SPOILER ALERT.

Not only are the pharmaceuticals mentioned in Caged Flower real, the descriptions are very accurate. Cullman Wallace obviously did his research.

Violet overhears Dr. Chalsey dictating a request for "diazepam, five milligram injection." Diazepam is better known as Valium, and injectable diazepam is commonly available in ten milliliter bottles at a strength of 5 milligrams per milliliter.

Midazolam, the drug Dominic steals from Dr. Chalsey's office, is a very common surgical anaesthetic, most often used for premedication instead of induction and maintenance of anesthesia. It is well-known by the brand name Versed, which reportedly comes from "versatile sedative." Midazolam is available in ten milliliter bottles at a strength of 5 milligrams per milliliter, as identified in the book. Dominic's comment that there are "over twenty doses in those bottles" is quite plausible, as the recommended initial dose is between 1 to 2.5 milligrams, with additional midazolam given in small increments very slowly, and checking for desired sedation effects after a certain period of time before administering more. Individual reaction to midazolam varies, however, and his fears about killing Galen and Mrs. Dantner are justified. It is a central nervous system (CNS) depressant, and can interfere with respiratory and cardiac function. As Dominic mentioned, it is indeed supposed to be administered only in a clinical setting, where the patient can be monitored closely and resuscitative measures can be administered immediately.

Interestingly, Violet's comment about it not having been around before 1972 was a good guess---the initial patent was filed in May of 1972, and patent issued in October of 1973. So quite likely it wouldn't be in any medical books dated 1972 or earlier. As Dominic raised the possibility that midazolam was the drug in the "emergency syringes", one hopes that Mrs. Dantner was trained in advanced life support---her reckless use of injectable midazolam could be quite dangerous. And Mrs. Dantner's reaction to the flavor of mizadolam in her tea is not surprising---midazolam has a rather bitter taste.

The "little white pills" Jaedlyn was being given are lorazepam (as we discover in Book Two), known by the brand name Ativan. Her description given there would most likely be a generic form and not Ativan, as Ativan pills bear a distinct A shape/imprint.

All these drugs do fall into a class of medications called benzodiazepines. All share similar traits (sedation, anti-anxiety, etcetera) but some have different "specialty" uses. Both diazepam and midazolam are effective muscle relaxants, and Violet immediately feeling "all the strength go out of her" supports the belief that the emergency syringes contained midazolam. Diazepam is central to the plot of Book Two, where it is correctly identified as a longer-acting medication (or speaking technically, it has one of the longest elimination half-lives among the benzodiazepines).

The flumazenil Dr. Chalsey mentions having available "if it comes to that" is a benzodiazepine antagonist used to hasten recovery for patients sedated with a benzodiazepine, and useful in situations of benzodiazepine overdose. It "competes" for the same receptors in the brain that benzodiazepines do, and can halt or even reverse the action of a benzodiazepine in the body. However, use of flumazenil has associated dangers, including seizures and benzodiazepine withdrawal symptoms, and it is not recommended for routine use in patients with a decreased level of consciousness.

As for the other drugs mentioned in the novel, we can only guess at what they might be. Since we know Dr. Chalsey was ordering diazepam, it's possible the blue pill given to Dominic and Violet at dinner was diazepam, which a number of companies manufacture in blue to greenish-blue pills. The notorious orange juice may have been laced with midazolam, as midazolam suspended in flavored syrups (including orange) is sometimes used by dentists and other physicians with pediatric patients. The flavoring reduces the bitter taste, which could easily explain the comment that the orange juice was "homemade, bits of pulp floating on the top and with the faint bitterness of natural orange."

The influenza vaccination given to the entire house would be the current year's selection, as determined by the World Health Organization. We hear Dr. Chalsey dictating a request for prices for "multidose flu shots", which would have arrived as glass vials with multiple doses in a single bottle.

What was being given to Violet in the IV following the escape attempt remains a mystery. A benzodiazepine is quite likely, but which one is uncertain. We know that Violet experienced hallucinations while strapped to Dr. Chalsey's exam table, but she did not seem to experience hallucinations from the intravenous medication. If the IV was midazolam, it could possibly be explained that another medication was in the syringe or the orange juice, and it was the combination of those two drugs that caused the hallucinations (which went away after she was dropped down to one drug and the other was eliminated from her system). Midazolam is used in "twilight sedation" where amnesia of the procedure is preferred, and Violet's abrupt shifts in consciousness could be an argument for that. Also an argument for it being midazolam is Violet's realization that she had no strength, and that she still "felt like all her bones had turned to rubber."

(From Dr. Chalsey's comment during her semiconsciousness about having "only done this once, and you know what happened then", it's possible we'll find out for certain in a future book. Book Two reveals exactly what he meant by that comment.)

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