Nayzilam vs Valtoco: How do they compare?

Key Points

• Nayzilam (midazolam) and Valtoco (diazepam) are two rescue nasal sprays that may be used for frequent seizure activity that is different from a patient’s usual pattern (also known as seizure clusters).
• Nayzilam was FDA approved in 2019 for patients ages 12 years and older. Valtoco was approved in 2020 for patients ages 6 years and older.
• The dosage of Nayzilam and Valtoco are different. Follow your healthcare provider’s instructions carefully to use these medications safely and effectively.

Nayzilam (midazolam) and Valtoco (diazepam) are both FDA-approved nasal sprays for treating seizure clusters (frequent seizure activity that is different from a normal seizure pattern). They are also known as nasal rescue medications. Both medications are benzodiazepines and work similarly. They also have similar side effects, but their dosages are not the same.

Below, we will review some key differences between these two treatment options. These are not all differences you need to know. Make sure to review the full product information and speak to your healthcare professional if you have any questions.

Nayzilam and Valtoco have different active ingredients

Both Nayzilam and Valtoco belong to a group of medications called benzodiazepines. However, they each contain different active ingredients. Nayzilam contains midazolam, whereas Valtoco contains diazepam.

Both medications attach to a signaling protein in the brain called the gamma-aminobutyric acid type A (GABA-A) receptor. This is thought to calm down activity in the brain, which stops seizures.

Nayzilam and Valtoco are FDA approved for different age groups

Nayzilam and Valtoco have only been studied and approved for certain age groups. Nayzilam is FDA approved for people ages 12 years and older, while Valtoco is FDA approved for people as young as 6 years old.

Nayzilam and Valtoco have different dosages

Both Nayzilam and Valtoco should be sprayed into the nose. However, the dose and instructions differ between them. Nayzilam is available as a single-dose nasal spray that contains 5 mg in 0.1 mL of solution. Valtoco also comes as a 0.1 mL single-dose nasal spray, but it is available in three different strengths: 5 mg, 7.5 mg, and 10 mg.

• Nayzilam: Give 1 spray (5 mg) into one nostril. The dose can be repeated in the other nostril after 10 minutes if the patient has not responded. Do not use more than 2 doses per seizure cluster. Also, do not treat more than 1 episode every 3 days and more than 5 episodes per month.
• Valtoco: The recommended dose depends on the patient’s age and weight. The usual dose is 0.2 mg/kg for children 12 years and older, or 0.3 mg/kg for children ages 6 to 11 years old, sprayed into one nostril. The dose can be repeated after at least 4 hours. Do not use more than 2 doses per seizure cluster. Also, do not treat more than 1 episode every 5 days and more than 5 episodes per month.

The reason these medications are not recommended to be used too often is because of the risk of tolerance. This means using them too frequently can cause them to not work as well anymore. If you are needing to use them more than what is recommended, speak to your healthcare provider to adjust your maintenance medications.

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Nayzilam and Valtoco are controlled substances

Nayzilam and Valtoco are classified as schedule IV controlled substances. This is because their active ingredients, midazolam and diazepam, have a potential for abuse and addiction. Remember to store your medication up and away from children, pets, and guests.

Nayzilam and Valtoco have similar side effects

Local nasal irritation is common from using Nayzilam and Valtoco. This can include discomfort in the nose, change in taste, and a bloody nose. Nose and throat side effects are temporary, and should resolve within the same day after taking a dose. Additionally, both medications can cause sleepiness and a headache. Talk to your healthcare provider if you experience bothersome side effects from either of these medications.

How well do Nayzilam and Valtoco work?

In clinical studies, seizures stopped in 53.7% of patients treated with Nayzilam within 10 minutes compared to 34.3% of patients taking a placebo (no active medication). Of those treated, 31% required a second dose.

In a small study, 65% of patients who took intranasal diazepam were seizure-free during the 12-hour observation period. In patients treated during another study, 48.5% required a second dose.

Everyone responds differently to medications. Follow up with your healthcare provider to learn what to expect with your rescue medication.

This is not all the information you need to know about Nayzilam (midazolam) and Valtoco (diazepam) for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and discuss this information and any questions you have with your doctor or other health care provider.