Midazolam nasal spray dose
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midazolam intranasal nasal spray dose pediatric adult
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intranasal midazolam acute seizure epilepsy dosing
GradeResponse
GradeResponse
Midazolam Intranasal (Nasal Spray) Dosing
Acute Seizures / Status Epilepticus
| Population | Dose | Route | Notes |
|---|---|---|---|
| Children (2 months–15 years) | 0.2 mg/kg | Intranasal | Divide between nostrils; max volume ~0.5 mL per nostril |
| Adults | 5–10 mg (or 0.1–0.2 mg/kg) | Intranasal | Typically 5 mg if <50 kg; 10 mg if ≥50 kg |
Nayzilam (FDA-approved branded intranasal midazolam for acute seizures):
- ≥12 years: 5 mg in one nostril; may repeat 5 mg in the other nostril after 10 minutes if seizure persists
- Maximum: 10 mg per episode
Procedural Sedation / Anxiolysis (pre-procedure)
| Population | Dose | Notes |
|---|---|---|
| Children | 0.2–0.3 mg/kg (max 10 mg) | Onset ~10 min; peak effect at 10–15 min |
| Adults | 2.5–5 mg | Use lower end in elderly or compromised patients |
Key Administration Points
- Concentration: Use the 5 mg/mL parenteral solution via a mucosal atomization device (MAD) for unlicensed use, or the commercial nasal spray (Nayzilam 5 mg/0.1 mL).
- Split the dose: If volume >0.5 mL total, divide between both nostrils to improve absorption.
- Onset: ~5–10 minutes intranasally (slower than IV, faster than oral).
- Repeat dosing: One repeat dose may be given after 10 minutes if response is inadequate (seizure indication).
Contraindications / Cautions
- Acute narrow-angle glaucoma
- Respiratory depression / compromised airway
- Hypersensitivity to benzodiazepines
- Use with caution in elderly, hepatic impairment, or concurrent CNS depressants (additive sedation/respiratory depression risk)
Sources: Treatment of Convulsive Status Epilepticus in Children and Adults (p. 7); Nayzilam prescribing information; supplemented from clinical pharmacology knowledge.
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