Seizures can be unpredictable, often happening randomly, at unexpected times. For people living with epilepsy, this can become a safety concern. Typically, seizures only last between one and three minutes. In some cases, seizures can last longer or occur in clusters. These situations are considered seizure emergencies. To be prepared in the event of unexpected seizure emergencies, rescue medications are often prescribed by a patient’s provider. These medications are fast-acting treatments designed to stop a seizure once it occurs, providing immediate relief and preventing complications that could be caused by prolonged seizure activity. Rescue medications are not to be used in place of forgotten or missed doses of daily medication.  

Rescue medications are available in different forms including nasal sprays, rectal gels, and injections. Some commonly prescribed rescue medications include diazepam (Valium) & midazolam (Versed) which are benzodiazepines that work by calming the brain’s overactivity. These are most commonly available as nasal sprays and rectal gels. Lorazepam (Ativan) is another rescue medication that is typically injected by emergency personnel in emergency response settings.  

History of Rescue Medications 

Prescription rescue medications are a relatively new option for individuals living with epilepsy. The first option on the market in the 1990’s was a diazepam gel administered rectally to patients.  Rectal gels were the only FDA approved rescue medication options for about twenty years and remain the only option for young children.  

Intranasal midazolam (nasal spray) was approved for use in patients twelve years of age and older the Unites States in 2019, followed closely by an intranasal option for diazepam which received approval for patients over the age of six in 2020, revolutionizing the rescue medication market.  

Other routes of administration of rescue medications have been researched and made available such as sublingual (under the tongue), buccal (in the cheek), orally disintegrating tablets, and intramuscular (shots, similar to an epi-pen). However, these options are not FDA-approved and are uncommon. Some of these options may be seen in countries outside of the Unites States¹. 

Efficacy 

• Rectal Diazepam: Typically stops seizures within 15 minutes of administration but continues to work preventing seizures for a longer period². 

• Nasal Diazepam: Typically stops seizures within just a few minutes after administration but continues to work preventing seizures for a longer period³. 

Follow prescription instructions or ask your doctor about how frequently rescue medications can be used, due to the length of time they may remain active within each patient’s body.  

Side Effects 

• Rectal Diazepam: Generally well-tolerated. 

• The most common side effect reported was drowsiness.  

• Less frequently, side effects such as dizziness, headache, pain, stomach pain, nervousness, diarrhea, clumsiness, euphoria, asthma, stuffy nose, and skin rashes have been reported⁴.  

• Nasal Rescue Medications: Generally well-tolerated. 

• Most common side effects reported were nasal discomfort and drowsiness.  

• Less frequently, side effects such as headache, slurred speech, throat irritation, runny nose, abnormal taste, or nose bleeding may occur⁵.  

It is difficult for researchers to confirm if reported side effects are due to the seizure activity, or the medications administered. It is important to communicate all side effects to your provider.  

Rescue Medication Application 

All prescribed medications should come with administration instructions. Typically, seizure rescue medications are instructed to be administered after five-minutes of continuous seizure activity, or clusters of seizures. Application of rectal medications can be burdensome, hard to apply, and sometimes seen as embarrassing if done in a public setting. Nasal medications are typically much quicker and easier to administer regardless of body positioning. After rescue medications have been applied, someone should stay with the individual and monitor their activity for up to four hours. Once a person starts to feel normal again after the seizure and rescue medication administration, they should be able to return to their regular activity.  

Rescue medications are typically able to be administered at home by family members or caretakers. It’s crucial that the proper training is given to caretakers who handle medication administration, as timing is paramount to the effectiveness of the medication. In some settings, such as schools and daycare centers, there may be restrictions on who is able to administer the medications. Make sure you are up to date on the restrictions within your state and communicate effectively with the individuals who may oversee medication administration for yourself or your child in these settings.  

Seizure action plans can be very helpful tools to communicate instructions on recognizing, documenting, and responding to seizure situations in a setting where there may be multiple caretakers such as a school.  

It’s essential for people living with epilepsy to maintain regular check-ups with their healthcare provider to ensure that their overall treatment plan is effective and that they are using rescue medications appropriately. Please speak with your doctor if you are interested in yourself or your child being prescribed rescue medications.  

If you have questions regarding specific treatment options for epilepsy, please speak with your doctor. The information, including text, graphics, images and other material on this website and provided by the Epilepsy Foundation of Northeastern New York, is for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 

If you are interested in learning more about seizure recognition and first aid, please reach out to our team by calling (518) 456-7501 or visiting our website for additional resources. 

Citations 

1. Samanta, D. (2021, October). Rescue therapies for seizure emergencies: Current and future landscape. Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. https://pmc.ncbi.nlm.nih.gov/articles/PMC8448953/ 

2, 4. Matthew, H., & Patty, S. O. (2020, April 17). Rectal Rescue Medicines. Epilepsy Foundation. https://www.epilepsy.com/treatment/seizure-rescue-therapies/rectal-rescue-medicines 

3, 5. Kamil, D. (2020, April 4). Nasal rescue medicines. Epilepsy Foundation. https://www.epilepsy.com/treatment/seizure-rescue-therapies/nasal-rescue-medicines#How-long-does-it-take-to-work