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Seizure treatment in children: can intranasal midazolam be used without an atomizer?

Karini Da Rosa1, Cassiano Mateus Forcelini2, Débora Miotto Lorenzetti2

  • 1Postgraduate Studies in Human Aging, Universidade de Passo Fundo, Passo Fundo, RS, Brazil.

Einstein (Sao Paulo, Brazil)
|September 17, 2025
PubMed

Insights

Intranasal midazolam for pediatric seizures showed similar plasma levels whether administered via syringe or atomizer. This validates the common Brazilian practice of using syringes for rapid nasal delivery in emergencies.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Pharmacology
  • Neurology

Background:

  • Convulsive status epilepticus is a common pediatric neurological emergency with significant morbidity and mortality.
  • Intranasal midazolam is the preferred treatment, typically administered via atomizer.
  • Brazilian pediatric emergency settings often utilize rapid intranasal midazolam instillation with syringes.

Purpose of the Study:

  • To compare plasma midazolam levels in children treated with intranasal midazolam via atomizer versus syringe.
  • To validate the efficacy of syringe-only intranasal midazolam administration in pediatric emergencies.

Main Methods:

  • An exploratory cross-sectional study conducted in a Brazilian hospital emergency department.
  • Thirteen children with tonic-clonic status epilepticus received intranasal midazolam via atomizer or syringe at similar dosages.
  • Peak plasma midazolam concentrations were measured approximately 10 minutes post-administration and compared between groups.

Main Results:

  • No significant difference in peak plasma midazolam concentrations was observed between the syringe and atomizer groups (148.8 ng/mL vs. 133.3 ng/mL).
  • Similar time from administration to sampling and weight-adjusted doses were noted between the groups.
  • The study supports the equivalence of midazolam absorption regardless of intranasal delivery device.

Conclusions:

  • The study validates the common Brazilian practice of using syringes for rapid intranasal midazolam delivery in pediatric emergencies.
  • Intranasal midazolam administration via syringe is as effective as using an atomizer in achieving comparable plasma concentrations.
  • Further research is recommended to investigate the clinical outcomes associated with syringe-based intranasal midazolam administration.
Abstract

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