Route of delivery

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Route for Delivery

•      Rectal Diazepam – ‘Rectal’ means to administered the drug into the rectal mucosa through the anal opening

•      Buccal Midazolam – ‘Buccal’ means a route to administer the drug into the space between a persons gum and cheek.

Issues to consider…

•      Rectal Diazepam commonly used as an emergency treatment since 1917

•      There will be issues related to maintaining the person’s privacy and dignity while administering medication

•      There may also be 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 may change in the future

Issues to Consider…

•      Midazolam Maleate is an ‘Unlicensed Medication’ within 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 the different versions

•      The amount of active ingredients (the strength) may differ from one version to another

•      It is recommended that an individual sticks to the same version.

When to Administer Buccal Midazolam

•      In the workplace – you should only give the medication as advised in the person’s individual care plan when medication is prescribed by the GP and reviewed on a regular basis

•      One Tonic clonic seizure immediately follows another with no recovery in between

•      When the seizure lasts 5 minutes

•      If the seizure is known to always last longer than 5 minutes the prescribing practitioner may have agreed to administer the drug immediately as the seizure occurs

•      Three tonic-clonic seizures in one hour

•      The tonic-clonic seizure has lasted 2 minutes longer than what is usual for the individual.

Benefits of Use

•      The priority for use of ‘emergency medications’  is to stop prolonged seizures activity

•      It is known the longer a seizure continues, the more difficult it will be to control and potentially there could be damage

•      The administration of these medications is relatively simple, causing little disruption to the person’s daily life, reducing the need to attend hospital.

Onset of action

•      These drugs should start to work within 5 to 10 minutes (or stated in care plan)

•      The seizure may not be completely stopped but should begin to be controlled

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