Nayzilam
Nayzilam (midazolam) is a nasal spray that quickly treats seizure attacks in people with a seizure condition called epilepsy. It comes in a ready-to-use spray device, but the person giving the medication must know when and how to give it properly. Nayzilam (midazolam) commonly causes drowsiness, throat irritation, and nasal discomfort. Nayzilam (midazolam) is only available as a brand-name medication.
What is Nayzilam (midazolam)?
What is Nayzilam (midazolam) used for?
Seizure attacks in people with epilepsy who are 12 years of age and older
How Nayzilam (midazolam) works
Nayzilam (midazolam) is a benzodiazepine. It's thought to slow down activity in your brain to help stop seizures.
Drug Facts
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What are the risks and warnings for Nayzilam (midazolam)?
Nayzilam (midazolam) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Extreme sleepiness and difficulty breathing
Risk factors: Taking Nayzilam (midazolam) with opioids, alcohol, or other medications that cause drowsiness or affect breathing | Taking medications that interact with Nayzilam (midazolam) | Older adults | Lung or breathing problems
Nayzilam (midazolam) can cause serious drowsiness, tiredness, trouble breathing, and low blood pressure. If you also drink alcohol or are taking opioid medications or other sedatives, these effects are more likely to happen, be more severe, and can even result in death. Talk to your provider to make sure it's safe for you to take Nayzilam (midazolam) with your other medications. They might see if other medication options are available. If you develop difficulty breathing or have trouble waking up easily, get medical help right away.
Misuse and addiction
Risk factors: History of substance of alcohol use disorder | Taking higher than recommended doses of Nayzilam (midazolam)
Nayzilam (midazolam) has risks of misuse and addiction, which can potentially lead to overdose (taking too much medication) and death. Misuse often involves using higher than recommended doses of Nayzilam (midazolam). Your provider will ask you questions before you start Nayzilam (midazolam) to assess your risk of misuse and addiction. To lower your risk, take Nayzilam (midazolam) exactly as prescribed to you.
Dependence and withdrawal
Risk factors: Taking Nayzilam (midazolam) for a long time | Taking Nayzilam (midazolam) at higher than recommended doses | Taking Nayzilam (midazolam) more often than recommended | Stopping Nayzilam (midazolam) suddenly
If you're taking Nayzilam (midazolam) for a long period of time, using it at higher doses, or using it more often than recommended, you might become physically dependent on the medication. This can raise your risk for withdrawal symptoms if you stop the medication or lower your dose suddenly. These withdrawal symptoms can include unusual involuntary movements, muscle pain, anxiety, panic attacks, shaky hands, and fast heart beat. More severe symptoms, like more seizures, can be life-threatening.
To lower your risk of dependence and withdrawal symptoms, take Nayzilam (midazolam) only as prescribed. It should be taken only as needed for seizure attacks. If you've been using this medication more frequently than recommended and want to stop, ask your provider how you can do so safely.
Suicidal thoughts or behaviors
Anti-seizure medications like Nayzilam (midazolam) can raise your risk of suicide or thoughts of suicide. Watch for any new or worsening depression and any unusual changes in mood. Report any concerning behavior to your provider. If you have thoughts of hurting yourself, call 911 or get medical attention right away.
Difficulty with concentration, focus, and memory
Taking Nayzilam (midazolam) affect your concentration and focus. It can also affect your ability to remember things for several hours after a dose. Avoid activities that require you to be alert, like riding a bike or operating machinery, until these effects go away. If you've had a seizure attack, remember that it might be against the law in some states to drive for a few months afterwards, even if you feel back to normal after getting a dose of Nayzilam (midazolam).
Rise in eye pressure in people with glaucoma
Risk factors: Glaucoma
Benzodiazepines, such as Nayzilam (midazolam), can raise eye pressure in people who have glaucoma. If you have open-angle glaucoma (the most common type of glaucoma), make sure that you're taking appropriate medications for it before you use Nayzilam (midazolam). If you've been diagnosed with narrow-angle glaucoma, you shouldn't use Nayzilam (midazolam) since the effects can be dangerous to your eyesight.
What are the side effects of Nayzilam (midazolam)?
Common Side Effects
- Drowsiness (10%)
- Nasal discomfort (9%)
- Headache (4%)
- Throat irritation (3%)
- Runny nose (3%)
Other Side Effects
- Slurred speech
- Weird taste in the mouth
- Tearing up or watery eyes
Serious Side Effects
- Withdrawal: unusual involuntary movements, muscle pain and stiffness, shaky hands, stomach upset, anxiety, panic attacks, changes in mood or behavior, fast heart beat, more seizures
- Accidentally taking too much (overdose): trouble breathing, extreme sleepiness, difficulty thinking straight, confusion, weakness, bluish fingernails and lips, hard time walking or moving normally, coma
- Thoughts of hurting yourself or suicide
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Dizziness
- Drowsiness
- Headache
- Irritation inside the nose or throat
- Runny or stuffy nose
Pros and cons of Nayzilam (midazolam)
Pros
Works within 10 minutes to treat seizure attacks
Might help prevent another seizure attack from happening within 24 hours
Good option for someone who can't take anything by mouth, such as in the middle of a seizure attack
Cons
Only for treating seizure attacks, not for long-term seizure control
Caregivers need special training to know when and how to give the medication properly.
Can't use in children younger than 12 years of age
Only available as a brand-name medication
Pharmacist tips for Nayzilam (midazolam)
Nayzilam (midazolam) should only be used for stopping seizure attacks, or when a bunch of seizures happen in a row that are different than typical seizure activity. Don't use Nayzilam (midazolam) as your regular seizure prevention medication.
Seizure attacks can happen at any time, so it's best to have Nayzilam (midazolam) with you or your child at all times.
It's important for caregivers to feel confident about when and how to give this medication properly. It's also important to know what to watch for afterwards and when to get medical help. You might need to teach this information to other people in case you or your child has a seizure attack.
Nayzilam (midazolam) comes with an instruction manual with helpful images. Read and review the instructions with other caregivers. Ask a provider if you have any questions about how to use Nayzilam (midazolam).
The Nayzilam (midazolam) nasal spray is ready to use as soon as you take it out of the blister pack. Each nasal spray device contains only one dose. Don't test, "prime", or play around with the plunger before you place the nozzle inside the nostril for the dose. Otherwise, you might lose the dose.
After the Nayzilam (midazolam) dose is given, keep the person on their side. This position makes it easier to breathe while recovering from a seizure. Stay with the person, and watch for continued seizure activity or changes in breathing or skin color. Write down the date and time of the seizure attack, the type and number of seizures that you observe, and the time(s) that you gave Nayzilam (midazolam). All of this information is important to share with the provider later on.
Your provider might recommend a second dose if needed. The second dose should be given at least 10 minutes after the first dose. Don't give a second dose if the person having the seizures is having trouble breathing or is more sleepy than usual. Call 911 if this happens.
After you use each Nayzilam (midazolam) nasal spray device, throw it away in a safe place away from children or pets.
Check the expiration date of your Nayzilam (midazolam) device regularly and replace it if it's about to expire. This makes sure your medication works as it should when you need to use it. It's important that you get the full effect from Nayzilam (midazolam) when you have a seizure attack.
Keep Nayzilam (midazolam) in the blister pack until it's about to be used. Keep this medication at room temperature.
Frequently asked questions about Nayzilam (midazolam)
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Nayzilam (midazolam) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5mg | 2 nasal sprays | $632.83 | $316.42 |
Typical dosing for Nayzilam (midazolam)
Adults and children 12 years of age and older: Spray 1 dose (5 mg) into one nostril. After 10 minutes, if the seizure isn't controlled, spray a second dose into the other nostril. Don't use more than 2 doses of Nayzilam (midazolam) to treat a seizure attack.
It isn't recommended to use Nayzilam (midazolam) more than once every 3 days or more than 5 times in a month. Talk to your provider if you or your child has a seizure attack more often than this because it means that your seizures aren't well controlled. Your provider will need to adjust your daily seizure medications so that the attacks happen less often.
How much does Nayzilam (midazolam) cost?
Nayzilam (midazolam) contraindications
Narrow-angle glaucoma
What are alternatives to Nayzilam (midazolam)?
Seizure attacks in people with epilepsy who are 12 years of age and older
Seizure cluster in people with epilepsy who are 6 years of age and older
Seizure clusters in people ages 2 years and older with epilepsy
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References
Best studies we foundCenters for Disease Control and Prevention. (2022). Seizure first aid.
Detyniecki, K.,et al. (2019). Safety and efficacy of midazolam nasal spray in the outpatient treatment of patients with seizure clusters — a randomized, double-blind, placebo-controlled trial. Epilepsia.
Hospira, Inc. (2023). Midazolam hydrochloride injection, solution [package insert]. DailyMed.
Li, W., et al. (2019). Clinical characteristics and pregnancy outcomes of new onset epilepsy during pregnancy. Medicine.
MedlinePlus. (2023). Drug use and addiction.
Meridian Medical Technologies LLC. (2023). Seizalam- midazolam hydrochloride injection, solution [package insert]. DailyMed.
Ordean, A., et al. (2014). Clinical presentation and management of neonatal abstinence syndrome: An update. Research and Reports in Neonatology.
Padagis US LLC. (2022). Midazolam hydrochloride syrup [package insert]. DailyMed.
UCB, Inc. (n.d.). Nayzilam reminders.
UCB, Inc. (n.d.). Understanding seizure clusters.
UCB, Inc. (2023). Instructions for use: Nayzilam® (NAY-zil-am) (midazolam) nasal spray, CIV.
UCB, Inc. (2023). Nayzilam- midazolam spray [package insert]. DailyMed.
U.S. Department of Transportation National Highway Traffic Safety Administration. (2003). Driving when you have had seizures.
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