Treatment of Prolonged Seizures with Buccal Lorazepam or Midazolam

This handout tells you how to treat prolonged seizures using medicine given between the gums and the cheek (buccal medicine).

Prolonged tonic-clonic seizures or clusters of shorter seizures left untreated can sometimes lead to status epilepticus. Status epilepticus is a seizure that lasts for 30 minutes or longer. Treatment within 3-5 minutes can stop this from happening. You may prevent a trip to the emergency room if you treat seizures early. 

Lorazepam and midazolam are easy, safe and effective buccal medicines. Side effects are not common but can include:

• Feeling tired for 1-2 hours

• Feeling agitated or restless 

• Shallow breathing 

Overdose can cause breathing to stop, so never give more than the prescribed dose.

The dose below of lorazepam or midazolam, 2mg/ml oral syrup, has been prescribed by your doctor:

Lorazepam_________________________

Midazolam_________________________ 

If a seizure is longer than 5 minutes after you have given this medicine, call 911.

If a prolonged seizure or clusters of seizures happen again the same day, you can give lorazepam or midazolam again one hour after the first dose.

Check the Expiration Date 

Lorazepam is good for 90 days after the bottle is opened. It needs to be kept in the fridge. 

Midazolam can be stored at room temperature. Midazolam syrup does not expire after it is opened. We still suggest you replace the bottle at least once a year. 

Directions 

1. Open the medicine bottle and insert a new sterile 1mL or 3mL syringe to draw up the correct amount of medicine. You do not need needles.

   

2. If the person is in a chair and has no head support, support the head by standing behind him and holding his chin. Be careful not to press on the throat.

   

3. If the person is lying on the floor or is in a chair with a head support in place, hold the chin to keep the head steady and turn the head to one side.

   

4. Open the mouth gently by holding the chin, apply downward pressure on the lower lip and wipe away any excess saliva. Do not try to part the teeth.

   

5. Place the syringe between the lower gum and the cheek on one side of the mouth. Slowly give half the amount of medicine into the mouth. Remove the syringe. Close the lips together and rub the cheek on the outside. Repeat this on the other side of the mouth to give the rest of the medicine.

   

6. Do not give the medicine too quickly, as this may cause the person to choke or swallow it. If a small amount is swallowed, it is not a problem.

   

7. Place the person on his side. Watch for an ongoing seizure and signs of breathing problems.

   

When to Call 911

• No air movement at mouth or nose

• Gasping

• Blue color of the lips/face

If breathing stops, give rescue breaths until help arrives.