Section 01 · Monograph
Midazolam
Reviewed Nov 2026FDA label
Nayzilam / SeizalamBenzodiazepine · rescue
- Forms
- NS: 5mg/spray (Nayzilam) | IM: 5mg/mL (Seizalam)
- Dose
- Nayzilam 5mg intranasal, may repeat x1 after 10 min | Seizalam 10mg IM (adult status epilepticus)
- MOA
- ↑GABA-A Cl- channel frequency
Black Box Warning
- Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma and death
- Abuse, misuse and addiction risk
- Dependence and withdrawal reactions
Indications
- Nayzilam (intranasal): acute treatment of intermittent bouts of increased seizure activity (seizure clusters) in patients 12 years and olderFDA-labeled
- Seizalam (IM): status epilepticus in adultsFDA-labeled
Mechanism of Action
- Benzodiazepine that enhances GABA-A receptor chloride channel opening frequency, producing rapid anticonvulsant and sedative effects
Full Dosing
Adult / usual
- Nayzilam: 5mg (one spray) in one nostril; a second 5mg dose in the opposite nostril at least 10 minutes later if needed; maximum two doses per episode, one episode every 3 days, five episodes per month
- Seizalam: 10mg IM once for adults over 40kg (5mg for 13-40kg per label)
Contraindications
- Acute narrow-angle glaucoma
- Known hypersensitivity to midazolam
Drug Interactions
- Opioids and other CNS depressants: severe sedation and respiratory depression
- CYP3A4 inhibitors (ketoconazole, macrolides, protease inhibitors, grapefruit) increase midazolam levels
Adverse Effects
- Somnolence, headache
- Nasal discomfort, throat irritation, rhinorrhea (intranasal)
- Respiratory depression
- Paradoxical agitation
- Dependence and withdrawal
Monitoring Parameters
- Respiratory status and sedation with airway support available
- Misuse and abuse risk
- Seizure control
Pregnancy & Lactation
- Late-pregnancy benzodiazepine exposure can cause neonatal sedation or withdrawal
- Present in milk; monitor infants for sedation