Intranasal Midazolam (Versed®) - Vial

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Midazolam (muh-da-zuh-lam) is the generic name for Versed®. Midazolam is given through the nose and is absorbed quickly. This medicine works in the brain to stop both cluster and prolonged seizures. Cluster seizures are seizures that happen close together. Prolonged seizures are seizures that last more than 5 minutes. During a seizure, it can be hard to give your child medicine in their mouth. The seizures should stop within 5 minutes after giving the medicine.

Warning

If your child is allergic to midazolam, they should notHHV227_Photo_2 take this medicine. See the signs of an allergic reaction on page 3 in “When to Call 911.”

Giving This Medicine

  • Midazolam is given through the nose (intranasally).You will have a bottle (vial) of midazolam, a syringe, a needleless access device, and a Mucosal Atomization Device (MAD), also known as an atomizer (Picture 1).
  • The atomizer creates a fine spray to give the medicine into your child’s nose.
  • Read the label carefully. Make sure you are giving the right dose of the right medicine.
  • Stay with your child until they have received the dose of medicine.
  • Do not remove the medicine from the vial until needed.
  • Midazolam does not replace your child’s other medicines. Do not stop giving other medicines without talking to your child’s doctor or health care provider.

How to Prepare the Medicine

  1. Take the plastic wrap off the needleless access device, the syringe, and the MAD device.
  2. Put the open end of the needleless access device onto the tip of the syringe. Twist it to the right to lock it in place.
  3. Take off the cap from the vial of medicine and from the needleless access device.
  4. Pull back the plunger in the syringe to the number of milliliters (mL) needed for the dose of the medicine.
  5. Put the needleless access device into the rubber stopper of the medicine vial and turn it upside down.
  6. Push the plunger and pull it back to draw out the right amount of liquid.
  7. If there are air bubbles in the liquid in the syringe, tap the side of the syringe to bring the bubbles to the top. Push the plunger just enough to push the bubbles back into the vial. Pull the plunger back again to draw the right amount of liquid into the syringe.
  8. Pull the needleless access device out of the vial of medicine. Put the cap back on it. Twist the top to the left to take off the needleless access device.
  9. Put the MAD on the syringe. Twist the large, open end of the MAD onto the syringe tip.

How to Give This Medicine

  1. If your child has a runny nose, clean the nose before giving the medicine.HHV227_Photo_3
  2. Hold your child’s head steady with your free hand. Insert the head of the MAD device into one nostril snugly (Picture 2).
  3. Quickly press in the plunger to give half of
    4.      the dose into that nostril.
  4. Put the MAD device head into the other nostril.
  5. Quickly press the plunger fully to give the other half of the dose.

Possible Side Effects

  • Sleepiness
  • Nausea
  • Stuffy nose
  • Agitation
  • Nasal irritation
  • Dizziness
  • Headache
  • Breathing changes

When to Call the Doctor

Call your child’s doctor or health care provider if any side effects continue or cause problems. If you have any questions, be sure to ask the doctor, nurse, or pharmacist.

When to Call 911

Stay and watch your child after giving this medicine. Call 911 if:

  • Your child has a seizure that lasts more than 5 minutes after giving midazolam.
  • Your child has seizures that are more severe or happen more than before.
  • Your child’s color is gray or blue and their breathing is shallow.
  • Your child has any of these signs of an allergic reaction:
    • Trouble breathing, swelling of the tongue
    • Swelling of hands, feet, or ankles
  • There is another problem that concerns you.
  • Your child’s doctor or health care provider tells you to do so.

Medicine Storage and Disposal

  • Always keep medicine in the original vial from the pharmacy.
  • Do not keep this medicine in the refrigerator. Store at room temperature.
  • If you carry medicine in your purse or bag, keep it in its childproof vial. Keep your purse or bag out of the reach of children and pets.
  • Do not use this medicine after the expiration date printed on the container.
  • Throw away expired medicine or medicine that is no longer needed at a medicine return bin. You can find these at rxdrugdropbox.org.

How to Throw Away Used Needles and Syringes

  • Do not bend or break off the needleless access device.
  • Put the used syringe and needleless access device into a puncture-resistant container with a cover, such as a used bleach bottle, a coffee can, or a sharps container.
  • Do not let the sharps container get too full. When the container is two-thirds full, tape down the cover or lid, and label the container, “SHARPS – DO NOT RECYCLE.” Put the container in the middle of a full trash bag. In the state of Ohio, you are allowed to put the trash bag out for regular trash pick-up. You may also put the container into a bag and return it to your local hospital for disposal.

CAUTION: Syringes and needleless access devices should only be used once. Keep syringes and supplies out of the reach of children and others who might misuse them.

Intranasal Midazolam (Versed®) - Vial (PDF)

HH-V-277 Reviewed 6/18 Copyright 1979, Nationwide Children’s Hospital