Midazolam for stopping seizures

This leaflet is about the use of midazolam to stop seizures. (Seizures may also be called convulsions or fits.) 

This leaflet has been written specifically for parents and carers about the use of this medicine in children. The information may differ from that provided by the manufacturer. Please read this leaflet carefully. Keep it somewhere safe so that you can read it again.

Never give your child more than one dose of  midazolam during one seizure unless you have been told to do this by the hospital doctor.

Name of drug

Midazolam buccal liquid

Brand names: Buccolam®, Epistatus® 

Why is it important for my child to take this medicine?

Midazolam is used to stop a seizure.

What is midazolam available as?

Midazolam is available as buccal liquid medicine, which is given inside the cheek. There are two different products.

• Buccolam® liquid medicine in prefilled oral syringes: 5 mg in 1 mL. This medicine is licensed for use in children.
• Epistatus® liquid syrup in a bottle with 4 oral syringes: 50 mg in 5 mL. This medicine is not licensed for use in children but can be ordered specially from your pharmacist.

The Medicines for Children leaflet Unlicensed Medicines explains the difference between licensed and unlicensed medicines.

It is important that your child always has the same brand of midazolam, as they are different strengths. Keep a record of which medicines your child has.

When should I give midazolam?

You should give midazolam if your child’s seizure lasts more than 5 minutes. Follow these steps:

Do not give your child another dose of midazolam unless you have been told you can by your doctor or nurse.

Do not give your child rectal diazepam or any other drug.

How much should I give?

Your doctor will work out the amount of midazolam (the dose) that is right for your child. It is normally the whole syringe full unless your doctor tells you otherwise. The dose will be shown on the medicine label. 

It is important that you follow your doctor’s instructions about how much to give.

Do not give your child more than one dose of midazolam during one seizure unless you have been told to do this by the hospital doctor.

How should I give it?

Midazolam needs to go into the space between the inside of the cheek and the teeth, which is called the buccal cavity.  Your doctor or nurse will show you what to do.

• The medicine quickly gets from the cheek into the blood to stop the seizure. If you put the midazolam into the middle of the mouth it will not work as well because it cannot get into the blood so quickly.
• Your child does not need to swallow the medicine. (It is not harmful if they do swallow it, but it will not work as well.)

What if my child is sick (vomits)?

Do not give your child another dose of midazolam unless you have been told you can by your doctor or nurse.

What if I don’t give it?

If you do not give the midazolam, or do not give the right dose, your child’s seizure may not stop. This could be dangerous and your will need to call an ambulance o take your child to hospital straight away.

What if I give too much? 

If you think you may have given your child too much midazolam, or your child’s breathing slows down or stops, telephone for an ambulance straight away.

Are there any possible side-effects?

We use medicines to make our children better, but sometimes they have other effects that we don’t want (side-effects).

• Your child may be sleepy after having midazolam. They should have a sleep if they want to.
• Your child may be confused. They probably won’t remember having the seizure.

Your child’s breathing may become a little shallow for a while. You do not need to worry about this. However, if you think your child is not breathing or if your child’s lips get a blue tinge, call an ambulance straight away.

There may, sometimes, be other side-effects that are not listed above. If you notice anything unusual and are concerned, contact your doctor. You can report any suspected side-effects to a UK safety scheme at http://www.mhra.gov.uk/yellowcard.

Can other common medicines be given at the same time as midazolam?

• You must not give your child any other medicine to stop the seizure, unless your doctor has said that you can do this.

Is there anything else I need to know about this medicine?

• Make sure that your child always has their midazolam with them.
• Make sure that anyone who looks after your child knows what to do and how to give midazolam if your child has a seizure.
• It is best that your child always has the same brand of midazolam (Buccolam or Epistatus). Write down which brand you use, and how much you give. Keep this information with you.

Only give midazolam to your child. Never give it to anyone else, even if they seem to be having a seizure, as this could do harm.

If anyone else takes the medicine by accident, take them to a doctor straight away.

• Make sure that the midazolam you have at home have not reached the ‘best before’ or ‘use by’ date on the packaging. Give old medicines to your pharmacist to dispose of.

Where should I keep this medicine? 

• Keep the medicine in a cupboard, away from heat and direct sunlight. It does not need to be kept in the fridge.
• Make sure that children cannot see or reach the medicine.
• Keep the medicine in the container it came in.

Who to contact for more information 

Your child’s hospital doctor, epilepsy nurse or pharmacist will be able to give you more information about midazolam and other medicines used to treat epilepsy.