How Quickly Does Nayzilam Stop Seizures?
Nayzilam, a nasal spray formulation of midazolam, works rapidly to stop seizures in patients with epilepsy. It begins acting within 10 minutes, with peak effects around 21 minutes and a median time to seizure stoppage of 1.3 minutes after administration in clinical trials.[1][2]
Patients or caregivers spray it into one nostril during a seizure cluster. If the seizure doesn't stop within 10 minutes, a second dose can be given in the other nostril.[1]
What Do Clinical Studies Show on Onset Time?
In the ARTEMIS1 pivotal trial (Phase 3), Nayzilam ended 53.4% of seizure clusters within 30 minutes, compared to 34.5% with placebo. Seizure termination occurred in 73.2% of episodes overall, typically fast—median 1.9 minutes post-dose for successful cases. No serious respiratory depression was reported.[2][3]
Real-world data aligns, with users reporting seizure cessation in under 5 minutes frequently, though individual response varies.[4]
How Does Nayzilam Compare to Other Rescue Treatments?
| Treatment | Form | Median Time to Seizure Stop | Key Notes |
|-----------|------|-----------------------------|-----------|
| Nayzilam (midazolam) | Nasal spray | 1.3–1.9 min | FDA-approved for clusters; no refrigeration needed.[1] |
| Diastat (diazepam) | Rectal gel | 2.5–5 min | Slower absorption; requires privacy.[5] |
| Valtoco (diazepam) | Nasal spray | ~2 min | Similar speed; competing benzodiazepine.[6] |
| Intramuscular midazolam | Injection | 3 min | Hospital use; not home-friendly.[7] |
Nayzilam edges out rectal options for convenience and speed in outpatient settings.[2]
What Factors Affect How Fast It Works?
Absorption is quickest on an empty stomach or upright position, but efficacy holds across scenarios. Body weight under 40kg may need dose adjustment. It targets GABA receptors to hyperpolarize neurons, halting seizure spread almost immediately once absorbed nasally.[1][8]
Avoid alcohol or opioids, as they amplify sedation risks.[1]
When Does Nayzilam Not Work or Cause Issues?
It fails in ~27% of clusters within 30 minutes, often needing rescue meds like IV benzodiazepines. Common side effects include sleepiness (23%), runny nose (10%), or upper airway issues (5%). Overdoses risk respiratory depression, treatable with flumazenil.[1][3]
Not for status epilepticus; call 911 if seizures persist >5 minutes post-second dose.[1]
Availability, Dosing, and Cost Details
Approved by FDA in 2019 for ages 12+ with seizure clusters (2+ seizures ≥30 min apart). Dosing: 5mg (yellow)/10mg (red) sprays; one per nostril max.[1]
No patents listed as expired on DrugPatentWatch.com; generics unlikely soon.[9] List price ~$700 per two-dose kit; copay cards cut to $25 for eligible patients.[10]
Sources:
[1]: Nayzilam Prescribing Information (UCB)
[2]: FDA Approval Summary
[3]: ARTEMIS1 Trial (Epilepsia, 2020)
[4]: Epilepsy Foundation Patient Reports
[5]: Diastat Data (AED Study Group)
[6]: Valtoco Label (Neurelis)
[7]: Midazolam IM Studies (NEJM)
[8]: Midazolam Pharmacokinetics (CNS Drugs)
[9]: DrugPatentWatch.com - Nayzilam
[10]: GoodRx Pricing