If you or your child has seizure clusters, every minute can feel like forever. Rescue medications are made for these situations. They can help stop a seizure cluster before it becomes more serious, and newer nasal spray options are often much easier to give than older rescue treatments.

These nasal sprays are small enough to carry with you and simple enough for family members, teachers, or other caregivers to learn how to use. They aren’t meant to replace daily seizure medication, but they can be an important part of a seizure action plan.

Here’s what to know about nasal spray for seizures, including how these medications work, who they’re for, and what to expect if your neurologist prescribes one.

Which Nasal Sprays Are Approved for Seizures?

Currently, the U.S. Food and Drug Administration (FDA) has approved two nasal rescue medications for seizure clusters.

Diazepam Nasal Spray

Diazepam nasal spray, sold under the brand name Valtoco, is approved for the acute treatment of seizure clusters in adults and children ages 2 and older with epilepsy. Acute treatment means it’s used when a seizure cluster happens, rather than every day to prevent seizures. It’s a benzodiazepine, a class of medications that works by calming overactive electrical activity in the brain.

Midazolam Nasal Spray

Midazolam nasal spray, sold under the brand name Nayzilam, is another benzodiazepine. It’s approved to treat seizure clusters in people ages 12 and older.

Although they contain different active ingredients, both work in similar ways to stop seizure clusters.

Your neurologist will recommend the most appropriate option based on factors like age, medical history, other medications, insurance coverage, and personal preference.

How Do These Medications Work?

Both nasal sprays belong to a group of medications called benzodiazepines.

They increase the effects of a naturally calming brain chemical called gamma-aminobutyric acid (GABA). This chemical helps slow the unusual electrical activity causing the seizure cluster.

If you’ve used rescue medications like rectal diazepam or injectable midazolam before, the medication itself may be familiar. The main difference is how it’s given.

Instead of needing an injection or rectal medication, the medicine is given through the nose in just a few seconds.

Who Are Nasal Rescue Medications for?

Nasal rescue medications are typically prescribed for people who have predictable seizure clusters or acute repetitive seizures. Your neurologist may recommend one if you or your child:

• Has seizure clusters that are different from their typical seizures
• Needs a rescue medication that can be given quickly outside a hospital
• Would benefit from a treatment that’s easier for caregivers, teachers, or family members to give

These medications aren’t right for everyone. For example, they aren’t intended to treat every seizure someone has. They also may not be recommended for people with certain medical conditions or those taking medications that could increase the risk of extreme sleepiness (sedation) or breathing problems.

Your neurologist will review your medical history and other medications before prescribing a nasal rescue medication.

How Often Can You Use a Nasal Spray For Epilepsy?

These medications are designed for occasional rescue use, not regular treatment.

For example, diazepam nasal spray should not be used to treat more than one seizure cluster every five days or more than five seizure cluster episodes in one month. Midazolam nasal spray should not be used to treat more than one seizure cluster every three days or more than five seizure cluster episodes in one month.

Talk with your neurologist if you need rescue medication more often than expected. Frequent use doesn’t necessarily mean the medication isn’t working. Instead, it may mean your regular epilepsy treatment needs to be adjusted to better prevent seizure clusters.

Are They Easier To Use Than Older Rescue Medications?

For many families, yes. Before nasal sprays became available, rectal diazepam was one of the main rescue options used outside the hospital. Many people and caregivers prefer nasal sprays because they’re more discreet, easier to carry, and simpler to give in public places like school, work, or community settings.

That doesn’t mean one option is better for everyone. Some people continue to do well with older rescue medication, while others prefer nasal sprays because they’re easier to use and offer more privacy.

What Are the Possible Side Effects?

Like all medications, nasal rescue therapies can cause side effects. The most common include:

• Sleepiness or drowsiness
• Headache
• Nose discomfort or irritation
• A runny nose
• An unusual taste in the mouth

Because these medications are benzodiazepines, they can also slow breathing and cause significant sedation, especially if they’re taken with opioids, alcohol, or certain other medications.

Although uncommon, serious allergic reactions and other severe side effects can occur. Your neurologist will review what to watch for and when to call 911 after giving a rescue medication.

A Few Practical Tips

If you’re prescribed a nasal spray for epilepsy, a little preparation goes a long way:

• Read the instructions before you ever need to use it.
• Make sure family members, caregivers, teachers, or coaches know where it’s kept and how to use it.
• Check expiration dates regularly.
• Store it according to the manufacturer’s instructions, and avoid exposing it to extreme temperatures.
• Keep your seizure action plan with the medication whenever possible.

Be Prepared

For many people with epilepsy, nasal rescue medications have made treating seizure clusters faster, simpler, and less stressful than before. If you think you or your child could benefit from one, talk with your neurologist. Together, you can decide if you need a rescue nasal spray in your seizure action plan.

If you already have a rescue nasal spray, keep your neurologist updated on how often you’re using it. If seizure clusters are happening more often or you need rescue medication more often, talk with your neurologist about whether your treatment plan needs to change.

Join the Conversation

On MyEpilepsyTeam, people share their experiences with epilepsy, get advice, and find support from others who understand.

Have you ever used or given a nasal rescue medication? Let others know in the comments below.