The safety and tolerability of intranasal midazolam in epilepsy

Abstract

Midazolam is a short-acting benzodiazepine that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage of being water-soluble, with a rapid onset of action and it can be administered orally or intranasally, implementing an early intervention at the pre-hospital setting. This article aims to provide an overview of intranasal midazolam in the acute management of epileptic seizures. Available data suggest that midazolam 0.2 mg/kg is as effective as diazepam 0.5 mg/kg, especially in children with febrile or afebrile seizures. Local mucosal irritation seems to occur in less than one-third of cases while serious side effects such as respiratory depression in about 1%. Future studies need to be focused on adults and optimized technologies for intranasal delivery. Moreover, comparisons with buccal midazolam are warranted.

Keywords::

• antiepileptic drug
• epilepsy
• intranasal
• midazolam
• status epilepticus
• treatment

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Midazolam (MDZ) is a short-acting benzodiazepines that has clearly demonstrated to be an effective option for the acute management of epileptic seizures. It has the advantage of being water-soluble and it has a rapid onset of action.

• Available data seem to suggest that MDZ-intranasal (IN) may represent an effective and safe option for the acute treatment of epileptic seizures in children, but data in adults are more than limited and adopted technologies for the IN delivery are heterogeneous.

• Future studies comparing the IN with the buccal formulation of MDZ will be of interest.

Notes