Buccal midazolam

Buccal Midazolam is the name of an emergency medication that can be used to stop seizures that last too long.

Buccal Midazolam can only be administered by people trained to do so. There are other emergency medications but these may need to be administered by a healthcare professional in hospital.

Emergency medicine is used to stop status epilepticus early on, before it can cause long-term damage. If the emergency medicine stops the status epilepticus, the person may not need to go to hospital.

What is buccal midazolam?

Buccal Midazolam – Buccal midazolam is one type of emergency medicine used to stop prolonged seizures.

Buccal – means the space between the gum and cheek where the medicine is administered.

Midazolam – is the name of the medicine.

Midazolam works by reducing electrical activity in the brain which can stop seizures.

Administering buccal midazolam

Buccal midazolam is most commonly prescribed to treat prolonged tonic-clonic seizures.

The NICE guideline for epilepsy sets out the below recommendations for the use of Buccal Midazolam:

  • Convulsive status epilepticus (seizures lasting 5 minutes or more)
  • Repeated/cluster seizures (usually 3 or more seizures which stop on their own in 24 hours)
  • Prolonged seizures (seizures lasting more than 2 minutes longer than a persons usual seizure)

For more information, please see: Nice Guidelines 7 Treating status epilepticus, repeated or cluster seizures, and prolonged seizures | Epilepsies in children, young people and adults | Guidance | NICE

Not everyone with epilepsy will be prescribed buccal midazolam as emergency medication for their seizures. If someone with epilepsy is known to be at increased risk of status epilepticus, their doctor may prescribe them buccal midazolam or another alternate emergency medication.

Buccal Midazolam can only be administered by designated carers and staff who have received training from an appropriate medical professional.

Best practice guidelines for buccal midazolam training

You can find the best practice guidelines for training professional carers in the administration of buccal midazolam here – ESNA-Midazolam-Guidelines.pdf (esna-online.org)

Care plans

The individual who has been prescribed buccal midazolam should also have been given a care plan completed by a member of their healthcare team.

This care plan will tell you which of their seizure types buccal midazolam is prescribed for and when to give it.

Download a care plan

Buccal midazolam care plan