[tri-med] Re: Versed/Tegretol OD/Benecalorie

----- Original Message ----- 
From: "Pamela Padgett"
> But he said he honestly doesn't prescribe Versed

We use Versed (or Midazolam as its known here) as you know.
If you ask the drug companies they will certainly send you information on
its use as a seizure medication. (do a net search on which companies supply
it in the US) I recently spoke to them about dosing and absorption via
different routes of administration and the companies were GREAT in sending
what information was available - both published and unpublished trials. Its
the same drug family as Valium.

But for what and how we use it...........

As a qualifier Alex doesn't have seizures but Shapiro's Syndrome however we
use it the same way as its prescribed for kids with seizures.

The hospital supplies us with vials of Midazolam (Versed). These are the
same vials that they use for IV administration of the drug. By choice we
choose to use the plastic vials as opposed to the glass vials (obviously for
breakage reasons). We get a script for 5 vials at a time, with repeats - so
that means we can use 5 vials a month without getting special permission
from the neuro (if we were using more than 5 a month I think I would want
him to know anyway)

Over here its an S4 drug - the same restrictions on it as for Valium or any
of the other benzo's.

The strength that we use is 5mg in 1 ml. Its the same dose up to adulthood
so its a "safe" range and not determined by weight as closely as some other
drugs. (same as diastat)

Its administered buccally - which just means that we draw the liquid from
the vial up in a 1 ml needless syringe and then administer it by placing the
liquid between Alex's teeth and his gums. So no need to try and open
clenched teeth or the like. It only needs to stay there for a minute or so
to work. Its only 1ml so there is very little risk of aspiration, and in
fact you don't want them to swallow it. (Tastes absolutely horrid anyway!!)
Swallowing it greatly reduces the amount of the drug thats absobed.

Absorption of the drug via the mucosal membranes is similar (actually
marginally better) than absorption via the rectum. From memory (I can pull
out the literature if you need) the absorption via buccal delivery is
between 75 and 85%
So the same amount IV you get 100% absorption, Buccally its about 85%,
ingested (so absorbed via the stomach) its about 25%.

The drug company here didn't have much information about the Versed nasal
spray - thats a US "thing" as yet. Its made up by hospital labs and the
trials as yet are not completed. From personal accounts the nasal spray
supposedly stings like all heck and is the biggest draw back.

The big plus is that buccal administration is so much more dignified than
rectal diastat. It starts working within minutes and while it has the same
effect on the seizure as valium (diastat) it has no effect on respiration
(so there is no depression of breathing), heart rate or blood pressure. Its
not a "knock out" drug, so once the seizure stops it has no effect on the
level of consciousness (so you can better guage that the seizure is over)
and the person can assist themselves sooner. However because it as an
amnesiatic drug (conscious sedation) they have little or no memory
afterwards. (Alex remembers but the memory is less painful and a lot more
vague).

Its not as long lasting as valium - it wears off in 20 minutes to an hour
and for this reason we have been OK'ed to give a second dose if need be 20
minutes after the first. I wont give more than the two doses (in fact only
once have I given the second dose) as if he needs more than 2 doses he
should be in hospital anyway.

If there are any problems it can be quickly reversed with a dose of Narcan
but thats rarely needed as its so short acting. Short acting also means that
there is also no benzo hangover!!

For us the Midazolam buys us time to administer other drugs that are longer
lasting but which take a lot longer to take effect.

I have a daughter who suffered from seizures and I would much rather have
the midazolam than diastat anyday!!!!!!!!!!

Someone once said (can't remember who) that they couldn't get midazolam
because it was a preferred drug of drug addicts. I asked Alex's neurologist
about that and he said that drug addicts would much prefer valium than
midazolam, it gives them a longer high. As a date rape drug it has limited
use because it tases so bad (that I tried with just a drop - its FOUL if you
get it on your tongue but no tatse if left between the teeth and gum) and is
so short acting. So apparently its easier to dissolve a tablet or two of
valium - don't know by experience because thats not my scene and I haven't
taken valium since my days as a runner. (long distance running and I used to
take valium to relieve muscle spasms after a race - gosh that was a long
long time ago!! Not sure I could even get into a jog around the block these
days!!!)

"I wanted a perfect ending. Now I've learned, the hard way, that some poems
don't rhyme, and some stories don't have a clear beginning, middle, and end.
Life is about not knowing, having to change, taking the moment and making
the best of it, without knowing what's going to happen next. Delicious
ambiguity."
- Gilda Radner -

Keep Looking For Rainbows!!
   _--_|\
 /Karen \
 \ _.--._ /
          v Karen, Mum to Alex (8 years, T-18 Mosaic)
http://members.optushome.com.au/karens


                  Building ___ooOOoo__ Rainbows
                       www.trisomyonline.org
                  Families Helping Families On-line

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