Seizure disorders:

Indications for: NAYZILAM

Acute treatment of intermittent, stereotypic episodes of frequent seizure activity (eg, seizure clusters, acute repetitive seizures) that are distinct from a patient’s usual seizure pattern in those with epilepsy.

Adult Dosage:

Give as single spray into one nostril; if no response after 10mins, may give additional spray into opposite nostril; max 2 sprays/episode. Max treatment: one episode every 3 days or 5 episodes/month.

Children Dosage:

<12yrs: not established.

NAYZILAM Contraindications:

Acute narrow-angle glaucoma.

Boxed Warning:

Risks from concomitant use with opioids. Abuse, misuse, and addiction. Dependence and withdrawal reactions.

NAYZILAM Warnings/Precautions:

Increased risk of drug-related mortality from concomitant use with opioids. Decreased pulmonary reserve. COPD. Monitor for the emergence or worsening of depression, suicidal thoughts/behavior, and/or unusual changes in mood or behavior. Open-angle glaucoma. Impaired cognitive function. Obesity. CHF. Assess patient's risk for abuse, misuse, addiction prior to and during therapy. Avoid abrupt cessation. Withdraw gradually. Drug or alcohol abusers. Hepatic or moderate to severe renal impairment. Elderly. Debilitated. Neonatal sedation and withdrawal syndrome; monitor neonates exposed during pregnancy or labor. Pregnancy (esp. late stage). Nursing mothers: monitor infants.

NAYZILAM Classification:


NAYZILAM Interactions:

Increased risk of profound sedation, respiratory depression, coma, and death with opioids or other CNS depressants (eg, other benzodiazepines, sedatives/hypnotics, anxiolytics, tranquilizers, muscle relaxants, general anesthetics, antipsychotics, alcohol); reserve concomitant use in those for whom alternative options are inadequate; limit dosages/durations to minimum required; monitor. Avoid concomitant with moderate/strong CYP3A4 inhibitors (eg, erythromycin, diltiazem, verapamil, ketoconazole, itraconazole, clarithromycin). Caution with concomitant mild CYP3A inhibitors.

Adverse Reactions:

Somnolence, headache, nasal discomfort, throat irritation, rhinorrhea; severe cardiorespiratory reactions, agitation, involuntary movements (including tonic/clonic movements and muscle tremor), hyperactivity, combativeness; withdrawal reactions.


Hepatic (CYP3A4).

Drug Elimination:

Renal. Half-life: 2.1–6.2 hours (midazolam); and 2.7–7.2 hours (1-hydroxy midazolam).

Generic Drug Availability:


How Supplied:

Single-dose nasal spray—2 units