The Rise of Intranasal Rescue Therapies: A Non-Invasive Solution
For many years, the options for emergency seizure rescue medication administered outside a hospital were limited, often involving rectal gels or buccal formulations. While effective, these methods could be challenging to administer, particularly in public settings, and faced potential issues with absorption or patient comfort. The development of intranasal (into-the-nose) rescue medications represented a significant advancement, offering a more socially acceptable, convenient, and rapid alternative.
Intranasal delivery takes advantage of the highly absorbent mucous membrane inside the nose, allowing the medication to enter the bloodstream quickly and bypass the digestive system. This leads to a faster onset of action, which is critical for stopping a prolonged or cluster seizure. Two FDA-approved intranasal benzodiazepines, midazolam (Nayzilam) and diazepam (Valtoco), have become standard rescue therapies for managing acute, repetitive seizures in community settings. They work by enhancing the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that calms overactive nerve impulses in the brain to stop seizure activity.
Intranasal Midazolam (Nayzilam)
Nayzilam is the brand name for midazolam nasal spray, a fast-acting benzodiazepine rescue therapy. It is approved for the short-term treatment of seizure clusters in patients 12 years of age and older. The medication comes in a prepackaged, single-dose nasal spray unit containing 5 mg of midazolam.
Patients or caregivers are instructed on how to properly administer Nayzilam at the onset of a seizure cluster. A single spray is typically given into one nostril. If the seizure cluster continues after 10 minutes, a second dose may be administered in the opposite nostril if prescribed by a healthcare provider. It is important not to use more than two doses per seizure cluster episode. Nayzilam should not be used more than once every three days or more than five times a month.
Intranasal Diazepam (Valtoco)
Valtoco is the brand name for diazepam nasal spray, another FDA-approved benzodiazepine for seizure emergencies. It is approved for use in patients aged 2 years and older for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity. Valtoco is designed to deliver a dose based on the patient's age and weight, with different strengths available.
For higher doses (e.g., 15 mg or 20 mg), two nasal sprays may be required, one for each nostril. Caregivers are trained to administer the spray during a seizure cluster. A second dose may be given at least 4 hours after the first, if prescribed. The administration is non-invasive and can be done by a family member, friend, or other caregiver. It is not intended for daily use and should not be used for more than one seizure cluster episode every five days or five times a month.
Comparison of Intranasal Seizure Rescue Medications
| Feature | Nayzilam (Midazolam) | Valtoco (Diazepam) |
|---|---|---|
| Generic Name | Midazolam | Diazepam |
| FDA Approved Age | 12 years and older | 2 years and older |
| Mechanism | Benzodiazepine; enhances GABA | Benzodiazepine; enhances GABA |
| Speed of Absorption | Rapid absorption via nasal mucosa | Rapid absorption via nasal mucosa |
| Key Dosing Info | Single spray (5 mg) per nostril; second dose after 10 minutes if prescribed | Weight and age-based dosing; can involve one or two sprays |
| Repeat Usage | Max 1 episode every 3 days; max 5 episodes/month | Max 1 episode every 5 days; max 5 episodes/month |
| Ease of Administration | Simple, single-spray delivery | Simple, prepackaged device, can be single or dual-nostril |
How to Administer an Intranasal Rescue Medication
To ensure proper delivery and effectiveness, individuals and caregivers should follow these steps, as advised by the prescribing doctor:
- Prepare the device: Keep the medication in a blister pack until needed. Do not prime or test the spray, as each device contains a single, pre-measured dose.
- Position the person: Ensure the person is in a safe location, away from potential hazards, and on their side if possible, especially during a convulsive seizure.
- Clean the nose (if necessary): If the person has a runny nose, it should be gently cleaned to ensure better absorption.
- Administer the spray: Hold the device correctly, with fingers on the sides of the nozzle and the thumb on the plunger. Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
- Press the plunger firmly: Push the plunger with a firm, quick motion to release the medication.
- Watch and wait: Stay with the person and time the seizure. Take note of when the medication was given. If prescribed, a second dose may be administered later.
Important Considerations and Side Effects
Using intranasal rescue medications requires careful use. These medications can cause drowsiness and dizziness, and the risk of serious breathing issues is higher when combined with other CNS depressants like opioids or alcohol. Benzodiazepines carry a risk of dependence and withdrawal if misused or stopped abruptly. Common side effects include nasal discomfort, runny nose, and nosebleeds. A healthcare provider should provide a Seizure Action Plan detailing when and how to use the medication and when to seek emergency help.
Conclusion
Intranasal rescue therapies offer a fast and non-invasive option for managing seizure emergencies, with Nayzilam approved for individuals 12 and older and Valtoco for those 2 and older. However, these medications must be used according to a healthcare provider's instructions, especially regarding interactions with other substances. A Seizure Action Plan is essential for safe use. For more information, visit the {Link: Epilepsy Foundation https://www.epilepsy.com/}.
