Midazolam - Emergency Epileptic Seizure Medicine

What does midazolam look like?  

Midazolam is a clear solution that comes in a plastic ampoule.

See the photo of a plastic ampoule of midazolam.

Plastic ampoules of midazolam come in 2 different volumes:

• 3mL of solution (5mg/mL) which contains 15mg of midazolam
• 1mL of solution (5mg/mL) which contains 5mg of midazolam

Make sure you check which one you have before you use it.

The prescription the doctor gives you will tell you how much of the solution to give. You will also find this information in your seizure plan and on the medicine packet. 

Midazolam also comes in a glass ampoule. Make sure your child gets a plastic ampoule from the pharmacy, not a glass ampoule.

What equipment do I need for giving midazolam?

You will need to get syringes to give midazolam. You don’t need a needle as you will not inject the midazolam. 

You need 1mL or 3mL syringes. This depends on the dose of midazolam your child needs.  

You need intravenous (IV) syringes (not oral syringes) because they fit into the midazolam plastic ampoule.  You can get these syringes from the local pharmacy, hospital or GP practice. 

See the photo of the type of syringe you will need - an IV syringe.

If your child will be having midazolam in the nose, you will need an atomiser device. An atomiser device attaches to the syringe. A health professional will give you an atomiser device with the midazolam if that is how they want you to give it to your child.

See the photo of an atomiser device that attaches to the syringe.

How do I store midazolam?

Store the midazolam ampoules at room temperature. Don’t leave the midazolam in a hot place like your car or bathroom. Keep it away from light.  

Keep midazolam in a safe place out of sight and reach of tamariki (children). 

The midazolam comes in a box of 5 ampoules which are in foil. The box may say the midazolam is for injection, but you will not be injecting it into your child.

See the photo of the box and foil packet that midazolam comes in.

Does midazolam have an expiry date? 

There is an expiry date on the box, but the midazolam will expire 8 months after you remove the ampoules from the foil. Check with your pharmacist when your ampoules will expire and write this date on the box. 

Regularly check the midazolam hasn’t expired and return any expired midazolam to your pharmacy. If you need an ongoing supply, you can get this from your GP.

How do I prepare the midazolam?

Steps on how to draw up midazolam

Follow these steps if your child’s seizure is still actively going at 4 minutes.

Before you start, make sure you know what dose of midazolam your child needs. This will be on your seizure plan and the packet. 

Step 1 - Get your midazolam and a syringe.

Step 2 - Twist off the top of the plastic ampoule of midazolam.

Step 3 - Insert the syringe into the ampoule so that it fits tightly.

Step 4 - Hold the syringe upright with the ampoule above the syringe.

Step 5 - Pull the syringe so the midazolam moves from the ampoule into the syringe. There are numbers on the side of the syringe so you can measure the right dose.

Step 6 - Gently push out any big air bubbles.

Step 7 - Check that the correct amount of midazolam is in the syringe.

Step 8 - Take the ampoule off the syringe.

How do I give the midazolam to my child during a seizure? 

Give the midazolam as directed by your doctor. Midazolam can be given either in between the teeth and cheek (buccal) or in the nose (intranasal). Your doctor will prescribe the best way to administer midazolam for your child. 

For general advice on what to do during your child’s seizure, see the KidsHealth page on seizure first aid. 

Instructions for giving buccal midazolam

Step 1 - Wipe off excess saliva and open your child’s lips.

Step 2 – Slowly, over a few seconds, squirt the midazolam from the syringe into the space between the teeth and the cheek - the cheek closest to the ground if they are on their side. 

There is no need to open your child’s jaw - they do not need to swallow the midazolam. It’s not harmful if your child does swallow the midazolam, but it will not work as well.

The midazolam is absorbed quickly into the bloodstream through the inner side of the cheek. 

You can wash and dry the syringe after using it. You can use it again in the future. 

See an emergency plan with steps on what to do if your child has a seizure and how to give buccal midazolam.

Print your child’s emergency plan and keep it with the midazolam. Refer to this plan when your child has a seizure.

Instructions for giving intranasal midazolam

Step 1 - Attach the syringe to the atomiser device.

Step 2 - Put the atomiser with the syringe attached into your child’s nostril.  

Step 3 - Give half of the dose into one nostril. 

Step 4 - Remove from the first nostril and insert into the other nostril to give the rest of the dose.

You can wash and dry the atomiser and syringe after using it. You can use it again in the future. 

See an emergency plan with steps on what to do if your child has a seizure and how to give intranasal midazolam. 

Print your child’s emergency plan and keep it with the midazolam. Refer to this plan when your child has a seizure.

What should I do after giving my child midazolam?

After you have given midazolam:

• watch your child’s breathing
• continue to time the seizure

Dial 111 within New Zealand and ask for urgent medical help if:

• the seizure does not stop within 1 minute of giving the midazolam 
• you are worried about your child’s breathing 

If your doctor has given you specific instructions on when to call 111, follow their instructions.

Printable emergency seizure plan

An emergency seizure plan is a step-by-step guide for what to do if your child is having a seizure. It includes steps to take for giving buccal or intranasal midazolam. Print out a plan and keep a copy with your supply of medicine. 

See the KidsHealth page for an emergency seizure plan for giving buccal midazolam

See the KidsHealth page for an emergency seizure plan for giving intranasal midazolam

The emergency seizure plans are both available as either a flow chart or as text instructions.