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What midazolam looks like

Midazolam in a plastic ampoule

A photo of a plastic ampoule of midazolam.

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

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.

 

Equipment needed for giving midazolam

Syringe for giving buccal midazolam with

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

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. 

nasal atomiser device for giving intranasal midazolam

A photo of an atomiser device that attaches to the 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.

 

How to 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.  

Midazolam box, foil packet and ampoule

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

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.

 

Midazolam 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 to 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.

Hands drawing up midazolam

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 to give the midazolam to your 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. 

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. 

Child having a seizure receiving buccal midazolam

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.

Emergency Plan For Giving Buccal Midazolam For A Seizure

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.

Child having a seizure recieving intranasal midazolam

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. 

Emergency Plan For Giving Intranasal Midazolam For A Seizure

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

What to do after giving your child midazolam

After you have given midazolam:

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

Call 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

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

A text infographic from KidsHealth showing step-by-step seizure management in children with instructions for administering midazolam buccally.
A flowchart infographic from KidsHealth showing step-by-step seizure management in children with instructions for administering midazolam buccally.

 

 

Acknowledgements

Illustrations by Dr Greta File. Property of KidsHealth. 

The content on this page has been developed and approved by the Paediatric Neurology Clinical Network, Paediatric Society New Zealand. 

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