Emergency seizure medicines: midazolam and diazepam brands and side effects

Medicines covered: Buccal or nasal midazolam and rectal or nasal diazepam

Common brand examples
• Buccal midazolam: Buccolam and Epistatus
• Nasal midazolam: Nayzilam in the United States
• Rectal diazepam: Stesolid and Diastat/Diastat AcuDial
• Nasal diazepam: Valtoco in the United States

Products, licensed ages, strengths and routes vary by country. A nasal product must not be given rectally, and a rectal or buccal product must not be used by another route unless specifically directed.

How rescue medicines are used
A clinician may prescribe rescue medicine for prolonged seizures or seizure clusters. Each person needs a written emergency seizure plan stating which product to use, the dose, when to give it, whether a second dose is permitted and when to call emergency services.

Common side effects
• Sleepiness or reduced alertness
• Dizziness, weakness or poor coordination
• Slurred speech
• Nasal discomfort with nasal products
• Rectal discomfort with rectal products
• Temporary memory or behaviour changes
• Paradoxical agitation can occasionally occur

Most important risk
Midazolam and diazepam can slow breathing. Risk increases with repeated doses and with opioids, clobazam or other sedating medicines. Rett syndrome can involve breathing irregularities, so carers must follow the individual emergency plan precisely.

Call emergency services according to the plan, and urgently if
Breathing is slow, shallow or difficult; lips become blue; the person cannot be roused normally; the seizure continues beyond the stated time; another seizure begins without recovery; injury occurs; or it is the first known seizure.

Safety reminders
• Carers should receive practical training for the exact prescribed product.
• Check expiry dates and storage instructions regularly.
• Record the time, dose, seizure duration and response.
• Never give another person’s rescue medicine.
• Do not alter the dose or repeat it unless the written plan permits it.

NICE epilepsy guidance: https://www.nice.org.uk/guidance/ng217
General emergency-medicine information: https://www.youngepilepsy.org.uk/about- ... medication

Information checked 4 September 2026. This post cannot replace an individual emergency seizure plan or hands-on training. Follow the prescribed plan and local emergency-service instructions.