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Information for the administration of Intrabuccal Midazolam by parents & carers

What is Midazolam?

Midazolam is part of a group of drugs called Benzodiazepines. It is used to help control seizures. It is available in bottles containing 10mg in 1ml of liquid. The trade name is Epistat.

General Management of the Seizure

In the event of the child having a prolonged seizure the following steps should be taken:

  1. Make the child safe and note the time of when the seizure started.
  2. Make the child comfortable, preferably lying down on the floor or a bed (ease them to the floor if they are sitting). Do not move the child more than is necessary.
  3. Loosen any tight clothing, remove glasses and ensure there are no objects or furniture that could cause any harm.
  4. Ensure the airway is not obstructed and turn the child onto their side to allow vomit or phlegm to be expelled rather than inhaled. Do not place anything into the mouth or attempt to force the teeth apart. Do not attempt to restrict the convulsive movements.
  5. Call for assistance if someone else is present.

When to give Intrabuccal Midazolam

  • If a seizure lasts longer than the agreed time, usually 5 minutes, then midazolam must be used.
  • The dose and timing will be stated on the individual emergency protocolfor the child.

How to administer Intrabuccal Midazolam

  1. Remove childproof cap from bottle.
  2. Insert syringe into the hole in the bung.
  3. Turn bottle upside down.
  4. Withdraw correct dose of Midazolam liquid.
  5. Position the point of the syringe gently into the mouth, between the teeth and the cheek. Do not attempt to open the teeth.
  6. Slowly squirt the contents of the syringe into the mouth, across the lining of the cheek and gums.
  7. Replace childproof cap.

If no response to medication is seen within 5 minutes or you are concerned about the child's condition, an ambulance must be called. Do not give further medication unless instructed by a GP or another doctor.

If the child responds to the medication and fitting stops, place the child in recovery position. Stay with the child until fully recovered.

What are the side effects?

These are mild, and may include:

  • Drowsiness
  • Light-headedness
  • Unsteadiness

Storage of Midazolam

Midazolam must be stored in a locked cupboard, below 25C. There is no need to refrigerate.

The expiry date must be checked regularly, and medicine that is out of date must not be used.

Please contact the Epilepsy Nurse on 01803 655586 if you have any questions about the information in this leaflet

Patient information prepared by Child Health Department © South Devon Healthcare NHS Foundation Trust, 01/03.

Date leaflet last updated: 06%2F04%2F2004