Nayzilam (Midazolam) – Nasal

What Is Nayzilam?

Nayzilam (midazolam) is a prescription nasal spray used to treat seizure clusters—groups of seizures that occur over a short time. Nayzilam is an anticonvulsant that belongs to a class of medications called benzodiazepines, sometimes referred to as “benzos.” Benzodiazepines work to control seizures by calming nerve impulses in the brain.

Drug Facts

Generic Name: Midazolam

Brand Name(s): Nayzilam

Administration Route(s): Nasal

Drug Availability: Prescription

Therapeutic Classification: Anticonvulsant

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Midazolam

Dosage Form(s): Spray

What Is Nayzilam Used For?

The Food and Drug Administration (FDA) approved Nayzilam for the acute (short-term) treatment of seizure clusters in people aged 12 years and older.

"Seizure cluster" describes an increase in seizure activity, different from your normal seizure patterns. Your healthcare provider may use another term to describe this condition, such as acute repetitive seizures, recurrent seizures, or crescendo seizures. While the definition of seizure clusters varies, experiencing two or more seizures in 24 hours is one way to characterize the condition.

Nayzilam is a rescue medication, meaning that it is intended to treat an active seizure cluster attack immediately. It is different from the epilepsy medications you take every day to control your symptoms.

Nayzilam (Midazolam) Drug Information - Illustration by Dennis Madamba

Verywell / Dennis Madamba

How to Take Nayzilam

Nayzilam is different from other nasal sprays you may have used in the past. The FDA provides instructions for use. Read the FDA instructions in full before you start using Nayzilam.

Follow these instructions to ensure you receive the appropriate dose:

  • Each nasal spray unit contains one dose of Nayzilam. Do not test or prime the pump—this will waste the dose. 
  • When a dose is needed, remove the nasal spray unit from the blister packaging. 
  • Hold the nasal spray unit with your thumb on the plunger and your pointer and middle finger on each side of the nozzle. Be careful not to press the plunger with your thumb.
  • Insert the tip of the nozzle into one nostril until your pointer and middle finger touch the bottom of your nose. 
  • Press the plunger firmly with your thumb using one continuous movement. It is not necessary to breathe in deeply while administering the dose. 
  • Throw the nasal spray unit and blister packaging in the trash. 
  • If seizure activity continues 10 minutes after the first dose, you may administer a second dose if your healthcare provider has told you. Follow the above steps to administer the second dose in the opposite nostril.

Storage

Store Nayzilam at room temperature, unopened, and in its original blister packaging. Nayzilam may cause serious harm if taken inappropriately. Store Nayzilam and all medications in a safe location

How Long Does Nayzilam Take to Work?

Nayzilam is a fast-acting rescue medication used to treat an active seizure cluster. One dose may be enough to stop the attack within 10 minutes for some people. Other people may require a second dose if seizure activity continues (if instructed by their medical provider). Never give more than two doses of Nayzilam. If your seizures continue after two doses, seek emergency medical care.

What Are the Side Effects of Nayzilam?

Like any medication, Nayzilam may cause side effects. Let your healthcare provider know of any persistent or worsening side effects. 

This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Watch out for these common reactions associated with Nayzilam:

  • Headache
  • Nasal discomfort 
  • Runny nose 
  • Sleepiness
  • Throat irritation

Severe Side Effects

Rarely, Nayzilam may cause severe side effects. Contact your healthcare provider right away if you think you have a serious side effect. Call 911 if your symptoms feel life-threatening.

Serious side effects include:

  • Oversedation, breathing problems, and coma—especially if taken with opioid pain medications, alcohol, or other sedating drugs 
  • Increased eye pressure in people with acute narrow-angle glaucoma. Do not use Nayzilam if you have this condition   
  • Allergic reactions including hives, itching, difficulty breathing, swelling of the mouth, face, lips, tongue, or throat

Report Side Effects

Nayzilam may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Nayzilam Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For nasal dosage form (spray):
    • For seizure clusters:
      • Adults and children 12 years of age and older—5 milligrams (mg) or 1 spray into one nostril. A second spray may be taken 10 minutes after the first dose if needed. Do not use a second dose if you have trouble breathing or excessive sleepiness during a seizure cluster episode. Do not use more than 2 doses to treat a single episode.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.

Missed Dose

Only take Nayzilam as needed. Do not use more Nayzilam than instructed by your healthcare provider.

Overdose: What Happens If I Take Too Much Nayzilam?

Taking too much Nayzilam can cause serious symptoms, especially when taken with opioid pain medications, alcohol, or other sedating drugs. Overdosing on Nayzilam may cause:

  • Sedation
  • Confusion
  • Problems with coordination or balance
  • Coma 

What Happens If I Overdose on Nayzilam?

If you think you or someone else may have overdosed on Nayzilam call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses, has a seizure, has trouble breathing, or can’t wake up after taking too much Nayzilam, call 911 immediately.

Precautions

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It is very important that your doctor check your or your child's progress while you are using this medicine to make sure that this medicine is working properly and to check for unwanted effects.

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Do not change your dose or suddenly stop using this medicine without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping it completely. This may help prevent a possible worsening of your seizures and reduce the possibility of withdrawal symptoms including changes in behavior, discouragement, feeling sad or empty, irritability, lack of appetite, loss of interest or pleasure, trouble concentrating, seeing or hearing things that others do not see or hear, thoughts of killing oneself, trouble sleeping, unusual movements, responses, or expressions.

Symptoms of an overdose include: confusion, drowsiness, lack of coordination, loss of consciousness, relaxed and calm feeling, or sleepiness. Call your doctor right away if you notice these symptoms.

This medicine may cause respiratory depression (serious breathing problem that can be life-threatening), especially when used with narcotic pain medicines. Tell your doctor if you are using any narcotic medicine, such as codeine, fentanyl, hydrocodone, morphine, or oxymorphone.

This medicine will add to the effects of alcohol and other central nervous system (CNS) depressants. CNS depressants are medicines that slow down the nervous system, which may cause drowsiness or make you less alert. Some examples of CNS depressants are antihistamines or medicine for hay fever, allergies, or colds, sedatives, tranquilizers, or sleeping medicine, other prescription pain medicine or narcotics, barbiturates or seizure medicine, muscle relaxants, or anesthetics (numbing medicines), including some dental anesthetics. This effect may last for a few days after you stop using this medicine. Check with your doctor before taking any of the other medicines listed above while you are using this medicine.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Also tell your doctor if you have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you or your caregiver notice any of these side effects, tell your doctor right away.

This medicine may cause drowsiness, trouble with thinking, trouble with controlling movements, or trouble with seeing clearly. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Get up slowly or lie down for a while to relieve dizziness or lightheadedness.

Check with your doctor right away if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your doctor may want your eyes be checked by an ophthalmologist (eye doctor).

Call your doctor right away:

  • If your seizures still continue after using this medicine.
  • If your seizures are different from your previous episodes.
  • If you are alarmed by the number or severity of your seizure episodes.
  • If you are alarmed by the color or breathing of the patient.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Nayzilam?

Certain conditions increase your risk of developing complications from Nayzilam. Your healthcare provider may choose a different treatment for you if:

  • You’ve had an allergic reaction to midazolam in the past. 
  • You have acute narrow-angle glaucoma.

What Other Medications Interact With Nayzilam?

Nayzilam may interact with other medications you take. Be sure to let your provider know about all the medicines you use, including nonprescription products. 

Avoid taking Nayzilam with the following medications:

  • Moderate or severe CYP3A4 inhibitors, such as Nizoral (ketoconazole), erythromycin, and Calan or Verelan (verapamil), which can cause increased sedation when combined
  • Opioids, due to the risk of respiratory depression
  • Other central nervous system depressants, such as other benzodiazepines, muscle relaxants, and antipsychotic medications

Opioids and Other Sedating Medications

Using opioids or other sedating drugs with Nayzilam increases the chance of developing respiratory depression, which causes slowed breathing and reduced oxygen levels.

Specifically, watch out for opioid pain medications, including:

  • Codeine 
  • Fentanyl 
  • Hydrocodone (found in Vicodin) 
  • Hydromorphone 
  • Methadone 
  • Oxycodone (found in Percocet and OxyContin) 
  • Oxymorphone 
  • Tramadol 

Avoid other benzodiazepines, such as:

Other medications that can have this effect when taken with Nayzilam include:

  • Barbiturates like phenobarbital 
  • Sleep medications, such as Lunesta (eszopiclone), Ambien (zolpidem), and Sonesta (zaleplon)
  • Certain antipsychotics, such as Zyprexa (olanzapine) and Seroquel (quetiapine)

You should also avoid drinking alcohol with Nayzilam.

Drugs That Increase Nayzilam Levels

Some medications prevent your body from breaking down Nayzilam and can cause increased Nayzilam levels if taken together, including:

  • Reyataz (atazanavir)
  • Biaxin (clarithromycin) 
  • Tybost (cobicistat)
  • Prezista (darunavir)
  • Cardizem CD, Cartia, and Taztia (diltiazem)
  • Multaq (dronedarone)
  • Erythrocyn (erythromycin
  • Diflucan (fluconazole)
  • Lexiva (fosamprenavir)
  • Crixivan (indinavir)
  • Sporanox (itraconazole)
  • Nizoral (ketoconazole)
  • Lopinavir
  • Serzone (nefazodone)
  • Viracept (nelfinavir)
  • Noxafil (posaconazole)
  • Norvir (ritonavir)
  • Fortovase (saquinavir) 
  • Calan or Verelan (verapamil
  • Viekira XR (ombitasvir, paritaprevir, ritonavir, dasabuvir) 
  • Vfend (voriconazole)

Many other medications may interact with Nayzilam. Always ask your healthcare provider before starting anything new.

What Medications Are Similar?

Other benzodiazepines like Nayzilam can also treat seizure clusters but differ primarily on the route of administration. Products are available as nasal sprays, oral tablets, and rectal gels. Nasal sprays like Nayzilam are convenient, faster acting than rectal products, and can easily be administered by a parent or caregiver.

Other seizure cluster medications include:

  • Diastat and AcuDial (diazepam rectal gel)
  • Valtoco (diazepam nasal spray)
  • Ativan (oral lorazepam)

This is a list of drugs also prescribed for seizure clusters. It is not a list of drugs recommended to take with Nayzilam. You should not take these drugs together. Ask your healthcare provider if you have any questions.

Frequently Asked Questions

  • What is Nayzilam used for?

    Nayzilam is a prescription nasal spray used to treat seizure clusters—a condition that describes an increase in your regular seizure activity. Some medical professionals define this as two or more seizures in 24 hours. Nayzilam is a rescue medication, so you won’t use it every day. It is different from the other epilepsy medications you take daily to control your symptoms.

  • How does Nayzilam work?

    Nayzilam is a benzodiazepine and treats seizures by calming nerve impulses in the brain.

  • How long does it take for Nayzilam to work?

    Nayzilam is quickly absorbed and can stop seizure activity within 10 minutes. Some people may require a second dose (if their provider recommends it) if seizures continue 10 minutes after the first dose.

  • What are the side effects of Nayzilam?

    The most common side effects of Nayzilam include headache, nasal discomfort, runny nose, sleepiness, and throat irritation.

  • When should you seek medical care for your seizure cluster?

    If your seizures have not stopped after two doses of Nayzilam, seek emergency medical care right away.

  • How often can you use Nayzilam?

    Always follow your healthcare provider’s instructions for when to take Nayzilam. Your provider may recommend taking up to two doses of Nayzilam to treat a seizure cluster. Do not use Nayzilam to treat a seizure cluster more than once every three days, and do not use it for more than five seizure clusters per month.

How Can I Stay Healthy While Taking Nayzilam?

If you have seizure clusters, you know the unpredictable nature of the condition can be a source of constant stress. Increased seizure activity can impact your daily functioning, work productivity, and social interactions. Fortunately, Nayzilam is one effective option that can quickly end a seizure episode.

Patients and caregivers alike appreciate Nayzilam’s convenient nasal formulation. Previously, rectal diazepam was the most common treatment choice. Work with your healthcare provider to develop a rescue plan to treat your seizure clusters and share this information with anyone involved with your care. Quickly administering treatment can help end an attack, prevent unnecessary hospital visits, and get you back to living your life.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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  1. Food and Drug Administration. Nayzilam (midazolam) nasal spray, CIV label.

  2. Jafarpour S, Hirsch LJ, Gaínza-Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: definition, prevalence, consequences, and management. Seizure. 2019;68:9-15. doi:10.1016/j.seizure.2018.05.013