[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/) › Remimazolam

# Remimazolam

## Benzodiazepines?

Benzodiazepines

## High alert?

An error with this medicine can cause serious harm: double checks and protocols are used.

An ultra-short-acting intravenous benzodiazepine broken down by tissue esterases. Used for procedural sedation and, in some countries, anaesthesia.

Updated Nov 12, 2026

## Quick facts

**Group**
[Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

**Target**
GABA-A receptor, benzodiazepine site

**Used for**
Sedation for short procedures in adults

**Key effects**
Low blood pressure · Low oxygen saturation · Nausea

**Monitor**
Continuous oxygen saturation · Depth of sedation

**ATC**
N05CD14

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**GABA-A receptor, benzodiazepine site**Remimazolam

ⓘ The figure shows diazepam, a benzodiazepine that occupies the same site, bound to the human GABA-A receptor (α1β2γ2) with GABA; no structure with remimazolam is available.

**Target in 3D:** GABA-A receptor, benzodiazepine site. PDB structure 6X3X (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/6X3X) · Drag to rotate · pinch to zoom

Remimazolam binds the benzodiazepine site of the GABA-A receptor, like midazolam, and increases the chloride current that GABA opens, so neurons are hyperpolarised and the patient is sedated. It was designed as a 'soft drug': an ester group lets tissue esterases (mainly liver carboxylesterase) split it quickly into an inactive metabolite, an idea also used for remifentanil. So it wears off fast, even after long infusions, and flumazenil can reverse it.

- Binds the benzodiazepine site of GABA-A
- More chloride enters: neurons hyperpolarise
- Sedation and amnesia within moments
- Esterases split it to an inactive acid: fast offset

## Indications

- Sedation for short procedures in adults (for example endoscopy, bronchoscopy)
- Induction and maintenance of general anaesthesia (approved in some countries)

## Adverse effects

### Common

- Low blood pressure (less than with propofol)
- Low oxygen saturation and slowed breathing
- Changes in heart rate
- Nausea, vomiting, headache, drowsiness

### Serious (rare, important)

- Respiratory depression and airway obstruction, especially with opioids
- Marked hypotension in frail patients
- Delayed recovery in severe liver impairment

## Contraindications

- Hypersensitivity to remimazolam or other benzodiazepines
- Use without staff and equipment for airway management and monitoring

## Key interactions

**Opioids**
Usually given together; deeper sedation and respiratory depression.

**Alcohol and other CNS depressants**
Additive sedation.

**Flumazenil**
Reverses the sedation; re-sedation is possible, so it is not used routinely.

## What is monitored

- Continuous oxygen saturation, breathing and capnography where available
- Blood pressure and heart rate
- Depth of sedation and recovery before discharge

## Administration and safety

- Intravenous only, by staff trained in sedation, with oxygen, airway equipment and flumazenil available.
- Usually given with an opioid; each dose is titrated to effect.
- No pain on injection, unlike propofol.

## Pregnancy and breastfeeding

Information on use in pregnancy is limited.

## Nursing care

- Before: confirm fasting, airway assessment and baseline vital signs.
- During: watch breathing, oxygen saturation and blood pressure continuously.
- After: monitor until awake and stable; no driving the same day.
- Report delayed waking, especially in liver disease.

## Pharmacokinetics

**Absorption**
Intravenous only.

**Metabolism**
Hydrolysed by tissue esterases (liver carboxylesterase) to an inactive metabolite, not by CYP enzymes.

**Elimination**
Metabolites are excreted in the urine.

**Onset and duration**
Rapid onset and recovery; offset is faster than midazolam, close to propofol.

## Memory aid

REMImazolam is REMIfentanil's benzodiazepine cousin: an ester that esterases switch off.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does remimazolam wear off faster than midazolam?

Tissue esterases rapidly split its ester to an inactive metabolite.

## Which antidote reverses remimazolam?

Flumazenil, the benzodiazepine-site antagonist.

## Which other anaesthetic drug uses the same 'ester soft drug' design?

Remifentanil.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/remimazolam/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**High alert**
An error with this medicine can cause serious harm: double checks and protocols are used.

## Connections

## Related drugs 4

- [Midazolam](https://durgical.com/en/pharmacology/midazolam/)
- [Propofol](https://durgical.com/en/pharmacology/propofol/)
- [Flumazenil](https://durgical.com/en/pharmacology/flumazenil/)
- [Remifentanil](https://durgical.com/en/pharmacology/remifentanil/)

[← Back to the class: Benzodiazepines](https://durgical.com/en/pharmacology/classes/benzodiazepines/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Remimazolam: pharmacological characteristics and clinical applications in anesthesiology](https://pmc.ncbi.nlm.nih.gov/articles/PMC8841266/) (Anesthesia and Pain Medicine, via PubMed Central, 2022); [Human GABAA receptor alpha1-beta2-gamma2 subtype in complex with GABA plus diazepam](https://www.rcsb.org/structure/6X3X) (RCSB Protein Data Bank, 2020); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N05CD14) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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