Comprehensive medication guide to Midazolam including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
Generic injectable midazolam is typically billed through the medical benefit as part of a hospital or procedure claim. Nayzilam nasal spray is covered under the pharmacy benefit, usually at Tier 3–4 specialty tier with prior authorization; copays vary widely by plan and may be reduced significantly with the UCB Nayzilam Patient Savings Card.
Estimated Cash Pricing
$9–$165 for generic injectable and oral syrup formulations at retail; Nayzilam nasal spray runs approximately $640–$800 retail (with GoodRx from ~$640 for a 2-spray unit). Generic injectable vials as low as $3–$15 with discount cards.
Medfinder Findability Score
62/100
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Midazolam is a short-acting benzodiazepine medication that calms the central nervous system. First FDA-approved in 1985, it is on the World Health Organization's List of Essential Medicines and is one of the most widely used sedatives in healthcare. The original brand name Versed has been discontinued, but generic forms remain widely available in injectable and oral formulations. Active brand names include Nayzilam (midazolam nasal spray for seizure clusters) and Seizalam (IM injection for status epilepticus).
Midazolam is primarily used in clinical settings — operating rooms, ICUs, emergency departments, and dental offices. The Nayzilam nasal spray is an important exception, as it is prescribed for at-home use by epilepsy patients as an emergency rescue medication to stop seizure clusters. The oral syrup formulation is used to help children relax before procedures and may be dispensed at retail pharmacies.
Midazolam is a DEA Schedule IV controlled substance, reflecting its potential for abuse and dependence. It requires a valid prescription from a licensed prescriber with DEA registration.
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Midazolam works by enhancing the activity of GABA (gamma-aminobutyric acid), the brain's primary inhibitory neurotransmitter. It binds to the benzodiazepine site on GABA-A receptors throughout the central nervous system, increasing the frequency of chloride ion channel opening in response to GABA. This hyperpolarizes neurons and reduces their ability to fire, producing sedation, anxiolysis (anxiety relief), and anterograde amnesia (temporary inability to form new memories).
Midazolam has a unique chemical property: it is water-soluble at the acidic pH of its formulation (making it easy to inject), but becomes lipophilic (fat-soluble) at physiologic body pH. This allows it to rapidly cross the blood-brain barrier, explaining its fast onset — as little as 1–3 minutes via IV. It is metabolized primarily by the CYP3A4 liver enzyme, with an elimination half-life of approximately 1.8–6.4 hours (mean ~3 hours), making it one of the shortest-acting benzodiazepines.
For seizure rescue, midazolam's GABA enhancement dampens the abnormal, synchronous neuronal firing that characterizes a seizure. Its rapid action and flexible administration routes (intranasal, intramuscular, IV) make it ideal for emergency seizure treatment, particularly when IV access is unavailable.
1 mg/mL — injectable solution
IV or IM use; 50 mL vials; used for procedural sedation and ICU infusions
5 mg/mL — injectable solution
IV or IM use; 2 mL, 5 mL, 10 mL, and 20 mL vials; used for anesthesia induction and procedural sedation
2 mg/mL — oral syrup
Approximately 118 mL bottle; used for pediatric pre-procedure sedation (0.25–0.5 mg/kg dose)
5 mg/0.1 mL — nasal spray (Nayzilam)
Unit-dose intranasal device; 5 mg per spray; 1–2 sprays per seizure episode; for epilepsy rescue in patients 12+
50 mg/10 mL (5 mg/mL) — IM injection (Seizalam)
Prefilled syringe for intramuscular injection; used by paramedics/EMS for status epilepticus
Midazolam availability varies significantly by formulation. Generic injectable midazolam (1 mg/mL and 5 mg/mL vials) is primarily distributed through hospital and healthcare supply chains and is not regularly stocked at most retail pharmacies. As of early 2026, midazolam is not on the FDA's active shortage list, but localized supply gaps remain a real challenge — particularly for Nayzilam nasal spray and the oral syrup.
Nayzilam (midazolam nasal spray) is a specialty product manufactured only by UCB. It is not regularly stocked at most retail pharmacy chains, including CVS and Walgreens. Patients are typically best served by specialty pharmacies. The midazolam oral syrup is also niche and may require ordering at retail pharmacies or filling at a compounding pharmacy if unavailable.
If you are having trouble finding midazolam or Nayzilam at a pharmacy near you, medfinder calls pharmacies in your area to find which ones can fill your specific prescription — delivering results to your phone by text.
As a DEA Schedule IV controlled substance, midazolam can be prescribed by any licensed prescriber with an active DEA registration number. However, the clinical context determines which specialists most commonly prescribe each formulation. For seizure rescue therapy (Nayzilam), the prescribing provider is almost always a neurologist or epileptologist. For procedural and ICU uses, midazolam is administered by clinical staff in monitored settings and is not typically dispensed at retail pharmacies.
Neurologists and Epileptologists: Primary prescribers of Nayzilam for epilepsy rescue; epileptologists at comprehensive epilepsy centers for complex cases
Anesthesiologists: Use injectable midazolam for anesthesia induction and procedural sedation
Emergency Medicine Physicians: Administer midazolam for status epilepticus and procedural sedation in the ED
Intensivists (ICU Physicians): Prescribe midazolam continuous infusions for mechanically ventilated patients
Dentists and Oral Surgeons: Use midazolam for conscious sedation during dental procedures (with appropriate state sedation permit)
Nurse Practitioners (NPs) and Physician Assistants (PAs): Can prescribe Schedule IV medications in most states with DEA registration; NPs in neurology practices frequently manage Nayzilam prescriptions
Telehealth availability for Nayzilam prescribing is limited but growing. Some neurology practices offer telemedicine follow-up visits where Nayzilam can be renewed for established epilepsy patients in states that allow controlled substance prescribing via telehealth. Initial evaluation for epilepsy typically requires an in-person visit.
Yes. Midazolam is a DEA Schedule IV controlled substance. This classification reflects that the drug has accepted medical use but carries a potential for abuse, misuse, and dependence. Schedule IV is one of the lower-risk controlled substance categories — below Schedule I (no medical use), II (high abuse potential), and III (moderate-high abuse potential) — but it still requires strict prescribing and dispensing controls.
Practical implications of Schedule IV status include: requiring a valid prescription from a DEA-registered prescriber; pharmacies must maintain special dispensing records; prescriptions for Schedule IV drugs generally allow up to 5 refills within 6 months (rules vary by state); some states have stricter requirements. Pharmacies typically maintain limited controlled substance inventory, which can contribute to access challenges for specific midazolam formulations.
For Nayzilam (midazolam nasal spray), keep the medication in a secure location to prevent misuse. Do not share it with others — sharing a controlled substance is illegal and dangerous.
Drowsiness and sedation (expected effect)
Anterograde amnesia (temporary memory loss for events after administration)
Dizziness and coordination difficulties
Nausea and vomiting
Headache
Nasal irritation, throat irritation, runny nose (Nayzilam nasal spray)
Pain or redness at the injection site (injectable forms)
Hiccups (injectable forms)
Respiratory depression: Slow, shallow, or stopped breathing — call 911 immediately (BLACK BOX WARNING)
Paradoxical reactions: Agitation, involuntary movements, combativeness instead of sedation
Severe hypotension: Dangerous drop in blood pressure
Allergic reactions: Hives, swelling, difficulty breathing
Cardiac arrest (rare; primarily with rapid IV administration in vulnerable patients)
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Lorazepam (Ativan)
Longer-acting benzodiazepine; preferred for ICU sedation and hospital treatment of status epilepticus when IV access is available
Valtoco (Diazepam Nasal Spray)
Direct alternative to Nayzilam for outpatient seizure rescue; FDA-approved for ages 2+; available in 5 mg, 7.5 mg, 10 mg weight-based doses
Diastat (Rectal Diazepam)
Alternative seizure rescue for ages 2+; less convenient but widely available; approved for the same cluster seizure indication
Propofol
Non-benzodiazepine IV sedative; preferred for procedural sedation and ICU use when faster weaning and extubation are priorities; not a controlled substance
Dexmedetomidine (Precedex)
Alpha-2 agonist sedative used in ICU; produces less respiratory depression than midazolam; increasingly preferred in current ICU protocols
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Opioids (fentanyl, morphine, oxycodone)
majorBoxed warning: profound sedation, respiratory depression, coma, and death. Avoid concurrent use outside of monitored clinical settings.
Other benzodiazepines
majorAdditive CNS and respiratory depression; use only under close medical supervision.
Alcohol
majorSignificantly enhances sedative effects; do not consume alcohol around time of midazolam administration.
Ketoconazole and azole antifungals
majorCYP3A4 inhibitors; increase midazolam blood levels significantly, prolonging and intensifying sedation.
Rifampin
majorCYP3A4 inducer; dramatically reduces midazolam blood levels, potentially rendering it ineffective.
Carbamazepine, phenytoin, phenobarbital
moderateCYP3A4 inducers; reduce midazolam efficacy; important for epilepsy patients on multiple antiepileptic drugs.
Grapefruit juice
moderateInhibits intestinal CYP3A4; increases absorption of oral midazolam; avoid with oral forms.
St. John's Wort
moderatePotent natural CYP3A4 inducer; may significantly reduce midazolam blood levels.
Midazolam is a cornerstone medication in modern medicine — used daily in operating rooms, ICUs, emergency departments, and in the hands of epilepsy patients and caregivers around the world. Its rapid onset, short duration, and flexible administration routes make it uniquely versatile. For epilepsy patients relying on Nayzilam as their seizure rescue medication, access to this drug can be a matter of life and death.
If you have trouble finding midazolam or Nayzilam at your local pharmacy, do not delay. Call multiple pharmacies, try independent and specialty pharmacies, contact UCB's patient support program at 1-888-786-5879, and always keep your prescriber informed so they can prescribe a backup if needed.
To quickly find pharmacies with midazolam in stock near you, use medfinder — we call pharmacies near you to find which ones can fill your prescription, and send you results by text. No hold music, no repeated phone calls.
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