Understanding Nayzilam Side Effects

Nayzilam (Midazolam nasal spray) is a rescue medication used to stop seizure clusters in people with epilepsy ages 12 and older. Like all medications, it comes with potential side effects. Because Nayzilam is used during an emergency — when someone is having a seizure cluster — it's important for both patients and caregivers to know what to expect and what's cause for concern.

If you're new to this medication, you may want to start with our overview of what Nayzilam is and how it works.

Common Side Effects

These side effects are the most frequently reported in clinical trials. They're generally mild and usually go away on their own:

• Drowsiness (somnolence) — This is the most common side effect. Nayzilam is a benzodiazepine, so sleepiness is expected. The person who received the medication should rest in a safe position.
• Headache — Some people experience a headache after the seizure episode and medication use.
• Nasal discomfort — Since the medication is sprayed into the nose, temporary burning, stinging, or irritation in the nasal passages is common.
• Throat irritation — Some of the spray may drain down the back of the throat, causing mild irritation.
• Runny nose (rhinorrhea) — The nasal spray can trigger a runny nose for a short time after use.

These side effects are generally not dangerous and should resolve within a few hours. However, the drowsiness from Nayzilam can last longer. The person should not drive, operate machinery, or do anything that requires full alertness until they feel completely recovered.

Serious Side Effects: When to Call 911

Nayzilam carries some serious risks, especially related to breathing. Call 911 immediately if you notice any of the following after giving Nayzilam:

• Respiratory depression — slow, shallow, or difficult breathing
• Airway obstruction — snoring, gurgling sounds, or signs the person's airway is blocked
• Oxygen desaturation or apnea — the person's lips or fingertips turn blue, or they stop breathing temporarily
• Excessive sedation — the person cannot be woken up or is much more sedated than expected
• Cardiac arrest — in rare cases, particularly in people with other health conditions

Certain people are at higher risk for these serious side effects, including:

• Elderly patients
• People with COPD or other lung conditions
• People taking opioid medications
• People taking other CNS depressants (alcohol, other benzodiazepines, barbiturates)

For a detailed look at medications that can interact with Nayzilam, see our guide on Nayzilam drug interactions.

Boxed Warnings

Nayzilam carries three FDA boxed warnings — the most serious type of safety alert. These are:

1. Risk with Opioids

Taking Nayzilam with opioid medications can cause profound sedation, respiratory depression, coma, and death. If the person also takes opioids, make sure the prescribing doctor knows. Close monitoring is essential.

2. Abuse, Misuse, and Addiction

Nayzilam contains Midazolam, a Schedule IV controlled substance. It has the potential for abuse and misuse. Follow your doctor's dosing instructions carefully — do not use it more often than prescribed.

3. Physical Dependence and Withdrawal

Using Nayzilam more frequently than recommended can lead to physical dependence. Stopping suddenly after frequent use may cause withdrawal symptoms. Stick to the prescribed dosing limits: no more than 2 doses per episode, no more than 1 episode every 3 days, and no more than 5 episodes per month.

What Caregivers Should Watch For

Since Nayzilam is often given by a caregiver during a seizure cluster, caregivers play a critical role in monitoring for side effects. After giving Nayzilam:

1. Keep the person on their side — This helps keep the airway clear
2. Watch their breathing closely — Count breaths per minute. Normal is 12–20 breaths per minute for adults
3. Stay with them — Don't leave the person alone until they're fully alert
4. Note the time — Track when you gave the dose and when the seizure stops
5. Call 911 if — Breathing becomes slow or stops, the seizure doesn't stop within 10 minutes of the second dose, or the person doesn't wake up

Side Effects vs. Post-Seizure Symptoms

It can be hard to tell the difference between Nayzilam side effects and normal post-seizure (postictal) symptoms. After a seizure cluster, people commonly experience:

• Confusion
• Fatigue and sleepiness
• Headache
• Muscle soreness

Nayzilam can add to the drowsiness and confusion that naturally follows a seizure. This overlap is expected. What you're watching for is excessive sedation or any breathing problems, which could signal a more serious reaction to the medication.

How to Reduce Side Effects

You can't eliminate side effects entirely, but these steps can help:

• Follow dosing instructions exactly — Don't give more than the prescribed amount
• Tell your doctor about all medications — Especially opioids, other benzodiazepines, and medications that interact with Nayzilam
• Don't blow the nose after administration — This can reduce the medication's effectiveness and may increase nasal irritation
• Store Nayzilam properly — Keep it at room temperature so the spray works correctly when needed

Talking to Your Doctor About Side Effects

If you or your caregiver notice concerning side effects after using Nayzilam, contact your neurologist. Things worth reporting include:

• Side effects that seem worse than expected
• Breathing problems of any kind
• Paradoxical reactions — instead of calming down, the person becomes more agitated or combative
• Suicidal thoughts or unusual mood changes

Your doctor may adjust your treatment plan, discuss alternative rescue medications, or provide additional guidance for caregivers.

Key Takeaways

• Common side effects include drowsiness, headache, and nasal discomfort — these usually resolve on their own
• Serious side effects involving breathing require immediate emergency care
• Caregivers should monitor breathing closely after giving Nayzilam
• Nayzilam carries boxed warnings about opioid interactions, abuse potential, and dependence
• Report any concerning side effects to your neurologist

For more information about Nayzilam, including how it works and its mechanism of action, visit our other guides. If you need help finding Nayzilam in stock, MedFinder can help you locate a pharmacy near you.