Are Valtoco and Nayzilam the same thing? Key Differences Explained

October 10, 2025 •

4 min read

While both Valtoco (diazepam) and Nayzilam (midazolam) are FDA-approved benzodiazepine nasal sprays for treating seizure clusters, they are distinctly different medications and are not the same thing. They differ in their active ingredients, age indications, and dosing protocols.

Quick Summary

Valtoco (diazepam) and Nayzilam (midazolam) are distinct nasal spray benzodiazepines for seizure clusters, differing in active ingredients, approved age groups, dosages, and dosing intervals, not being the same medication.

Key Points

Different Active Ingredients: Valtoco contains diazepam, while Nayzilam contains midazolam. Both are benzodiazepines, but they are distinct drugs.
Distinct Age Indications: Valtoco is approved for patients 2 years and older, while Nayzilam is approved for patients 12 years and older.
Dosing Differences: Nayzilam uses a single fixed dose, whereas Valtoco's dose is weight-based.
Varying Re-dosing Intervals: A second dose of Nayzilam can be given after 10 minutes, while Valtoco's re-dosing interval is at least 4 hours.
Shared Safety Warnings: Both carry similar risks of central nervous system depression, abuse potential, and dangerous interactions with opioids or alcohol.
Intranasal Administration: Both medications are administered as ready-to-use nasal sprays for ease of use during a seizure cluster.

Understanding Rescue Medications for Epilepsy

For many people with epilepsy, daily medications are effective at controlling seizures. However, some individuals experience 'seizure clusters,' or acute repetitive seizures, which are a pattern of seizures different from their typical episodes. These events can be frightening and require immediate intervention to prevent the situation from escalating into status epilepticus, a prolonged and dangerous seizure state. Rescue medications are designed for this exact purpose, offering a fast-acting treatment option that can be administered at home, work, or school. Valtoco and Nayzilam are two such rescue medications delivered as a nasal spray, but despite their similar use, they are not interchangeable.

The Core Difference: Active Ingredients

The most fundamental difference between Valtoco and Nayzilam lies in their active ingredients. While both drugs belong to the benzodiazepine class, they contain different specific compounds that affect their pharmacological profiles.

Valtoco contains diazepam, a benzodiazepine that has been used in various forms for many decades to treat epilepsy. It is formulated with special technology to enhance absorption through the nasal passages.
Nayzilam contains midazolam, another fast-acting benzodiazepine. Midazolam is known for its quick onset and is used for both sedation and seizure control.

Both diazepam and midazolam work by enhancing the effect of gamma-aminobutyric acid (GABA), the brain's primary inhibitory neurotransmitter. By increasing GABA's inhibitory signals, they calm overactive nerve activity and help stop a seizure.

A Closer Look at Valtoco (Diazepam)

Valtoco, approved by the FDA in 2020, is a nasal spray specifically formulated to deliver diazepam. Key features of Valtoco include:

Age Indication: It is approved for use in patients with epilepsy aged 2 years and older.
Dosing: Dosage is weight-based.
Administration: It is administered as a single spray into one nostril. For doses requiring more than one spray, a second device is used in the other nostril.
Re-dosing: A second dose can be given at least 4 hours after the first, if needed.
Maximum Frequency: No more than two doses should be given per seizure episode. It is recommended for use no more than once every five days and no more than five times per month.

A Closer Look at Nayzilam (Midazolam)

Nayzilam, approved by the FDA in 2019, is a nasal spray delivering midazolam. Its characteristics include:

Age Indication: It is approved for use in patients with epilepsy aged 12 years and older.
Dosing: It comes in a single-dose nasal spray device.
Administration: A single spray is given into one nostril.
Re-dosing: A second dose may be administered into the opposite nostril if seizure activity continues 10 minutes after the first dose.
Maximum Frequency: No more than two doses should be given per seizure episode. It is recommended for use no more than once every three days and no more than five times per month.

Valtoco vs. Nayzilam: A Comparison Table


Feature	Valtoco (Diazepam)	Nayzilam (Midazolam)
Active Ingredient	Diazepam	Midazolam
FDA Approval Age	2 years and older	12 years and older
Dosing	Weight-based	Fixed dose
Onset of Action	Typically works within 4 minutes	Can work in as little as 10 minutes
Re-dosing Interval	At least 4 hours after the first dose	10 minutes after the first dose
Maximum Frequency	No more than 1 episode every 5 days and 5 episodes per month	No more than 1 episode every 3 days and 5 episodes per month
Active Metabolites	Yes (desmethyldiazepam, temazepam, oxazepam)	Yes (1-hydroxy midazolam)
Protein Binding	Highly protein bound	Highly protein bound

Important Safety Considerations

Since both medications are benzodiazepines and CNS depressants, they share a number of important safety warnings.

CNS Depression: Both can cause drowsiness, dizziness, and sedation. Patients and caregivers should be aware of this, especially when driving or operating machinery.
Abuse and Dependence: Benzodiazepines carry a risk of abuse, misuse, and physical dependence, which can lead to life-threatening withdrawal reactions if used more frequently than recommended.
Opioid Interaction: The co-administration of either Valtoco or Nayzilam with opioids or alcohol can increase the risk of profound sedation, respiratory depression, coma, and death.
Suicidal Ideation: Like other antiepileptic drugs, they carry a warning about an increased risk of suicidal thoughts and behaviors.
Glaucoma: Both are contraindicated in patients with acute narrow-angle glaucoma.

Additionally, Valtoco contains benzyl alcohol, which can be toxic to neonates and infants. Therefore, it is not approved for use in children under 2 years old.

Choosing Between Valtoco and Nayzilam

The choice between Valtoco and Nayzilam depends on several individual factors, including the patient's age and weight, as well as the healthcare provider's clinical judgment. The decision should be made in consultation with a physician who can consider the specific needs of the patient.

For pediatric patients between 2 and 12 years old, Valtoco is the only FDA-approved intranasal option.
For patients 12 years and older, both are options, but they offer different dosing schemes. Nayzilam uses a fixed dose, whereas Valtoco uses a weight-based dose.
The specific onset and duration of action, although similar, may vary between individuals. Some studies suggest midazolam may have a faster onset but shorter duration than diazepam.

It is crucial for caregivers to receive proper training on how to identify seizure clusters and how to administer the prescribed medication. An individualized Seizure Action Plan, developed with the healthcare team, is highly recommended to ensure proper usage.

Conclusion

In conclusion, while both Valtoco and Nayzilam serve as rescue nasal sprays for the acute treatment of seizure clusters, they are not the same medication. They contain different active benzodiazepine ingredients—diazepam in Valtoco and midazolam in Nayzilam—and are approved for different age groups. Other differences in dosing and re-dosing intervals also exist. Understanding these key distinctions is vital for patients and caregivers to ensure safe and effective use of these important rescue therapies. For more information on epilepsy and seizure rescue therapies, the Epilepsy Foundation is an authoritative resource.

Frequently Asked Questions

No, you should not substitute Nayzilam for Valtoco or vice versa. These are different medications with distinct active ingredients, approved age groups, and dosing instructions. Always use the specific medication prescribed by your healthcare provider.

Valtoco typically works within 4 minutes, while Nayzilam can take up to 10 minutes for its effect to be fully realized. However, some comparative studies have suggested that midazolam (Nayzilam's active ingredient) might have a faster onset but shorter duration than diazepam (Valtoco's active ingredient).

They have similar side effect profiles because they are both benzodiazepines, and common side effects include sleepiness, headache, and nasal discomfort. However, their different active ingredients and formulations can cause subtle variations in side effects, and some people may tolerate one better than the other.

Valtoco is FDA-approved for children aged 2 years and older. Nayzilam is approved for patients aged 12 years and older. The correct medication depends on the patient's specific age.

Yes, both Valtoco and Nayzilam are prescription medications classified as controlled substances (CIV) due to their potential for abuse and dependence.

Both are administered as ready-to-use nasal sprays. For Valtoco, one or two devices may be needed depending on the prescribed dose, with sprays given in different nostrils if needed. Nayzilam is one spray per nostril per dose.

After administration, the caregiver should stay with the patient, monitor them closely, note the time the dose was given, and provide a safe resting area. Emergency medical help should be sought if the seizures do not stop, last longer than usual, or if there are signs of breathing problems.