What is Midazolam Nasal Spray: Uses, Dosage, Side Effects and More

Midazolam nasal spray is a fast-acting medication that helps stop seizures when they happen outside of a hospital setting. It's a liquid form of midazolam that you spray into the nose, where it gets absorbed quickly into the bloodstream. This medication belongs to a group called benzodiazepines, which work by calming overactive brain signals that cause seizures.

Having a rescue medication like this can bring tremendous peace of mind to families dealing with epilepsy. It's designed to be used by caregivers, family members, or the person themselves when a seizure lasts longer than usual or seems particularly severe.

What is Midazolam Nasal Spray Used For?

Midazolam nasal spray is primarily used to treat seizure emergencies in people with epilepsy. It's what doctors call a "rescue medication" because it's meant to stop seizures that are lasting too long or happening in clusters.

The medication works best for tonic-clonic seizures (formerly called grand mal seizures) and other types of seizures that don't stop on their own within a few minutes. Your doctor might prescribe it if you have a history of prolonged seizures or if your regular seizure medications sometimes aren't enough to prevent breakthrough seizures.

Some doctors also prescribe it for severe anxiety or panic attacks, though this is less common. The nasal spray form is particularly helpful because it can be given even when someone is unconscious or unable to swallow pills.

How Does Midazolam Nasal Spray Work?

Midazolam nasal spray works by enhancing the effects of a natural brain chemical called GABA. GABA acts like the brain's brake pedal, helping to slow down electrical activity when it gets too excited.

During a seizure, brain cells fire electrical signals much faster than normal, like a car engine revving out of control. Midazolam helps press that brake pedal, calming the overactive electrical activity and allowing the seizure to stop. This makes it a moderately strong medication that works quickly but safely when used as directed.

The nasal spray form is absorbed through the thin lining inside your nose, which has lots of blood vessels. This means the medication can start working within 2-3 minutes, much faster than pills that need to go through your stomach first.

How Should I Take Midazolam Nasal Spray?

Taking midazolam nasal spray correctly is important for it to work effectively. The medication comes in a pre-filled device that's designed to be easy to use, even during stressful situations.

Here's how to use it properly: First, remove the yellow safety cap from the device. Then, insert the tip gently into one nostril, pressing it firmly against the side of the nose. Press the plunger firmly and quickly to release the entire dose into that nostril. The person receiving the medication should be lying on their side if possible, but this isn't always necessary during an emergency.

You don't need to worry about eating or drinking anything before using this medication. In fact, it's often given when someone can't eat or drink safely due to a seizure. The spray works whether the person has eaten recently or not.

If you're a caregiver, it's helpful to practice using the device when you're calm so you'll feel more confident if you ever need to use it during an emergency. Many doctors recommend keeping the medication in an easily accessible place and making sure multiple family members know how to use it.

How Long Should I Take Midazolam Nasal Spray For?

Midazolam nasal spray isn't a medication you take regularly like daily seizure medications. Instead, it's used only when needed during seizure emergencies, similar to how you might use an inhaler during an asthma attack.

Each dose is meant to be used just once for a single seizure episode. If the first dose doesn't stop the seizure within 10 minutes, you should call emergency services rather than giving another dose, unless your doctor has specifically instructed you otherwise.

Most people keep this medication on hand for months or even years without needing to use it, which is actually a good thing. The medication has an expiration date, so you'll need to replace it periodically even if you haven't used it. Your doctor will let you know how often to check the expiration date and get a new prescription.

What Are the Side Effects of Midazolam Nasal Spray?

Like all medications, midazolam nasal spray can cause side effects, though most people tolerate it well when used as directed. The most common side effects are usually mild and temporary.

The side effects you're most likely to experience include drowsiness, dizziness, and feeling a bit unsteady on your feet. These effects are normal and expected after the medication works to calm brain activity. Some people also notice a strange taste in their mouth or slight nasal irritation where the spray was applied.

Here are the more common side effects that might occur within hours of using the spray:

• Drowsiness and feeling very sleepy
• Dizziness or feeling lightheaded
• Headache
• Nausea or upset stomach
• Nasal irritation or runny nose
• Feeling confused or disoriented
• Muscle weakness

These common effects usually fade as the medication wears off over the next few hours. It's important to rest and avoid driving or operating machinery until you feel completely normal again.

While rare, some people might experience more serious side effects that require medical attention. These uncommon reactions can include severe drowsiness that makes it hard to wake up, difficulty breathing, or unusual changes in heart rate.

Here are the less common but more serious side effects to watch for:

• Severe drowsiness or difficulty staying awake
• Slow or shallow breathing
• Confusion that doesn't improve after a few hours
• Severe dizziness or fainting
• Unusual agitation or restlessness
• Memory problems lasting more than a day

If you notice any of these more serious effects, it's important to contact your doctor or seek medical care. Remember, these reactions are uncommon, and the benefits of stopping a dangerous seizure typically outweigh these risks.

Who Should Not Take Midazolam Nasal Spray?

While midazolam nasal spray is safe for most people, there are certain situations where it might not be the right choice. Your doctor will carefully consider your medical history before prescribing this medication.

People who should avoid this medication include those with severe breathing problems like severe asthma or chronic obstructive pulmonary disease (COPD), especially if their breathing is already compromised. The medication can slow down breathing, which could be dangerous for someone who already has trouble breathing.

You should also let your doctor know if you have severe liver problems, as your body might not process the medication normally. People with a known allergy to midazolam or other benzodiazepines should not use this medication.

Certain medical conditions require extra caution, and your doctor will weigh the benefits against the risks:

• Severe kidney or liver disease
• Sleep apnea or other breathing disorders
• Muscle weakness conditions like myasthenia gravis
• Narrow-angle glaucoma
• History of substance abuse
• Severe depression or suicidal thoughts

Pregnancy and breastfeeding require special consideration too. While the medication may be used if the benefits outweigh the risks, your doctor will want to discuss this carefully with you if you're pregnant or nursing.

Midazolam Brand Names

Midazolam nasal spray is most commonly available under the brand name Nayzilam in the United States. This is the version specifically designed for seizure emergencies and comes in a user-friendly nasal spray device.

There's also a brand called Versed, but this is typically the injectable form used in hospitals and medical settings. The nasal spray version for home use is relatively new compared to other forms of midazolam, which is why Nayzilam is the main brand you'll encounter.

Generic versions of midazolam nasal spray may become available in the future, but currently, most prescriptions are filled with the brand-name version. Your insurance coverage and pharmacy can help you understand what's available and most cost-effective for your situation.

Midazolam Nasal Spray Alternatives

If midazolam nasal spray isn't right for you, there are other rescue medications available for seizure emergencies. The most common alternative is diazepam rectal gel, which works similarly but is given rectally instead of through the nose.

Another option is intranasal diazepam, which is also a benzodiazepine but comes in a different nasal spray formulation. Some doctors might prescribe clobazam or other oral medications for people who have frequent breakthrough seizures but don't need immediate rescue medication.

For some people, adjusting their regular seizure medications might be more appropriate than adding a rescue medication. Your doctor will help you understand which approach makes the most sense for your specific seizure pattern and lifestyle.

Is Midazolam Nasal Spray Better Than Diazepam Rectal Gel?

Both midazolam nasal spray and diazepam rectal gel are effective rescue medications for seizures, but they each have different advantages depending on your situation and preferences.

Midazolam nasal spray tends to work slightly faster because it's absorbed through the nasal lining, while diazepam rectal gel may take a few minutes longer to take effect. Many people find the nasal spray easier and more dignified to use, especially in public settings or when multiple caregivers might need to help.

The nasal spray is also more convenient for school settings or when traveling, since it doesn't require the person to be undressed or positioned in a specific way. However, diazepam rectal gel has been around longer and may be more familiar to some medical professionals.

Your choice might depend on personal comfort, ease of use for your caregivers, and how your body responds to different medications. Some people find one works better for their specific type of seizures, while others choose based on practical considerations like convenience and social comfort.