The Rise of Nasal Rescue Medications
Before the advent of nasal sprays, emergency seizure treatment often involved rectal diazepam gel, which could be inconvenient and socially challenging. Nasal spray rescue medications offer a non-invasive, faster, and more discreet alternative for managing seizure emergencies. The intranasal route allows for quick absorption into the bloodstream, leading to a faster onset of action compared to oral or rectal administration. These medications can be administered rapidly by a trained caregiver or in some cases, by the patient themselves, making them an important part of a Seizure Action Plan.
Nayzilam: A Midazolam Nasal Spray
Nayzilam (midazolam) is an FDA-approved nasal spray for the short-term treatment of seizure clusters in individuals aged 12 and older. It works by enhancing the calming effect of the neurotransmitter GABA in the brain to reduce excessive nerve activity. Each single-use spray delivers a specific amount of medication into one nostril. A second dose into the opposite nostril may be given if seizures persist, but only if directed by a healthcare provider. The use of Nayzilam should follow the guidelines provided by a healthcare professional regarding the frequency and number of doses per seizure cluster. Common side effects include drowsiness, headache, and nasal/throat irritation.
Valtoco: A Diazepam Nasal Spray
Valtoco (diazepam) is another FDA-approved nasal spray for treating intermittent, frequent seizure episodes in patients aged 2 years and older. It also increases GABA activity to decrease neuronal excitability. Its formulation improves absorption compared to older rectal diazepam. Dosing varies based on age and weight, and it is available in different strengths. The administration involves one spray in one or both nostrils depending on the prescribed dose. A second dose can be given at a later time if prescribed by a healthcare provider. Common side effects include drowsiness, headache, and nasal discomfort.
Comparison of Nayzilam and Valtoco
A comparison of Nayzilam and Valtoco shows key differences in approved age, dosing options, second dose timing, onset time, duration, and active ingredient. Nayzilam is approved for ages 12 and older with a single dose, while Valtoco is for ages 2 and older with multiple dosing options. Second doses can be given after a specific time interval for Nayzilam and after a different interval for Valtoco, if prescribed. Nayzilam may have a faster onset but shorter duration due to its shorter half-life compared to Valtoco's longer half-life. Nayzilam contains midazolam, and Valtoco contains diazepam.
Important Safety Information and Considerations
Nayzilam and Valtoco are benzodiazepines and come with important safety warnings. Using these sprays with other central nervous system depressants, such as opioids or alcohol, can cause severe drowsiness, respiratory depression, coma, or death. Both medications carry a potential risk for abuse, misuse, and addiction. Stopping benzodiazepines abruptly can result in withdrawal symptoms. These sprays are not intended for daily use, and a healthcare provider should be consulted before discontinuing any prescribed medication. Certain medical conditions, like narrow-angle glaucoma, may make these medications unsuitable. Additionally, antiepileptic drugs may increase the risk of suicidal thoughts; monitoring for mood changes and contacting a doctor is recommended if they occur.
Conclusion
Nasal seizure sprays like Nayzilam and Valtoco serve as essential tools for the emergency management of seizure clusters. They offer a rapid, non-invasive alternative to older methods, enabling quicker intervention outside of a hospital setting. Effective use depends on proper training for caregivers and patients and a clear Seizure Action Plan developed with a healthcare provider. These sprays are for acute events and do not replace daily seizure control medication. For additional details, you can visit the Epilepsy Foundation.
