Routes and Considerations for Administering Rectal Diazepam and Buccal Midazolam

Routes for Delivery

• Rectal Diazepam: Administered into the rectal mucosa through the anal opening.
• Buccal Midazolam: Administered into the space between a person's gum and cheek.

Issues to Consider

• Rectal Diazepam has been commonly used as an emergency treatment since 1917.
• Maintaining the person’s privacy and dignity during administration is crucial.
• Consider safety and manual handling issues.
• One version of Buccal Midazolam is licensed for children; others are available for all ages but are currently unlicensed.
• The licensing situation for Buccal Midazolam may change in the future.

Legal Considerations

• Midazolam Maleate is an unlicensed medication under the UK Medicines Act and EU Pharmaceutical Directive.
• Buccal Midazolam is a controlled medication and is prescription only.

Versions of Buccal Midazolam

• Midazolam is the generic name of the active ingredient.
• Brand names identify different versions.
• The strength of the active ingredient may vary between versions.
• It is recommended to stick to the same version for consistency.

When to Administer Buccal Midazolam

• Administer as advised in the individual’s care plan, prescribed by the GP and regularly reviewed.
• When one tonic-clonic seizure immediately follows another with no recovery in between.
• If a seizure lasts 5 minutes.
• If seizures are known to always last longer than 5 minutes, the prescribing practitioner may advise immediate administration.
• Three tonic-clonic seizures within one hour.
• When a tonic-clonic seizure lasts 2 minutes longer than usual for the individual.

Benefits of Use

• The priority is to stop prolonged seizure activity.
• The longer a seizure continues, the more difficult it is to control and potentially more damaging.
• Administration of these medications is relatively simple and minimally disruptive, reducing the need for hospital visits.

Onset of Action

• These drugs typically start working within 5 to 10 minutes (or as stated in the care plan).
• The seizure may not be completely stopped but should begin to be controlled.

Care Plan Advice

Each individual should have detailed advice in their care plan regarding actions to be taken if the initial dose does not control the seizure, including when and what further actions should be taken.