Canterbury DHB


Intranasal Midazolam Information Sheet

Intranasal midazolam can be used to treat dyspnoea with a significant anxiety component particularly for episodic dyspnoea/anxiety that can be anticipated in advance e.g. showering.


Prescribe midazolam intranasal spray 15 mg/3 mL, 1–2 sprays in each nostril hourly PRN (Total of 2–4 sprays hourly).

Adverse reactions:

Important: Patient must be able to self-administer the nasal spray. Self-administration of midazolam nasal spray mitigates possible harm (a sedated patient cannot administer further doses). Assess hand strength, dexterity, and cognition before prescribing.

Advice to patient regarding self-administration:

  1. On first use, prime by depressing the pump until you see mist spraying from the bottle.
  2. Hold spray bottle with thumb at base and nozzle between first and second fingers.
  3. With head upright, insert nozzle into nostril.
  4. Depress pump with a firm even stroke. Do not sniff.
  5. Do not tilt head back while spraying. Having head upright is preferable to avoid swallowing of solution but is not a prerequisite for treatment.
  6. Administer 1 spray at a time into each nostril (continue according to prescribed dose).

Note: Contents of the bottle expire one month after the date of preparation.

The nasal spray can be left at the patient’s bedside for immediate use but ensure the environment is appropriate so there is no danger of the spray being uplifted inadvertently by others. Keep it in a cool, dry place, but not in the fridge.

Patients must be assessed as being capable of self-administration and should be advised to inform nursing staff after each dose. Patients in the community should be asked to document their usage.


About this Canterbury DHB document (58015):

Document Owner:

Kate Grundy (see Who's Who)

Issue Date:

May 2018

Next Review:

May 2020


Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 58015