What is Buccal Midazolam

Video 35 of 47
6 min 54 sec
Want to watch this video? Sign up for the course or enter your email below to watch one free video.

Unlock This Video Now for FREE

This video is normally available to paying customers.
You may unlock this video for FREE. Enter your email address for instant access AND to receive ongoing updates and special discounts related to this topic.

Administration and Uses of Buccal Midazolam

Introduction to Buccal Midazolam

Buccal midazolam is a short-acting benzodiazepine used to treat prolonged seizures and prevent progression to status epilepticus. It is an effective alternative to rectal diazepam.

Understanding Buccal Midazolam

Buccal midazolam is administered in the buccal cavity (inside the gum). This medication, despite being unlicensed for seizure cessation, is supported by the National Institute for Health and Care Excellence (NICE) guidelines from 2004.

Licensed vs. Unlicensed Medication

Licensed medication is manufactured for specific uses, while unlicensed medication is prescribed for off-label uses. In such cases, the prescribing doctor assumes responsibility for its use.

Special Requirements for Buccal Midazolam

Buccal midazolam does not require special storage but should be kept out of direct sunlight. Typically, it has a shelf life of 18 months, so always check the expiry date before use.

Administration of Buccal Midazolam

To administer buccal midazolam:

  1. Ensure the medication is within its expiry date.
  2. Check the patient's name and prescribed dose.
  3. Confirm the seal is intact.
  4. Lift the cheek away from the gum and insert the syringe into the buccal cavity.
  5. Gently squeeze the medication into the mucous membrane.

Document the administration, including the time and dosage, in the drug book.

Alternative Administration Methods

Buccal midazolam can also be administered through the nasal cavity if prescribed for emergencies, such as hypersalivation or facial injuries that prevent buccal administration.

Dosage and Side Effects

The typical dosage for buccal midazolam should not exceed 20 milligrams in 24 hours. Common side effects include:

  • Sedation
  • Drowsiness
  • Light-headedness
  • Decreased alertness
  • Unsteadiness

Less common side effects include:

  • Low blood pressure
  • Slow heart rate
  • Skin reactions
  • Visual disturbances
  • Headache
  • Confusion
  • Breathing difficulties

Central Nervous System Toxicity

Central Nervous System (CNS) toxicity is a risk, particularly for patients on antidepressants, antipsychotics, or lithium. Monitoring for side effects is crucial, especially after the initial administration.

Potential for Respiratory Depression

Excessive buccal midazolam can cause respiratory depression, although it is less likely compared to diazepam. Always refer to your workplace's drug book or the British National Formulary (BNF) for detailed information.

Training and Guidelines

Carers and relatives must receive proper training and follow prescribed protocols when administering buccal midazolam. General Practitioners (GPs) and specialists are willing to prescribe it, recognising its effectiveness despite its unlicensed status.


Buccal midazolam is a critical medication for managing seizures. Proper administration, adherence to guidelines, and awareness of side effects ensure its effective and safe use.