Kids Health Info

Intranasal Midazolam

  • This leaflet answers some common questions about your child's medicine. It does not contain all available information. It does not take the place of talking to your child's doctor or pharmacist. This information may be different from the information in the manufacturer's Consumer Information. The information in this leaflet reflects the usage of medicine under medical supervision by patients of The Royal Children's Hospital (RCH). Medicine may be used in children in different ways or for different reasons than in adults - for more information see the leaflet: Medicines for Children.

     Midazolam is a benzodiazepine medication like diazepam and clonazepam. Midazolam works more quickly than diazepam but does not last as long.

    What is midazolam used for?

    Midazolam is used for: 

    • Emergency treatment of seizures  
    • Sedation during medical procedures
    • Premedication prior to medical procedures

    How is midazolam given for seizures?

    Midazolam can be:

    • Trickled inside the cheek - buccal
    • Sprayed or dripped into the nose - intranasal
    • Injected into a vein or muscle - intravenous (IV) or intramuscular (IM)

    Ambulance officers and emergency doctors give midazolam by injection into a muscle or vein. Intranasal midazolam is absobed directly into the blood stream through the lining of the nose. Swallowing midazolam is not recommended as it is not absorbed well through the stomach. The plastic ampoules are labelled "for slow IV or IM injection" but can be used for buccal and intranasal use.

    When is intranasal midazolam used?

    Midazolam can be used for the emergency treatment of seizures. Midazolam may be prescribed for a child with epilepsy who:

    • Has prolonged seizures
    • Has a pattern of seizures that recur close together
    • Lives a long way from emergency services

    Midazolam is not necessary for all children with epilepsy. Your doctor will tell you whether your child might benefit from you being able to give midazolam. Intranasal midazolam may be better than buccal midazolam in children who vomit or salivate prominently during seizures.

    First aid

    First aid for seizures is very important. It includes:

    • Preventing injury, for example, by moving things away from the child
    • Keeping your child's airway open and clear by putting your child on their side in the coma position
    • Timing how long the seizure lasts
    • See: Seizures-Safety issues and how to help. fact sheet
    • Unless your doctor gives you different instructions, call an ambulance before giving midazolam. Don't wait for the ambulance to arrive before giving the midazolam

    How to give intransal midazolam by mucosal atomizer device (MAD300)

    Use only 1ml plastic ampoules containing 5mg of midazolam. Do not use midazolam in glass ampoules

    Step 1: Open the plastic ampoule of midazolam by twisting off the top

    Step 1 intranasal midazolam

     

    Step 2: Insert the syringe into the ampoule and hold the ampoule and syringe upright with the ampoule higher. Withdraw the required dose as prescribed by your doctor into a 1ml syringe. Push out any big air bubbles and check the amount of midazolam in the syringe. Pull the ampoule and the syringe apart.

    step 2 intranasal midazolam

     

     

     

     

    Step 3: Attach the syring to mucosal atomizer device

    step 3 intranasal midazolam

     

    Step 4: Lay your child on their side in the first aid (coma) position or in the position to allow easy administration of intranasal midazolam. Insert mucosal atomizer device loosely into nostril and press the plunger quickly to give half of the prescribed dose. Remove device and insert into other nostril to give remaining dose. Your doctor will have allowed for the 0.1ml residual left in the atomizer

    step 4 intranasal midazolam

     

    Step 5: Watch your child's breathing and seizure activity while they remain lying on their side in the first aid (coma) position

    Step 6: Write down the time when the seizure started, when midazolam was given and when the seizure stopped. 

    Side effects of midazolam 

    • Midazolam has a sedative effect and your child may be sleepy for some time afterwards. Headache, nausea (feeling sick), vomiting, coughing and hiccups may also happen. Rarely, your child may become agitated, hostile or aggressive after having midazolam
    • Your child may have shallow or slow breathing after midazolam. If this happens, your child may need mouth-to-mouth resuscitation and you will need an ambulance
    • Intranasal midazolam may cause nasal irritation.  

    Important points to remember

    • Use the plastic ampoules containing 5mg midazolam in 1ml, NOT glass ampoules or plastic ampoules of other sizes or strengths
    • Midazolam needs to travel where your child goes, in case of a seizure when away from home
    • It is very important to follow your doctor's advice on when and how to give midazolam, when to phone an ambulance, and when to take your child to hospital
    • It is helpful for families and people who care for your child to do a first aid course to improce their ability and confidence in emergency situations. Contact RCH Safety Centre (03) 9345 5036 or St John's Ambulance (03) 9696 0000 or your local community health services
    • Midazolam needs to be stored at normal room temperature (below 25 C)
    • Midazolam needs to be protected from light (wrapped in foil). Take note of the date midazolam is taken out of its prescribing box and wrapped in foil as it needs to be discarded 8 months after exposure to light. Take note of the use by date
    • Keep midazolam locked away out of the reach of children and keep in a "snap lock" type container
    • Keep a record of your child's seizures and use of midazolam
    • Specific details for administration of midazolam in your child should be documented on an Emergency Medication Management Plan and referenced to a general Epilepsy Management Plan

    For more information

    Contact your child's paediatrican or neurologist

     

    Produced in consultation with the RCH Children's Neuroscience Centre & RCH Pharmacy. First published Jan 2006. Updated May 2014.

Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts.