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In this weeks Examiner, in the first part of a two part article, Eamonn dispenses expert advice on the use of the sedative Midazolam, commonly prescribed for epileptics.

Posted by Eamonn Brady on


Buccal Midazolam Directions (Quick-Guide)

For Epileptic Seizures (Part 1)

Eamonn Brady is a pharmacist and the owner of Whelehans Pharmacies, Pearse St and Clonmore, Mullingar. If you have any health questions e-mail them to


What is midazolam?

Midazolam is a sedative belonging to a group of medicines called benzodiazepines. Midazolam can be used to treat a number of different conditions, including seizures. It is prescribed for some but not all epileptics (eg) if a person has a history of longer seizures (also known as fits). If a seizure lasts for more than five minutes, it may be difficult to stop unless treatment is given. It is therefore important that rapid treatment is given to stop the seizures and therefore prevent status epilepticus. Status epilepticus is a condition where a person has a seizure or a series of seizures that last for 30 minutes or more, without a complete recovery of consciousness.


How is buccal midazolam given?

The midazolam solution should be placed against the sides of the gums and cheek so that the medicine is absorbed directly into the bloodstream. This is known as the buccal or oromucosal route. Administer slowly. If the medicine is swallowed accidentally, it might not work as quickly. Nowadays, Buccal Midazolam is prescribed mainly in an easy to use pre-filled syringe eg. Epistatus® Pre-filled syringe or Buccolam® pre-filled syringe.


Using Buccolam® pre-filled oral syringes or Epistatus® pre-filled oral syringes

  • Check the dose and expiry date of the pre-filled syringe provided.
  • Remove the oral syringe from the packaging.
  • Place the syringe into the side of the person’s mouth, between the gums and teeth.
  • If possible, divide the dose so you give half into one cheek and the remaining half into the other cheek.
  • Slowly push the plunger of the syringe down until the syringe is empty.
  • Watch for any breathing difficulties.
  • Confirm that the seizure has stopped.


How long does it take to work?             

Buccal Midazolam takes a few minutes to work so the seizure is likely to continue for a few minutes after administering. Some of the midazolam may flow out of the side of the mouth (especially as the patient is undergoing seizures); however, once the majority stays in the mouth then the patient will get enough into the bloodstream to work.


Free Demonstration

If you would like pharmacist Eamonn Brady to give you a demonstration how to administer buccal midazolam, email Whelehans at to request. There is no charge for this demo. If you need a demo for a few people, Eamonn can call out to your place of work/ residence to give a demo at no charge.


To be continued: Next week I will discuss how to administer buccal midazolam or and how to store


Disclaimer: This is a general guide; individual patients will have more specific guidance depending on their type of epilepsy and seizure history. Always follow the prescribing doctor’s advice. If a person is prescribed Buccal Midazolam, it is good practice to have written administration instructions or protocol specific for that patient (eg) When to administer? Can a 2nd dose be administered? After how long?


For health advice and information call in to Whelehans Pharmacies, log on to or dial 04493 34591 (Pearse St) or 04493 10266 (Clonmore).


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