Rescue Medicines for Seizures Worldwide

Rescue medicines are fast-acting medicines used to stop prolonged seizures or seizure clusters before they progress to a more dangerous emergency.

The medicine, route, dose and legal availability differ between countries, ages and care settings.

What rescue medicine is for

A rescue plan may be prescribed for someone who has:

prolonged convulsive seizures;
recurrent seizure clusters;
a history of status epilepticus;
a predictable seizure pattern in which early treatment reduces escalation.

Benzodiazepines are the main rescue medicines

Most community rescue treatment uses a benzodiazepine because these medicines act rapidly on GABA-A receptors and can terminate ongoing seizure activity.

Buccal midazolam

Buccal midazolam is placed between the gum and cheek, allowing absorption through the oral mucosa.

It is widely used in community practice in parts of Europe and elsewhere.

A 2025 comparison of UK and Norwegian practice found buccal midazolam was the first-line community rescue medicine reported by all surveyed clinicians in both countries.

Intranasal midazolam

Midazolam can also be delivered through the nose.

Commercial intranasal products are licensed for seizure clusters in some countries, while other settings use different formulations according to local practice and regulation.

Intranasal diazepam

Intranasal diazepam products are available in some jurisdictions, including the United States, for seizure clusters in defined age groups.

Availability is not global.

Rectal diazepam

Rectal diazepam is a long-established rescue route and remains important where buccal or intranasal formulations are unavailable.

It can be effective but may be less socially acceptable or practical in public settings.

Intravenous benzodiazepines

In hospitals, intravenous lorazepam or diazepam are established first-line treatments for acute convulsive seizures and status epilepticus when IV access is available.

These are not ordinary home rescue routes.

When IV access is not available

WHO-linked guidance recognises non-intravenous benzodiazepine routes where IV access is unavailable. Regional WHO guidance includes rectal diazepam and buccal or intranasal midazolam as options.

Why worldwide availability differs

Access is shaped by:

national medicine licensing;
controlled-drug regulation;
cost;
local formularies;
age-specific approvals;
community nursing and school policies;
availability of trained carers;
medicine supply chains.

Controlled-medicine rules

Benzodiazepines are controlled medicines in many jurisdictions.

WHO’s 2025 controlled-medicines guideline emphasises the need to balance safe regulation with reliable medical access.

A rescue plan matters as much as the medicine

The plan should specify:

which seizure pattern requires treatment;
how long to wait before giving it;
the exact dose and route;
whether a second dose is allowed;
when emergency services must be called;
what to do about breathing or injury.

Do not improvise doses

Rescue benzodiazepine doses depend on the product, route, age, weight and clinical plan.

Instructions for one formulation cannot safely be copied to another.

Respiratory effects

Benzodiazepines can cause sedation and respiratory depression, particularly with repeated doses or other sedatives.

The danger of untreated prolonged convulsive seizure must be balanced against medicine risk, which is why clear prescribing and training are essential.

Seizure clusters versus status epilepticus

A seizure cluster is a person’s recognised pattern of multiple seizures over a relatively short period.

Status epilepticus is a neurological emergency defined by seizure duration and failure of normal termination mechanisms.

Rescue medicine may be used for either, but the action plan can differ.

After rescue medicine

The person may be drowsy after both the seizure and the benzodiazepine.

Breathing, colour, responsiveness and recovery should be observed according to the individual’s emergency plan.

The central point

There is no single worldwide rescue formulation. Buccal midazolam, intranasal midazolam or diazepam and rectal diazepam are all used internationally, but licensing and availability vary sharply between countries.

Sources

Global note: emergency numbers, available formulations, age approvals and controlled-drug rules vary by jurisdiction.

Evidence checked: September 2026.