In this section
Midazolam (meh-daz-owe-lam) is a medication that is commonly used as emergency treatment for seizures. It is a benzodiazepine (ben-zo-die-az-eh-peen) medication like diazepam (valium) or clonazepam (clonn-az-eh-pam). Midazolam works more quickly than diazepam but does not last as long. It is also
occasionally used for sedation during medical procedures.
Midazolam can be delivered in three ways:
Swallowing midazolam is not recommended as it is not absorbed well through the stomach. Intranasal midazolam may be better than buccal midazolam in children who vomit or produce excessive saliva during seizures.
Buccal or intranasal midazolam may be prescribed for a child with epilepsy who:
Midazolam is not necessary for all children with epilepsy. Your doctor will tell you whether your child might benefit from buccal or intranasal midazolam.
If your child has a seizure, follow the correct first aid procedures before giving any medication. See our fact sheet
Seizures – safety issues and how to help.
The following information describes how midazolam can be given by parents or carers if a child is having a seizure. It may be different from the information in the manufacturer's consumer information.
It is very important to follow your doctor's advice on when and how to give midazolam and when to take your child to hospital.
Specific details for giving your child midazolam should be documented in an Emergency Medication Management Plan and your child's general Epilepsy Management Plan.
Unless your doctor gives you different instructions, call
000 for an ambulance BEFORE giving midazolam. Don't wait for the ambulance to
arrive before giving the midazolam.
Use only 1 mL plastic ampoules containing 5 mg of midazolam. Although the plastic ampoules are labelled 'for slow IV or IM injection', they can be used for buccal and intranasal use. Do not use midazolam in glass ampoules, or plastic ampoules of
other sizes or strengths.
Buccal midazolam can be given by either:
Each ampoule delivers about 18 drops (the volume can vary slightly from 16–20 drops, but this is OK).
Step 4: Watch your child's breathing and seizure activity while they remain lying on their side in the recovery position.
Step 5: Write down the time that the seizure started, when the midazolam was given and when the seizure stopped.
Buccal midazolam – syringe method
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. In rare cases, your child may become agitated, hostile or aggressive after having midazolam.
If your child has shallow or slow breathing, call an
Why is the information that comes with the midazolam so
different to this fact sheet's instructions?
The manufacturer's information may refer to midazolam for use in a different way, for instance when it is given as IV or IM injection. It is important to follow your doctor's instructions as outlined in your child's Emergency Medication Management Plan.
Developed by The Royal Children's Hospital Children's Neuroscience Centre and Pharmacy. We acknowledge the input of RCH consumers and carers.
Reviewed May 2018.
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