man swallows pill with water

Some fast-acting medicines (such as diazepam, lorazepam, or midazolam) can be used as a rescue medicine to stop seizures. They can be given by mouth in some situations outside of a hospital setting. This section shares information and questions to ask about using rescue medicines orally.

How can rescue medicines be used by mouth?

Some people don’t like the idea of using a medicine rectally. It can be socially embarrassing, especially in public, and hard to use. There are now better options than rectal Diastat for most people. If your health care provider has prescribed a rectal rescue medicine, talk with them about whether a different option is available for your seizures.

An oral rescue medicine may be recommended by a health care provider. Oral medicines can be pills, liquids, or patches. Rescue medicines can be given by mouth in 1 of 3 ways.

Oral

If a prescription just says, “take by mouth,” it usually means swallowing the medicine with water. The medical abbreviation P.O. (per os) may be on the prescription.

  • An oral rescue medicine should only be given if the person is awake and alert and is not at risk for choking on the pill or water.
  • If the medicine is in a tablet form, you may be told to chew it before swallowing. Chew medicine first only if your provider recommends it.
  • One medicine, clonazepam, may come as a wafer that can dissolve on the tongue. Another form of benzodiazepine is being developed to dissolve in the mouth too.

Sublingual

This means that the medicine is placed under the tongue where it will dissolve and be absorbed into the bloodstream. The person should not drink or eat anything until the medicine is gone.

Buccal

This means that the medicine can be placed in the mouth between the cheek and the gum. The medicine dissolves and is then absorbed into the bloodstream. Usually, medicines that can be taken under the tongue can also be placed between the cheek and the gum. The person should not drink or eat anything until the medicine is gone.

Who should get oral medicines that are not swallowed?

Swallowing pills is easier for most people. Yet there are situations where it is not safe or possible for a person to swallow a pill. These may include

  • An infant or young child who cannot swallow
  • A person who is too sleepy or not able to cooperate
  • Someone who cannot keep the medicine in their mouth (for example, a person who drools or has vomited)
  • A person who has a medical or neurological condition that makes swallowing unsafe
  • A person who is having too many seizures

In these situations, talk to your provider about other forms of rescue medicine, such as a nasal or rectal one.

Specific orders needed from your health care provider include

  • Name of the drug
  • The dose of each pill or liquid and how much to take at each dose
  • When it should be given - for example, after a certain number of seizures or after clusters of seizures that last a certain period of time
  • How often it can be taken and how much in one day
  • Times when it should NOT be taken
  • How to take it – swallow, sublingual or buccal

What are lorazepam and diazepam used for?

Both of these medicines can be used to help stop seizures on an “as needed” basis. However, if they are used every day, they may not work as well. They are NOT intended to take the place of your daily seizure medicine. Sometimes a small amount of one of these medicines may be prescribed to take daily with another seizure medicine, but for most people, lorazepam and diazepam are not used regularly.

  • Lorazepam is available under the brand name Ativan® or the generic name of lorazepam in pill form with different dosage strengths. It also comes as a concentrated liquid solution under the name Lorazepam or Ativan Intensol®. The liquid form has to be refrigerated, which makes it hard to carry with you. Lorazepam in an injection is only used in a hospital.
  • Diazepam for use in the mouth is available in pill form under the brand name of Valium®, in liquid form as Diazepam Intensol®, or in generic form. The injectable form is usually given only in a hospital.

How are lorazepam or diazepam given?

  • Either medicine may be swallowed whole with water or another liquid.
  • Pills or tablets can be dissolved under the tongue or between the cheek and the gum. They may get into the bloodstream quickly, up to 3 to 5 minutes. 
  • The liqiuid intensol form is usually given between the gum and the cheek. Use a specially marked dropper that comes with the solution to measure the correct dose. It could also be mixed with liquid or soft food to swallow.
  • It’s important to follow your health care provider’s directions and make a plan with them about how much to take, when to use it, and how often it can be used. Then write down each time you take a dose so you can make sure you don’t take too much.

How long does it take to work?

  • Lorazepam and diazepam act quickly in the brain to stop seizures. It may take up to 15 to 30 minutes to start working when it’s put under the tongue or between the cheek and the gum.
  • Diazepam gets into the brain quicker, but lorazepam tends to last longer and will help seizures over a longer period of time.
  • Talk to your provider about whether a second dose can be given and when.

What are some common side effects?

  • Side effects may occur, such as weakness, dizziness, headache, memory problems, fatigue, sleepiness or sedation, unsteady walking, respiratory depression, or low blood pressure.
  • In children, side effects may include sleepiness or sedation, irritability, silliness, hyperactive behaviors, or unsteady walking. Rarely respiratory depression or slowed breathing happens.
  • These medicines should not be used in people with certain forms of glaucoma, infants less than 6 months of age, people with severe breathing problems, or people who have a sensitivity to benzodiazepines or any of its ingredients.
  • These medicines should be used with caution in elderly or frail people, in people with psychiatric problems, or in people taking other drugs that affect the nervous system.
  • They should also be used cautiously, if at all, in people who are taking an opioid medicine (a group of medicines used to treat severe pain).
  • Do not stop this medicine suddenly.

Is special monitoring needed?

When rescue medicines are prescribed to help treat seizures, make sure you know what type of monitoring is needed.

  • Keep track of any side effects and know when to call your medical team.
  • Slowed breathing happens rarely. While it is listed as a possible side effect for many rescue medicines, changes in breathing may be due to the seizure.
  • If the person is sleepy after taking the medicine, let them rest for a while. When they are feeling back to baseline, let them return to their usual activity.
  • Watch the person to make sure the seizures have stopped. How long this may take will depend on their seizure frequency before the medicine was given and their usual seizure pattern.
  • The most important monitoring is to time the seizure. If the seizure lasts longer than usual, follow your health care provider’s advice on what to do next and when to call for emergency help. Make sure your Seizure Action Plan has this information on it.

What You Should Do When Using Rescue Medicines

Talk to your health care provider about the best way to use a rescue seizure medicine.

  • Make sure you have a specific plan on when to use it and when not to.
  • Include information on how to give these medicines on your Seizure Action Plan so others will know how best to help you.
  • Report all side effects to your health care provider.
  • Talk to your provider about all prescription and non-prescription medicines and herbal products or supplements that you are taking.
  • People who are prescribed these medicines or who are asked to give them to someone else (such as their child) should receive one-on-one teaching from a doctor, nurse or trained epilepsy educator.
  • Caregivers should call for emergency medical help (usually 911) if
    • Seizures continue after taking the medicine as prescribed by the doctor.
    • A convulsive seizure lasts longer than 5 minutes, even if the rescue medicine has been given.
    • Seizures look different than before.
    • Seizures occur one right after the other.
    • Changes in breathing or skin color are seen.
    • Unusual or serious problems occur.
    • You are worried or bothered by how the person is doing.
Authored By: 
Patty Obsorne Shafer RN, MN
Matthew Hoerth MD
Authored Date: 
04/2020
Reviewed By: 
Elaine Wirrell MD
on: 
Thursday, April 16, 2020