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Abstract SUMMARY Colonoscopy remains a key modality for diagnosing and evaluation of colorectal cancer and other lower GI pathology. Although it is considered the most accurate tool to manage diseases of the large bowel, it is a painful invasive procedure, so the use of sedation is necessary. In developed countries, using midazolam with or without short-acting opioids such as fentanyl is the most commonly used agents for colonoscopy. Patient satisfaction with as regard colonoscopy is an important scale for quality of colonoscopy and have been related to the ability to achieve adequate sedation during the procedure. The aim of our study was to compare the safety and feasibility of midazolam with that of midazolam/pheniramine in sedation of patients undergoing colonoscopy on Tanta university.This study a prospective study carried out on about 90 patients indicated for colonoscopy, from October 2020 to Septemper 2021 at the Department of Tropical Medicine and infectious diseases, Tanta University. Adding pheniramine maleate to midazolam is better than midazolam alone as it resulted in better patient-reported pain scores, less need for analgesia, and better endoscopist’s satisfaction without significant adverse events |