Understanding Nayzilam and its Generic, Midazolam
Nayzilam is the brand name for a rescue medication containing the active ingredient midazolam [1.2.1]. It is used for the acute treatment of seizure clusters, also known as acute repetitive seizures, in patients with epilepsy aged 12 and older [1.2.3]. Unlike daily anti-seizure medications, Nayzilam is a fast-acting treatment intended for emergency use by patients or caregivers to stop a bout of frequent seizure activity [1.5.1].
Midazolam belongs to a class of drugs called benzodiazepines, which have been a cornerstone of epilepsy treatment for decades [1.3.1]. While there is no therapeutically equivalent generic version of the Nayzilam nasal spray device currently available in the United States, midazolam itself is a well-established medication available in other forms [1.2.5, 1.2.4].
How Midazolam Works to Stop Seizures
Benzodiazepines like midazolam work by enhancing the effects of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA) [1.4.5]. GABA is an inhibitory neurotransmitter, meaning it calms down nerve activity. During a seizure, the brain's electrical activity becomes over-excited. By increasing GABA's effectiveness, midazolam helps to suppress this excessive electrical stimulation, thereby stopping the seizure [1.4.4, 1.4.5].
The nasal spray delivery method is a key feature of Nayzilam. The nasal passages have a rich blood supply, which allows for rapid absorption of the medication into the bloodstream [1.4.2]. Studies show Nayzilam can stop a seizure cluster within 10 minutes [1.2.4]. This makes it a practical and effective option for non-medical personnel to administer outside of a hospital setting, even if the patient is unconscious, as no inhalation is required [1.5.1].
Proper Administration of Nayzilam Nasal Spray
Caregivers should be trained by a healthcare professional on how to identify a seizure cluster and administer Nayzilam correctly [1.5.3]. The device is for a single use only and should not be tested or primed before use, as this will waste the dose [1.2.2].
The steps for administration are:
- HOLD: Hold the device with your thumb on the plunger and your index and middle fingers on either side of the nozzle [1.6.2].
- PLACE: Insert the tip of the nozzle into one of the patient's nostrils until your fingers touch the bottom of their nose [1.6.2].
- PRESS: Firmly press the plunger one time to deliver the full 5 mg dose [1.6.2]. The patient does not need to breathe in [1.6.1].
If the seizure cluster continues after 10 minutes, a second dose may be administered in the opposite nostril using a new device, if directed by a healthcare provider [1.6.3, 1.6.4]. No more than two doses should be used to treat a single episode [1.5.2].
Potential Side Effects and Safety Warnings
Like all medications, Nayzilam has potential side effects. The most common ones include drowsiness, headache, nasal discomfort, throat irritation, and a runny nose [1.7.1, 1.7.4].
Nayzilam also carries an FDA Boxed Warning for several serious risks [1.7.4]:
- Risks from Use with Opioids: Combining benzodiazepines with opioids, alcohol, or other central nervous system depressants can lead to severe drowsiness, profound respiratory depression, coma, and death [1.3.4, 1.7.1].
- Abuse, Misuse, and Addiction: As a Schedule IV controlled substance, Nayzilam has a potential for abuse and addiction, which can result in overdose and death [1.2.4, 1.7.1].
- Dependence and Withdrawal: Using Nayzilam more frequently than prescribed can lead to physical dependence. Suddenly stopping the medication can cause severe, life-threatening withdrawal symptoms, including more seizures [1.2.4, 1.7.1].
This medication is not for daily use. It should not be used for more than one seizure episode every three days or more than five times per month [1.6.4].
Nayzilam vs. Other Rescue Medications: A Comparison
Before the approval of nasal spray options like Nayzilam and Valtoco (diazepam), the standard out-of-hospital rescue medication was often diazepam rectal gel (Diastat). The intranasal route is generally considered easier and more socially discreet to administer than the rectal route [1.8.3, 1.3.3].
| Feature | Nayzilam (Midazolam Nasal Spray) | Valtoco (Diazepam Nasal Spray) | Diastat (Diazepam Rectal Gel) |
|---|---|---|---|
| Active Ingredient | Midazolam [1.2.1] | Diazepam [1.8.1] | Diazepam [1.3.3] |
| Administration Route | Intranasal (in the nose) [1.2.2] | Intranasal (in the nose) [1.8.1] | Rectal (in the rectum) [1.3.3] |
| Approved Age | 12 years and older [1.2.3] | 6 years and older [1.2.4] | Varies by product |
| Typical Onset | Within 10 minutes [1.2.4] | Within 4-10 minutes [1.8.1] | Within 15 minutes [1.8.3] |
| Social Discretion | High | High | Low [1.8.3] |
Cost and Availability
The list price for a two-dose box of Nayzilam is approximately $666.93, though the actual patient cost depends heavily on insurance coverage [1.11.2]. With coupons, the price can be around $645 [1.11.3]. While a direct generic equivalent for the Nayzilam device is not available, other forms of midazolam can be significantly less expensive [1.2.5, 1.11.1].
Conclusion
The generic for Nayzilam nasal spray is midazolam, a powerful benzodiazepine that offers a rapid, effective, and socially acceptable way to treat emergency seizure clusters outside of a medical setting [1.2.1, 1.9.4]. Its development marks a significant advancement in epilepsy care, providing patients and caregivers with a crucial tool for managing unpredictable seizures. However, due to its significant risks, including respiratory depression and potential for dependence, it must be used exactly as prescribed, and caregivers must be thoroughly trained on its proper administration [1.7.1, 1.5.3].
For more detailed information, consult the FDA's official medication guide [1.3.4].
