What is the maximum dose of nayzilam per seizure event?

Recommended Nayzilam Dose Per Seizure Event

Nayzilam (midazolam) nasal spray treats seizure clusters in patients aged 12 and older. The maximum dose per seizure event is 10 mg (two 5 mg sprays), one in each nostril. This applies when the first 5 mg spray fails to stop the seizure after 10 minutes.[1][2]

How Dosing Works Step-by-Step

• First dose: 5 mg (one spray) into one nostril.
  
• Wait 10 minutes. If seizure continues, give second 5 mg spray into the opposite nostril (total 10 mg).
  
• Do not give more than two doses (10 mg total) per cluster. Wait at least 12 hours before starting another cluster treatment.[1][3]
  
  

What Counts as One Seizure Event (Cluster)?

A cluster is 2+ seizures within 60 minutes without return to full baseline. Nayzilam stops the acute cluster; it does not prevent future seizures.[1]

Limits on Daily or Weekly Use

Maximum of one 10 mg cluster dose per 12 hours. No more than 5 doses (one 10 mg cluster + one 5 mg single dose) per week. Exceeding this raises risks like respiratory depression.[1][2]

Why the 10 mg Cap?

Midazolam is a benzodiazepine that calms brain activity but can slow breathing at higher doses. The FDA-approved limit balances efficacy with safety, based on clinical trials showing 10 mg controls most clusters.[1][4]

Risks of Overdosing or Misuse

Symptoms include severe drowsiness, shallow breathing, or coma. Emergency care needed if breathing stops. Patients with liver issues or on opioids face higher risks—lower doses may apply.[1][3]

Dose Adjustments for Weight or Age

Full 5-10 mg for patients ≥40 kg (most adults/teens). Pediatric data limited to ≥12 years; underweight patients may need monitoring.[1]

Sources
[1]: Nayzilam Prescribing Information (FDA)
[2]: Epilepsy Foundation Nayzilam Guide
[3]: Drugs.com Nayzilam Dosing
[4]: NEJM Clinical Trial on Midazolam Nasal Spray