Treatment of Prolonged Seizures and Prevention of
With Buccal Lorazepam or Midazolam
Prolonged tonic-clonic seizures or clusters
of shorter seizures left untreated can
sometimes lead to status epilepticus. Status
epilepticus is a prolonged seizure that
continues for 30 minutes or longer. Prompt
treatment within 3-5 minutes can stop a
seizure from becoming prolonged or status
epilepticus. Visits to an emergency room
might be avoided if seizures are treated
Buccal lorazepam or midazolam offers a
safe, effective and easy way to prevent a
seizure from progressing. Buccal medication
is given between the gums and the cheek.
Both lorazepam and midazolam are
absorbed well in the cheek and are easy to
use by caretakers.
Side effects of lorazepam and midazolam
are not common but can include sleepiness
for 1-2 hours, agitation, restlessness and
shallow breathing. Overdose can cause
breathing to stop, so never give more than
the recommended dose.
The dose below of lorazepam or midazolam,
available as 2mg/ml oral syrup, has been
prescribed by your doctor:
If a seizure continues 5 minutes after this
medicine is given, call 911.
If a long seizure or clusters of seizures
happen again the same day, lorazepam or
midazolam can be repeated if needed one
hour after the first dose was given.
Check expiration date on medicine bottle.
Lorazepam expires 90 days after the
bottle is opened and needs to be
refrigerated. Midazolam can be stored at
room temperature. There is no specific
expiration date for midazolam syrup when
opened. It is usually recommended that you
replace the bottle at least once a year.
Directions for giving lorazepam or midazolam are as follows:
Open the medicine bottle and insert a new sterile 1mL or 3mL syringe to
draw up the correct amount of medicine. No needles are needed.
If the person is in a chair and has no head support, support the head by
standing behind him and holding his chin. Be careful not to press on
If the person is lying on the floor or is in a chair with a head support in
place, hold the chin to keep the head steady and turn the head to one side.
Open the mouth gently by holding the chin, apply downward pressure
on the lower lip and wipe away any excess saliva. Do not try to part the
Place the syringe between the lower gum and the cheek on one side of
the mouth. Slowly give half the amount of medicine into the mouth.
Remove the syringe. Close the lips together and rub the cheek on the
outside. Repeat this on the other side of the mouth to give the rest of the
Do not give the medicine too quickly, as this may cause the person to
choke or swallow it. If a small amount is swallowed, it is not a problem.
Place the person on his side.
Watch for ongoing seizure activity and signs of breathing
CALL 911 if you see:
No air movement at mouth or nose
Blue color of the lips/face
If breathing stops give rescue breaths until help arrives.
Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright © 9/2016 University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing HF#7212.