Intranasal midazolam for prolonged convulsive seizures

Kutlu, Nurettin Onur; Yakıncı, Cengiz; Doğrul, Mehmet; Durmaz, Yaşar

doi:10.1016/s0387-7604(00)00155-8

Cited by 36 publications

(19 citation statements)

References 12 publications

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“…Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

Section: Discussionmentioning

confidence: 99%

“…Rectal diazepam emerged as the primary treatment option for breakthrough seizures in the past. However rectal diazepam has slower onset of action than the intravenously delivered drug and is not as effective at controlling seizures (10).Other disadvantages include low social acceptability and high cost of the commercial preparation [10][11][12].Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

mentioning

confidence: 99%

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Buccal Clonazepam versus Intravenous (I/V) Midazolam for Management of Acute Breakthrough Seizure –A Randomized Controlled Trial

Kumar¹

2016

JPNC

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Objectives: To compare efficacy and safety of buccal Clonazepam with I/V Midazolam in acute seizure therapy. Methods:A prospective, open label randomized controlled trial done on children with acute breakthrough seizure in known epileptics .200 breakthrough episodes were randomized to inject able midazolam (0.2mg/kg) or buccal clonazepam (0.01mg/kg) given on even days (IV Midazolam) and odd days (buccal Clonazepam).Results: Ninety two (92.0%) seizures were controlled IV Midazolam and eighty six (86.0%) in buccal Clonazepam group. No statistical significant (p=0.175) was observed .Recurrence after initial control was 8.0% in IV Midazolam and 9.0% in buccal Clonazepam group with no statistical significant (p=0.800) .Vital monitoring parameters maintained in both groups .16.0% revealed adverse reactions 10 min post drug administration, 4.0% in the midazolam, and 12.0% in clonazepam group (p value=0.119). Adverse effects required no intervention. Conclusions MonitoringPatients were monitored for vital parameters including heart rate, respiratory rate, blood pressure, saturation for ten minutes. The side effects of each drug were compared in different age groups with different semiology and etiology of seizures. We used Clonazepam (0.25/0.50/1.00mg) mouth dissolving dispersible clonazepam tablets. Statistical AnalysisData was recorded on a predesigned proforma and it was managed on a Microsoft Excel spread sheet. Statistical analysis was performed using software between the 2 groups: IV Midazolam and Buccal clonazepam. Categorical variables were summarized by frequency .Proportions were compared by chi-square test or Fisher's exact test (where expected frequency <5). Continuous variables having a normal distribution were summarized by mean and standard deviation; for others median was used .for continuous variables, student's 't' test , Mann Whitney U test or Wilcoxon signed rank sum test were applied as appropriate .P value of <0.05 was taken as significant . ResultsThe baseline characteristics of two drug groups with respect to age, sex, etiology of seizures, types of seizure, duration of seizure,EEG,neuroimaging were statistically comparable (

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“…Intranasal (I/N) midazolam was safe and effective in numerous clinical trials [13][14][15][16][17][18][19]. On I/N route drug is directly absorbed into the blood and CSF via nasal mucosa.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Buccal Clonazepam versus Intravenous (I/V) Midazolam for Management of Acute Breakthrough Seizure –A Randomized Controlled Trial

Kumar¹

2016

JPNC

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“…Prospective and retrospective evidence shows that intranasal midazolam terminates seizures at least as fast as rectal diazepam. 1,5,8,[12][13][14][15] Most clinical studies have used a 5 mg/mL midazolam solution dosed at 0.2 mg/ kg (divided into each nostril) administered via an intranasal mucosal atomization (IN-MADD) device or nasal dropper as suggested by Kyrkou and colleagues. 16 Three open-labeled studies prospectively evaluated the time to seizure cessation with a dose of nasal midazolam (Table).…”

Section: Time To Seizure Cessationmentioning

confidence: 99%

“…16 Three open-labeled studies prospectively evaluated the time to seizure cessation with a dose of nasal midazolam (Table). 5,14,15 Lahat and colleagues 5 assessed intranasal midazolam in the treatment of acute childhood seizures in the emergency department (ED). Children experiencing a generalized seizure lasting longer than 10 Of the 20 children participating in the study, intranasal midazolam successfully treated all but 1 patient, whose seizure was also refractory to diazepam and required phenytoin for seizure cessation.…”

Section: Time To Seizure Cessationmentioning

confidence: 99%

Treatment of Acute Seizures: Is Intranasal Midazolam a Viable Option?

Humphries

Eiland

2013

The Journal of Pediatric Pharmacology and Therapeutics

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Seizures in the pediatric population commonly occur, and when proper rescue medication is not administered quickly, the risk of neurologic compromise emerges. For many years, rectal diazepam has been the standard of care, but recent interest in a more cost-effective, safe alternative has led to the investigation of intranasal midazolam for this indication. Although midazolam and diazepam are both members of the benzodiazepine class, the kinetic properties of these 2 anticonvulsants vary. This paper will review available data pertaining to the efficacy, safety, cost, and pharmacokinetics of intranasal midazolam versus rectal diazepam as treatment for acute seizures for children in the prehospital, home, and emergency department settings.

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“…La voie intranasale est utilisée depuis plusieurs années pour le midazolam, en prémédication, dans le traitement de la crise comitiale, de l'agitation mais également dans les traitements palliatifs [33,[40][41][42]. Utilisée aussi bien chez l'enfant que chez l'adulte, cette voie d'abord a l'avantage d'être peu traumatisante et facile de réalisation [40,42].…”

Section: La Voie Intranasaleunclassified