Intranasal Midazolam

Be sure to discuss all questions and instructions with your care provider or pharmacist. 

• This medicine may make your child dizzy or drowsy. Do not let your child do anything that could be dangerous until you see how this medicine affects them.
• Do not give your child other medicines that contain alcohol or allow your child to drink alcohol while they take this medicine.  
• While taking this medicine your child should not consume foods or beverages containing grapefruit. Check the ingredient label of juices and other drinks before giving them to your child.
• It is important that patients tell the care team if they are sexually active, pregnant, or breastfeeding. 
• If your child has been taking this medicine regularly or for a long time, they should not stop this medicine until the care provider instructs. Stopping intranasal midazolam without slowly decreasing the dose can lead to withdrawal symptoms. These include feeling restless, diarrhea, headache, sweating, muscle cramps, trouble sleeping, nausea, or vomiting. If these symptoms occur, call your doctor or pharmacist right away. It could mean the dose is being decreased too fast. 

Intranasal midazolam at home   

• Be sure you know your child’s dose and how to give it correctly. Follow dosing instructions carefully. 
• Throw away the medicine devices after each use. Do not reuse.
• Store at room temperature.  
• This drug may be habit forming with long-term use. Watch for signs of misuse.  
• Do not share this medicine with anyone or give for reasons other than it was prescribed.
• Do not use the medicine past the expiration date.

How to give the medicine

Your care provider or pharmacist will instruct you on how to use the dose when you receive the medication for the first time.

Measure the dose (if using liquid medicine with a vial, syringe, and atomizer):

• Remove the plastic caps from the medicine vial (bottle) and the packaging from the syringe.
• Pull back on the syringe plunger and pull air into the syringe. The black part of the plunger should be at the 2 mL mark.
• Insert the syringe needle into the rubber seal on top of the medicine vial.
• Push the syringe plunger down and push the air into the vial until the black portion of the plunger is at the 0 mL mark.
• Keep the needle in the vial. Turn the medicine vial upside down so the bottom of the medicine vial is in the air and the syringe plunger is pointed toward the floor. 
• Pull the syringe plunger back slowly to fill the syringe. 
• Check that the medicine amount in the syringe is the same as your child’s prescribed dose. The prescribed dose can be found on the prescription label.
• Remove the syringe from the medicine vial.
• Remove the needle and the vial adapter from the syringe. 
• Twist the atomizer (nasal tip) onto the syringe. The medicine is now ready to give.

Measure the dose (if using the ready-to-use device):

• Remove the device from the box and the packaging.
• The dose is ready to be given when removed from the packaging.  Do not prime (squeeze) the device until it has been placed in a nostril.

Give the dose:

• To keep your child’s head from moving while you are giving the medicine, place your free hand on top of your child’s head.
• If using liquid medicine with a vial, syringe, and atomizer:
  • Insert the tip of the atomizer inside the right nostril. 
    • The tip of the atomizer should aim slightly up and toward the top of your child’s right ear.
    • Quickly press the syringe plunger to give half of the medicine in the right nostril.
  • Move the atomizer tip to the other nostril.
    • The tip of the atomizer should aim slightly up and toward the top of your child’s left ear.
    • Quickly press the syringe plunger to give the remaining medicine into the left nostril.
• If using the ready-to-use device:
  • The dose is ready to be given when removed from the packaging. Do not prime (squeeze) the device until it has been placed in a nostril.
  • Give the whole dose in one nostril. If you repeat the dose, use the other nostril with a new device.
• Your care provider will tell you if you can repeat the dose if the seizure does not stop within a certain amount of time.
• Throw away all used supplies once the dose has been given.

Call 911 if the seizure lasts more than 5 minutes after you give the medicine, or if your child does not become conscious after the seizure stops.