The FDA has approved midazolam nasal spray (Nayzilam,  for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in epilepsy patients aged 12 years or older.

Midazolam nasal spray is the first and only FDA-approved nasal option for treating seizure clusters. It is packaged as a single-use treatment that can be carried with a patient and administered by persons who are not healthcare professionals.

The most common adverse reactions (≥5% in any midazolam nasal spray treatment group) were somnolence, headache, nasal discomfort, throat irritation, and rhinorrhea.

Midazolam nasal spray is contraindicated in patients with acute narrow-angle glaucoma. Concomitant use of benzodiazepines, including midazolam nasal spray, and opioids may result in profound sedation, respiratory depression, coma, and death.