Midazolam Nasal Spray (Nayzilam)

Important information:

What is midazolam nasal spray?
Midazolam nasal spray or Nayzilam^® is also known as Versed^®. Midazolam calms the brain and stops seizures by preventing the nerve cells in the brain from firing abnormal electrical signals. Midazolam nasal spray is easy to give, safe, and painless for your child.

Why is midazolam given into the nose?
When midazolam is given into the nose, it is quickly absorbed and usually stops a seizure within 5 minutes.

How is midazolam nasal spray supplied?
Midazolam nasal spray comes in a pre-filled device with 5 mg of medicine. When you pick up your prescription, you will receive one box. One box contains two devices. Each device contains a full dose of the medicine. Your provider may instruct you to give one dose (first device), wait about 5-10 minutes to see if the seizure stops, and then give a second dose (second device) if needed.

Patient instructions:

• Use each device one time, and then throw it away. There is no extra medicine in the device, so do not spray to “test” it. Do not press the plunger until the device is in your child’s nose.

• Your child does not need to inhale or breathe deeply for the medicine to work. It is absorbed in the nose.

• There will be an expiration date on the box and device packages. Refill your prescription before the expiration date on the device.

How should I store the midazolam nasal spray?
The temperature range for storing midazolam nasal spray is 59°F to 86°F (15°C to 30°C). It is best to store it at room temperature whenever possible, which is 68°F to 77°F (20°C to 25°C). Do not refrigerate this medicine or keep it in your car where it may get too hot or too cold.

What do I do when I see my child having a seizure?

• Begin seizure first aid as instructed below.

• Note the time that the seizure starts so you will know when to give the midazolam nasal spray.

• Pay attention to what the seizure looks like and how long it lasts.

Seizure first aid includes these steps:

• Lower your child to the floor and move anything away from them that could be harmful such as a coffee table, toys, or sharp objects.

• If your child’s head is jerking or banging, then put something soft under their head to prevent injury.

• Remove eyeglasses and loosen anything tight around the neck, such as a necklace or necktie.

• Do not hold down or restrain your child.

• Place your child on their side to allow saliva to drain out if possible.

• Do not place anything into the mouth. Your child cannot swallow their tongue.

• Stay with your child until the seizure ends.

Call 911 if:

• You are concerned about your child’s color or breathing.

• The seizure does not stop after the first or second dose of midazolam nasal spray (as directed by your healthcare provider).

• Your child is not returning to baseline within about 5 minutes of the end of the seizure.

• Your child is injured during the seizure.

When do I give my child midazolam nasal spray?
Your healthcare provider will tell you when to give the midazolam nasal spray. Information should be on the prescription. For example, it may say “Administer Nayzilam for a seizure lasting longer than 5 minutes.”

To administer midazolam nasal spray:

• Begin with seizure first aid as outlined above.

• Open the midazolam nasal spray box and remove the device.

• Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Do NOT press the plunger yet. There is no extra medication, so do not attempt any test sprays.

• Insert the tip of the nozzle into one nostril until your fingers are against the bottom of the nose. Most of the nozzle should be inside the nose.

• Press the bottom of the plunger firmly with your thumb to give the medicine.

• Your child does not need to inhale or breathe deeply. The medicine is absorbed by the nose.

• Note the time that you gave the midazolam nasal spray.

• Stay with your child and monitor their color and breathing for 30 minutes after giving the medicine. If you notice the problems listed above, then call 911.

What if the seizure doesn’t stop? Should I give a second dose?

• Follow directions provided by your healthcare provider. If the seizure continues after you give the first dose of the midazolam nasal spray, then your healthcare provider may recommend giving a second dose in about 5-10 minutes.

• One box contains two devices to give two doses of the medicine. Use the second device if needed.

What kinds of side effects can I expect?
The most common side effect is sleepiness which wears off over several hours. Other less frequent side effects include nasal discomfort, headache, diarrhea, skin rash, dizziness, pain, stuffy nose, abdominal pain, nervousness, feeling unsteady or clumsy, and wheezing. Tell your healthcare provider if your child has any unexpected side effects.

If midazolam nasal spray stops my child’s seizure, do I still need to give my child their other seizure medicines?
Yes. Midazolam nasal spray is given in addition to your child’s usual anti-seizure medicines. Continue to give the usual anti-seizure medicines as prescribed.

You will receive a copy of midazolam nasal spray (Nayzilam) instructions with your prescription. You should read and understand these instructions before you give your child Midazolam nasal spray. These instructions can also be found on the manufacturer’s website ucb-usa.com/nayzilam-med-guide.pdf.

Ask your healthcare provider what you should do after you give your child midazolam nasal spray. They may tell you to call 911, the on-call neurologist, or your neurology provider.

If you have questions or concerns not answered here, then please talk with your healthcare provider or pharmacist.

Reviewed July 2024 Dennis Dlugos, MD, MSCE