Intranasal Midazolam Comparable to IV, Rectal Diazepam in Pediatric Seizure Emergency

Intranasal (IN) midazolam was equally effective and showed comparable safety for the treatment of acute pediatric seizure emergencies as compared to intravenous (IV) or rectal diazepam, according to new systematic review presented at the 42nd Annual Child Neurology Society.

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The review included results of seven randomized, prospective, active-comparator controlled, efficacy studies of IN midazolam in the treatment of acute seizure emergencies in pediatric patients (n=200). Four studies  compared IN midazolam to IV diazepam and 3 studies compared IN midazolam to rectal diazepam.

All studies demonstrated IN midazolam (0.2mg/kg) to be as effective as IV or rectal diazepam (0.2–0.5mg/kg) in treating seizure emergencies with a rapid onset of action. The compared drugs had similar safety profiles, with few reports of respiratory depression across all treatments.

Midazolam and diazepam are both benzodiazepines and are considered effective rescue therapies for seizure emergencies.  Findings from this systematic review suggest that IN midazolam may be a more convenient and socially acceptable option for children.

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