Alternatives to Nayzilam for Seizure Clusters

If you've been prescribed Nayzilam (Midazolam nasal spray) for seizure clusters but can't fill your prescription, you're probably feeling anxious — and understandably so. Having a reliable rescue medication is critical for people with epilepsy. The good news is that there are alternative medications your doctor may consider.

Before making any changes, always talk to your healthcare provider. This guide is meant to help you have an informed conversation with your doctor, not to replace medical advice. If you're looking for Nayzilam specifically, check out our guide on how to find Nayzilam in stock near you.

Why Might You Need an Alternative?

There are several reasons you might need to explore alternatives to Nayzilam:

• Supply issues: Nayzilam has experienced intermittent shortages because it has a single manufacturer and no generic version.
• Insurance coverage: Your plan may not cover Nayzilam or may require step therapy with other medications first.
• Cost: Without insurance, Nayzilam costs around $884 per prescription. Even with coupons, it remains expensive. See our guide to saving money on Nayzilam.
• Side effects: Some patients may not tolerate Nayzilam well. Read more about Nayzilam side effects.

Alternative #1: Valtoco (Diazepam Nasal Spray)

Valtoco is the most direct alternative to Nayzilam. Like Nayzilam, it's a benzodiazepine nasal spray approved for the acute treatment of seizure clusters in patients 6 years and older.

Key facts about Valtoco:

• Contains Diazepam (a different benzodiazepine than Midazolam)
• Available in multiple doses: 5 mg, 7.5 mg, 10 mg, 15 mg, and 20 mg
• Also administered intranasally
• FDA approved for ages 6 and older (Nayzilam is approved for 12+)
• Schedule IV controlled substance

Many patients and caregivers find Valtoco to be a comparable option since it offers the same convenient nasal spray delivery as Nayzilam.

Alternative #2: Diastat (Diazepam Rectal Gel)

Diastat has been used for decades as a rescue medication for seizure clusters. It contains Diazepam in a rectal gel form.

Key facts about Diastat:

• Available in multiple doses (2.5 mg, 10 mg, 20 mg)
• Long track record of safety and effectiveness
• Available as a generic, which can be more affordable
• The rectal route of administration is less convenient and can be uncomfortable or embarrassing, especially for teens and adults

While Diastat is effective, many patients prefer nasal sprays like Nayzilam or Valtoco because of the easier, more discreet route of administration.

Alternative #3: Lorazepam (Oral or Injectable)

Lorazepam is a benzodiazepine that's widely available and affordable. While it's not FDA-approved specifically for seizure clusters in an outpatient nasal spray form, some doctors prescribe oral Lorazepam as a rescue option.

Key considerations:

• Oral forms take longer to work than nasal sprays
• May be difficult to administer if the patient is actively seizing
• Very affordable and widely available as a generic
• Sometimes used as an interim solution while waiting for Nayzilam

Alternative #4: Clonazepam (Oral)

Clonazepam is another benzodiazepine sometimes used as an adjunctive treatment for epilepsy. It's taken orally and is available as an inexpensive generic.

Key considerations:

• Not specifically designed as a rescue medication for acute seizure clusters
• Slower onset of action compared to nasal sprays
• May be useful as part of an overall seizure management plan
• Very affordable

How to Choose the Right Alternative

The best alternative for you depends on several factors:

• Speed of action: Nasal sprays (Valtoco) work faster than oral medications
• Ease of use: Can a caregiver easily administer it during a seizure?
• Age: Valtoco is approved for younger patients (6+) than Nayzilam (12+)
• Cost and insurance: Generic options like Diastat or Lorazepam may be more affordable
• Availability: Some alternatives may be easier to find in stock

Your neurologist or epileptologist will consider your seizure type, overall medication regimen, and medical history when recommending an alternative.

Don't Go Without a Rescue Medication

The most important thing is to never be without a seizure rescue medication. If you can't find Nayzilam, work with your doctor immediately to identify an alternative. Seizure clusters can be dangerous, and having some form of rescue therapy is far better than having none.

Use MedFinder to search for Nayzilam or alternative medications at pharmacies near you. And check our complete guide to Nayzilam for more information about this important medication.