Buccal midazolam
This leaflet answers some common questions about your child's medicine. It does not contain all available information. It does not take the place of talking to your child's doctor or pharmacist. This information may be different from the information in the manufacturer's Consumer Information. The information in this leaflet reflects the usage of medicine under medical supervision by patients of The Royal Children's Hospital (RCH). Medicine may be used in children in different ways or for different reasons than in adults - for more information see the leaflet: Medicines for Children. Midazolam is a benzodiazepine medication like diazepam and clonazepam. Midazolam works more quickly than diazepam but does not last as long.
What is midazolam used for?
Midazolam is used for:
Emergency treatment of seizures
Sedation during medical procedures
Premedication prior to medical procedures
How is midazolam given for seizures?
Midazolam can be:
Trickled inside the cheek - buccal
Sprayed or dripped into the nose - intranasal injected into a vein or muscle - intravenous (IV) or intramuscular (IM)
Ambulance officers and emergency doctors give midazolam by injection into a muscle or vein.
Buccal midazolam is absorbed directly into the blood stram through the lining of the cheek.
Swallowing midazolam is not recommended as it is not absorbed well through the stomach.
The plastic ampoules are labelled 'for slow IV or IM injection' but can be used for buccal and intranasal use.

When is buccal midazolam used?
Buccal midazolam can be used for the emergency treatment of seizures. Buccal midazolam may be prescribed for a child with epilepsy who:
Has prolonged seizures
Has a pattern of seizures that recur close together
Lives a long way from emergency services.
Buccal midazolam is not necessary for all children with epilepsy. Your doctor will tell you whether your child might benefit from you being able to give buccal midazolam.
First aid
First aid for seizures is very important. It includes:
Preventing injury, for example, by moving things away from the child.
Keeping your child's airway open and clear by putting your child on their side in the coma position.
Timing how long the seizure lasts.
See: seizures-Safety issues and how to help. fact sheet
Unless your doctor gives you different instructions, call an ambulance before giving midazolam. Don't wait for the ambulance to arrive before giving the midazolam.
How to give buccal midazolam
Use only 1ml plastic ampoules containing 5mg of midazolam. Do not use midazolam in glass ampoules.
Each ampoule delivers approximately 18 drops (the volume can vary slightly from 16-20 drops, but this is OK).
Buccal midazolam can be given by either drops squeezed directly from the ampoule (AMPOULE METHOD) or from drops trickled from a syringe with midazolam drawn up (SYRINGE METHOD)

AMPOULE METHOD 1: Open the plastic ampoule of midazolam by twisting off the top.

2: Drip onto a tissue the drops that you do NOT need. For example, if your doctor prescribes half the contents of one ampoule (2.5 mg), first drip out 9 drops so that 9 drops remain in the ampoule to give to your child. If by accident you drip out 8 or 10 drops, just give the remainder as it is still a safe dose.

3: Lay your child on their side in the first aid (coma) position. Open their lips and squeeze the remaining midazolam from the ampoule into the inside of the lower cheek (closest to the ground), between the lips and side teeth. There is no need to open your child's jaw. The solution does not need to be swallowed. Give three squeezes of the ampoule to make sure it has all been given. Remove the ampoule to check that all of the solution has been squeezed out. If any remains, reinsert the ampoule and give three more squeezes.

4: Watch your child's breathing and seizure activity while they remain lying on their side in the first aid (coma) position. 5: Write down the time that the seizure started, when