Remimazolam

BYFAVO

Open Remimazolam in the interactive console ↗

Remimazolam ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Remimazolam ballicule

Remimazolam BYFAVO mascot mnemonic cartoon — Visual mnemonic: Remimazolam mascot
**“Rim’s amazing, By (far) my favorite!”**
hot pink → benzo theme
repurposing of midazolam’s Midis mascot

What it isUltra-short IV benzodiazepine GABA-A modulator for induction and maintenance of procedural sedation in adults.

Why this oneRapid tissue-esterase metabolism gives predictable offset and less dependence on hepatic or renal clearance than midazolam.

What limits itStill causes hypoventilation, apnea, hypotension, and bradycardia; continuous monitoring, rescue equipment, and flumazenil must be immediately available.

Remimazolam molecular structure (skeletal formula) — Molecular structure: Remimazolam

FDA-approved for

procedural sedation (2020)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Requires trained personnel and resuscitation equipment for monitoring; risks (profound sedation, respiratory depression) with concomitant opioid analgesics and other sedative-hypnotics

FDA dosing	Population	Start	Target	Max
Procedural sedation	Adults	5 mg IV push over 1 min	Supplemental 2.5 mg IV over 15 sec as needed	Titrate to effect
Procedural sedation	ASA III-IV	2.5-5 mg IV over 1 min	Supplemental 1.25-2.5 mg IV over 15 sec as needed	Titrate to effect

Renal Undefined

Hepatic Severe impairment: titrate carefully; reduced doses may be indicated

At least 2 min must elapse between supplemental doses

Instructions

Individualize and titrate to desired effect
Wait >=2 min before each supplemental dose
Continuously monitor vitals (capnography, pulse oximetry) during sedation and recovery

Available strengths

inj 2.5 mg/mL

Contraindications

History of severe hypersensitivity reaction to dextran 40 or dextran 40-containing products

Cautions

Hypersensitivity/anaphylaxis
Neonatal sedation and withdrawal syndrome
Pediatric neurotoxicity with exposures >3 h in developing animals

Adverse reactions

Hypotension
Hypertension
Hypoxia

Pregnancy Benzodiazepine use late in pregnancy may cause neonatal sedation/withdrawal

Lactation No human data; pump and discard milk for ~5 h after administration

Cost

Remimazolam (BYFAVO)

Strength		#/mo	generic $/unit	CostPlus
2.5 mg/mL	inj	per unit		not offered

NADAC is a voluntary CMS survey of what retail community pharmacies pay for the drugs they stock. Remimazolam is administered under clinical supervision and dispensed outside retail pharmacies, so it rarely appears on surveyed invoices.

Generic entry2034 est.

⚠ BOXED WARNINGS

Risk from concomitant use with opioids
Abuse, misuse and addiction
Dependence and withdrawal reactions

Classes and tags

Clinical profile

Therapeutic safety burden4 / 4

Overdose danger4 / 4

Weight-gain liability0 / 4

Sedation liability4 / 4

QT / Torsades2 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityApnea, hypotension and loss of protective reflexes require continuous monitoring and airway capability.

Open Remimazolam in the interactive console ↗