What Is Nayzilam?

Nayzilam is the brand name for Midazolam nasal spray, a rescue medication approved by the FDA to treat seizure clusters (also called acute repetitive seizures) in people with epilepsy who are 12 years of age and older. It was first approved in May 2019 and is manufactured by UCB Pharma.

Unlike daily seizure medications that you take to prevent seizures, Nayzilam is a rescue medication. That means you only use it when a seizure cluster is actually happening. Think of it like an EpiPen for allergic reactions — you keep it on hand and use it only when needed.

What Are Seizure Clusters?

Seizure clusters are episodes of frequent seizures that are different from a person's usual seizure pattern. For example, someone who normally has one seizure every few weeks might suddenly have several seizures within a few hours. These clusters can be frightening and potentially dangerous, which is why having a rescue medication available is so important.

Not everyone with epilepsy experiences seizure clusters, but for those who do, Nayzilam provides a way to treat the episode quickly — often administered by a caregiver at home, avoiding the need for an emergency room visit.

How Does Nayzilam Work?

Nayzilam contains Midazolam, which belongs to a class of drugs called benzodiazepines. It works by enhancing the activity of a brain chemical called GABA (gamma-aminobutyric acid), which calms overactive electrical signals in the brain that cause seizures. For a more detailed explanation, see our article on how Nayzilam works.

The nasal spray format allows the medication to be absorbed quickly through the lining of the nose, so it can start working fast — even when the person is having a seizure and can't swallow a pill.

How to Use Nayzilam

Nayzilam comes as a pre-filled, single-use nasal spray device. Each device delivers one 5 mg dose. Here's how to use it:

1. Remove the device from the packaging — don't test or prime it beforehand
2. Insert the tip into one nostril
3. Press the plunger firmly to spray the medication
4. Don't have the person blow their nose after the spray
5. If the seizure cluster continues after 10 minutes, give a second 5 mg dose in the opposite nostril

A caregiver can and often does administer Nayzilam, since the person having the seizure may not be able to use it themselves.

Dosage Guidelines

The dosing rules for Nayzilam are specific and important to follow:

• Starting dose: 5 mg (one spray into one nostril)
• Second dose: 5 mg in the opposite nostril if the seizure cluster continues after 10 minutes
• Maximum per episode: 2 doses (10 mg total)
• Maximum frequency: Do not treat more than 1 episode every 3 days
• Maximum per month: Do not treat more than 5 episodes per month

Using Nayzilam more frequently than recommended increases the risk of physical dependence and withdrawal, which is one of the medication's boxed warnings.

Who Should Not Use Nayzilam

Nayzilam should not be used by people who:

• Have a known allergy to Midazolam
• Have acute narrow-angle glaucoma

Additionally, Nayzilam should be used with extra caution in:

• Elderly patients (higher risk of breathing problems)
• People with COPD or other lung conditions
• People taking opioids or other CNS depressants
• Pregnant or breastfeeding women (discuss risks and benefits with your doctor)

For details on medications that may interact with Nayzilam, see our guide on Nayzilam drug interactions.

Important Safety Information

Nayzilam carries three boxed warnings from the FDA:

1. Opioid interaction risk — Using Nayzilam with opioids can cause profound sedation, respiratory depression, coma, and death
2. Abuse and addiction risk — Midazolam is a Schedule IV controlled substance with potential for misuse
3. Dependence and withdrawal — Using it more than recommended can cause physical dependence

For a complete breakdown of potential side effects, read our article on Nayzilam side effects.

Cost and Availability

Nayzilam is a brand-name medication with no generic available as of 2026. The cash price is approximately $884 for a pack of 2 nasal spray devices. With a coupon (such as through SingleCare), the price may be reduced to around $629.

UCB Pharma offers a Nayzilam Savings Card that may help eligible commercially insured patients pay as little as $0 per prescription. Patient assistance programs are also available for those who are uninsured or underinsured. Learn more in our guide on how to save money on Nayzilam.

Nayzilam has experienced intermittent supply issues because it's produced by a single manufacturer. If you're having trouble finding it, use MedFinder to check pharmacy availability, or read about the current shortage situation.

Nayzilam vs. Other Rescue Medications

Nayzilam isn't the only rescue medication for seizure clusters, but it has some advantages:

For a full comparison, see our article on alternatives to Nayzilam.

Key Takeaways

• Nayzilam is an FDA-approved nasal spray rescue medication for seizure clusters in patients 12 and older
• It's administered into the nose — often by a caregiver — and works quickly
• Dosing is limited: max 2 doses per episode, 1 episode every 3 days, 5 episodes per month
• It carries important safety warnings about opioid interactions, abuse potential, and dependence
• No generic is available; the cash price is around $884 but savings programs exist
• Use MedFinder to find Nayzilam in stock near you