Sedative and analgesic medications for gastrointestinal endoscopy in adults

Medication	Initial dose (adult)^*	Onset	Duration	Repeat dose^¶	Effects
Benzodiazepines
Midazolam	0.5 to 2 mg IV over 2 to 3 minutes	1 to 3 minutes	10 to 40 minutes	2 to 5 minutes	Sedative, amnestic, anxiolytic Potentiates effects of other agents Delayed recovery in older adults, patients with obesity or impaired hepatic function
Opioids
Fentanyl	25 to 50 mcg IV over ≥3 minutes	2 to 3 minutes	30 to 60 minutes	2 minutes	Analgesic, minimal sedation Respiratory depression, nausea and vomiting may occur Minimal hypotension and histamine release Reduce dose when used in combination with benzodiazepine Use with caution with MAO inhibitors
Meperidine	25 to 50 mg IV over 3 to 5 minutes	5 minutes	60 to 180 minutes	5 to 10 minutes	Analgesic, sedative Respiratory depression, nausea and vomiting may occur Hypotension, histamine release Reduce dose when used in combination with benzodiazepine Avoid with MAO inhibitors

Refer to UpToDate content on procedural sedation for gastrointestinal endoscopy in adults.

IV: intravenous; MAO: monoamine oxidase.

* Doses should be modified based on patient factors (eg, doses reduced for patients with comorbidities or older adults).

¶ Sedatives and analgesics: Repeat one-half initial dose at interval noted if needed to achieve desired depth and duration of sedation. Additional titration may be needed.

Data from:

Cohen LB, DeLegge MH, Aisenberg J, et al. AGA institute review of endoscopic sedation. Gastroenterology 2007; 133:675.
Early DS, Lightdale JR, Vargo JJ et al. Guidelines for sedation and anesthesia in GI endoscopy. Gastrointestinal endoscopy 2018; 87:327.

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Sedative and analgesic medications for gastrointestinal endoscopy in adults