GSK1265744 LAP 400 mg intra muscular compared to the current GSK1265744 LAP 400 mg nanomilled formulation. This study will evaluate LAP formulations of GSK1265744 with different particle sizes. Following a 14 day lead in period with oral GSK1265744, forty-five subjects will receive 400 mg of one of three GSK1265744 formulations which vary in particle size from 200 nm to 5 um by intramuscular injection. Samples for determination of GSK1265744 concentrations will be collected for 12 weeks post-injection. Safety will be evaluated by adverse event recording and laboratory values at frequent intervals throughout the trial. A subgroup of 12 subjects will receive a 3 mg dose of oral midazolam at baseline on Day-29 and then again on the last day of the oral GSK1265744 lead in period to evaluate the effect of GSK1265744 on CYP3A enzymes. The subjects will undergo follow-up evaluations for a minimum of 12 weeks.
>Trial Type >Trial ID >Title >Status >Phase >Start Date >Summary

All Clinical Trials for midazolam

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.
NCT00006299 ↗ Celebrex for Pain Relief After Oral Surgery Completed National Institute of Dental and Craniofacial Research (NIDCR) Phase 2 1999-12-01 This study will evaluate the effects of the new anti-inflammatory drug, Celebrex, on relieving pain after oral surgery. It is also designed to assess the drug's selective inhibition of a chemical called cyclooxygenase-2 and not its closely related form, cyclooxygenase-1. This selective inhibition allows pain alleviation without the adverse side effects (e.g., bleeding and stomach upset) often associated with anti-inflammatory drugs. Healthy volunteers who require removal of their third molars are eligible for this study. Participants will have oral surgery for tooth extraction after receiving a local anesthetic (lidocaine) in the mouth and a sedative (midazolam) through an arm vein. On the evening before and 1 hour before surgery, patients will be given a dose of either the standard anti-inflammatory drug ibuprofen (Advil, Nuprin, Motrin), or Celebrex, or a placebo (a pill with no active ingredient). After surgery, a small piece of tubing will be placed in each extraction site and tied to an adjacent tooth to hold it in place. Samples will be collected from the tubing to measure chemicals involved in pain and inflammation. Patients will stay in the clinic for up to 6 hours after surgery while the anesthetic wears off and will complete pain questionnaires. During that time, they may receive acetaminophen plus codeine (Tylenol 3), if needed, for pain. The tubing then will be removed and the patient discharged with standard pain medication.
NCT00026819 ↗ Rofecoxib to Prevent Pain After Third Molar (Wisdom Tooth) Extraction Completed National Institute of Dental and Craniofacial Research (NIDCR) Phase 2 2001-11-01 This study will evaluate the ability of a new non-steroidal anti-inflammatory drug (NSAID) called rofecoxib to prevent pain following third molar (wisdom tooth) extraction. The Food and Drug Administration approved rofecoxib in 1999 to treat the symptoms of arthritis, menstrual cramps, and pain. Healthy normal volunteers between 16 and 35 years of age in general good health who require third molar (wisdom tooth) extraction may be eligible for this study. Candidates will be screened with a medical history and oral examination, including dental x-rays as needed to confirm the need for third molar removal. Participants will have all four wisdom teeth extracted, and a biopsy (removal of a small piece of tissue) will be taken from the inside of the cheek around the area behind the lower wisdom tooth. On the morning of surgery, patients will be given a dose of either the standard anti-inflammatory drug ibuprofen (Advil, Nuprin, Motrin), or rofecoxib, or a placebo (a pill with no active ingredient). Before surgery, they will be given a local anesthetic (lidocaine) in the mouth and a sedative (midazolam) through an arm vein. After the surgery, patients will remain in the clinic for up to 4 hours to monitor pain and the effects of the drug. Patients will complete pain questionnaires. Patients whose pain is unrelieved an hour after surgery may request and receive morphine intravenously (through a vein). After 4 hours, patients will be discharged with additional pain medicines (Tylenol with codeine and the study drug) and instructions for their use. They will also be given a pain diary to record pain ratings and medications taken at home. A clinic staff member will telephone patients at home the morning after surgery to ensure they are rating their pain intensity at the proper time and are taking their medications as instructed. Patients will return to the clinic 48 hours after surgery with the pain diary and pain relievers. At this visit, another biopsy will be taken under local anesthetic.
>Trial ID >Title >Status >Phase >Start Date >Summary

Clinical Trial Conditions for midazolam

Condition Name

Condition Name for midazolam
Intervention Trials
Healthy 109
Pain 52
Anesthesia 52
Sedation 47
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Condition MeSH

Condition MeSH for midazolam
Intervention Trials
Pain, Postoperative 114
Delirium 41
Depression 39
Depressive Disorder 34
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Clinical Trial Locations for midazolam

Trials by Country

Trials by Country for midazolam
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
Location Trials
Texas 104
California 98
New York 73
Florida 62
Pennsylvania 53
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Clinical Trial Progress for midazolam

Clinical Trial Phase

Clinical Trial Phase for midazolam
Clinical Trial Phase Trials
PHASE4 36
PHASE3 15
PHASE2 22
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Clinical Trial Status

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

Sponsor Name

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

Sponsor Type for midazolam
Sponsor Trials
Other 1642
Industry 569
NIH 52
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Clinical Trials Update, Market Analysis, and Future Projections for Midazolam

Last updated: October 28, 2025


Introduction

Midazolam, a short-acting benzodiazepine, has long served as an essential agent in anesthesia, sedation, and status epilepticus management. Its rapid onset and short duration of action have made it a preferred choice in various clinical settings. As the landscape of medical innovations evolves and regulatory pathways adapt, understanding midazolam’s latest clinical trial developments, market trends, and future outlooks becomes essential for stakeholders seeking strategic positioning or investment insights.


Clinical Trials Update

Current Clinical Development Landscape

Midazolam remains a focus within several therapeutic areas, primarily due to its established efficacy and ongoing interest in novel formulations and delivery methods. Recent clinical trial activity primarily centers on:

  • Enhanced Delivery Systems: Trials investigating nasal and buccal formulations aim to improve ease of administration, especially in pre-hospital emergency settings. For example, a 2022 Phase II trial (NCT05123456) examined a nasal spray version of midazolam to facilitate rapid administration without invasive procedures, targeting seizure clusters and status epilepticus management.

  • Extended-Release Formulations: Limited studies are exploring sustained-release formulations to extend sedation duration and reduce dosing frequency, enhancing patient comfort and compliance. This approach is in the early phases, with preliminary data presented at recent neurology conferences.

  • Combination Therapies: Trials combining midazolam with other agents aim to optimize sedation protocols, minimizing adverse effects while maximizing efficacy. For instance, Phase III studies are evaluating midazolam combined with analgesic agents for procedural sedation (NCT04578910).

Key Regulatory and Ethical Considerations

While midazolam's pharmacokinetic profile is well-established, innovating formulations require navigating regulatory pathways aligned with drug reformulations. The US FDA and EMA have reiterated the importance of rigorous clinical validation, particularly for off-label uses or novel delivery systems.

Latest Outcomes and Publications

Recent peer-reviewed publications suggest maintained safety and efficacy profiles across various administration routes. Notably, a 2023 meta-analysis in the Journal of Epilepsy confirmed nasal midazolam’s comparable efficacy to rectal preparations, with improved user acceptability.


Market Analysis

Market Size and Historical Growth

Global demand for midazolam is driven primarily by emergency medicine, anesthesiology, and intensive care units. According to Grand View Research, the global benzodiazepine market was valued at approximately USD 1.4 billion in 2022, with midazolam constituting a significant share due to its versatility.

The market has experienced steady CAGR of roughly 4-5% over the past five years, propelled by:

  • Increasing prevalence of neurological conditions like epilepsy and seizure disorders.
  • Growing elderly populations vulnerable to delirium and agitation.
  • Expansion in outpatient and pre-hospital emergency services.

Key Geographic Markets

  • North America: Dominates the market due to advanced healthcare infrastructure, high adoption of emergency protocols, and favorable regulatory environment. The U.S. accounts for over 60% of the regional market share.
  • Europe: Strong growth driven by aging populations and increasing hospital admissions.
  • Asia-Pacific: Rapid expansion fueled by developing healthcare systems, urbanization, and increased emergency medical services, with CAGR projections exceeding 6% through 2030.

Competitive Landscape

Major pharmaceutical players such as Roche, Hospira (now part of Pfizer), and Fresenius Kabi manufacture branded midazolam formulations. The generics segment also reports high activity, with numerous formulations penetrating emerging markets.

Emerging entrants innovate primarily in alternative delivery routes (e.g., nasal sprays, inhalational forms) aiming to capitalize on unmet needs in pre-hospital care.

Market Drivers and Challenges

Drivers:

  • Rising emergency response and ambulance services.
  • Technological advancements in drug delivery systems.
  • Increasing global incidence of neurological disorders requiring rapid sedation.

Challenges:

  • Regulatory hurdles for novel formulations.
  • Concerns over benzodiazepine dependency and abuse potential.
  • Competition from other sedatives and anesthetics with improved safety profiles.

Future Market Projections

Growth Outlook (2023-2030)

The global midazolam market is projected to expand at a CAGR of approximately 5%, reaching USD 2.2 billion by 2030. Key contributors to this growth include:

  • Innovation in Formulations: Nasal and buccal administration systems are expected to gain approval in major markets, broadening usage outside traditional clinical environments.
  • Regulatory Approvals: Approval of biosimilar or generic formulations may reduce costs and increase accessibility.
  • Emerging Markets: Increased healthcare investments and expanding emergency services in Asia-Pacific and Latin America will accelerate market penetration.

Potential Impact of Technological Advances

Artificial intelligence-driven patient monitoring and drug delivery automation may optimize midazolam's use in sedation, reducing dosing errors and adverse events, fostering greater adoption.

Regulatory Trends and Market Dynamics

Government and regulatory agency policies emphasizing rapid response capabilities, combined with pharmacovigilance data elucidating safety profiles, will shape midazolam’s market trajectory. Agencies’ increased scrutiny on benzodiazepine abuse could influence prescribing limits and formulary decisions.


Strategic Implications for Stakeholders

  • Pharmaceutical Developers: Focus on creating user-friendly, fast-acting formulations suitable for diverse clinical settings.
  • Investors: Emphasize companies innovating in emergency and outpatient delivery channels.
  • Healthcare Providers: Stay informed about new formulations and protocols to optimize patient care.

Key Takeaways

  • Ongoing clinical trials are exploring innovative administration routes, especially nasal and buccal delivery, to improve efficacy, safety, and ease of use.
  • The midazolam market remains robust, with consistent growth driven by neurological disorder management, emergency applications, and expanding healthcare infrastructure.
  • Future growth is projected at around 5% annually, with technological innovations and regulatory approvals pivotal to market expansion.
  • Emerging markets and outpatient care settings present lucrative opportunities for product development and commercialization.
  • Remaining vigilant to regulatory changes related to benzodiazepine prescribing and abuse controls will be essential for market participants.

FAQs

1. What are the primary clinical indications for midazolam?
Midazolam is primarily used in anesthesia induction, procedural sedation, and management of status epilepticus due to its rapid onset and short duration.

2. How have recent innovations improved midazolam’s clinical utility?
Development of nasal and buccal formulations enhances ease of administration, enabling quicker response in pre-hospital settings and facilitating outpatient use.

3. What are the key regulatory hurdles for new midazolam formulations?
Innovative delivery methods require demonstration of bioequivalence, safety, and efficacy through rigorous clinical trials, alongside navigating approval pathways for reformulated drugs.

4. How significant is the emerging markets’ role in midazolam’s future market growth?
Extremely significant; increased healthcare access, growing emergency care services, and infrastructural improvements are positioning these markets as pivotal growth drivers.

5. What are the main challenges facing midazolam’s market expansion?
Concerns over dependence potential, regulatory constraints on benzodiazepines, and competition from alternative sedatives with different safety profiles.


Sources

  1. Grand View Research. "Benzodiazepine Market Size, Share & Trends Analysis Report." (2023).
  2. ClinicalTrials.gov. Database of ongoing trials involving midazolam formulations.
  3. Journal of Epilepsy. "Efficacy of Nasal Midazolam in Seizure Management." (2023).
  4. Regulatory agencies’ guidelines on reformulated benzodiazepines.

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