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Valtoco vs Nayzilam
Introduction
For patients experiencing seizure clusters or acute repetitive seizures, certain medications that affect the transmission of nerve signals in the brain can help control symptoms. Valtoco and Nayzilam are two such drugs prescribed for this condition. They both interact with gamma-aminobutyric acid (GABA) receptors in the brain to reduce overactive nerve firing associated with seizures. Valtoco is a nasal spray formulation containing diazepam, which enhances GABA activity to provide rapid relief from seizure symptoms. On the other hand, Nayzilam is a midazolam nasal spray that works similarly by augmenting GABA activity but has a slightly different chemical structure and pharmacological profile compared to diazepam.
What is Valtoco?
Valtoco (generic name Diazepam) and Nayzilam (generic name Midazolam) are both types of benzodiazepines, a class of medications designed to manage epileptic seizures. They were approved by the FDA in 2020 and 2019 respectively. Valtoco increases levels of free GABA, an inhibitory neurotransmitter in the brain that works to reduce nerve cell activity and prevent seizures from occurring. It is primarily used for acute treatment of intermittent, stereotypic episodes of frequent seizure activity that are distinct from a patient's usual seizure pattern in patients with epilepsy 6 years of age and older.
On the other hand, Nayzilam has a broad spectrum influence on GABA receptors but also affects dopamine to some extent. This results in it having more sedative effects than Valtoco which predominantly modulates GABA alone. These differences can affect their side effect profiles as well as how they might interact with other medications or conditions you may have, so it's important to discuss these factors thoroughly with your healthcare provider before starting either medication.
What conditions is Valtoco approved to treat?
Valtoco and Nayzilam are both approved for the treatment of seizure clusters:
- Valtoco (diazepam nasal spray) is used in patients 6 years of age and older
- Nayzilam (midazolam nasal spray) is indicated for use in patients at least 12 years old.
How does Valtoco help with these illnesses?
Valtoco aids in managing seizures by enhancing the effect of GABA, a major inhibitory neurotransmitter in the brain. It accomplishes this by binding to specific sites on GABA receptors, which increases the influx of chloride ions into neurons and hyperpolarizes them. This makes it harder for these neurons to fire, thus reducing their excitability. The heightened activity of GABA plays an integral role in calming down neural activity, preventing excessive firing that can lead to a seizure. Hence, Valtoco can mitigate the extreme effects of seizures and aid patients in controlling their condition.
On the other hand, Nayzilam also works as an antiepileptic drug but is used specifically for acute treatment of intermittent episodes of increased seizure activity (seizure clusters). Like Valtoco, Nayzilam enhances the inhibitory effects of GABA but does so via nasal administration method providing rapid relief during severe seizure episodes.
What is Nayzilam?
Nayzilam, or midazolam, is a fast-acting benzodiazepine that slows down brain activity to stop seizures. It functions by enhancing the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, which results in sedative, sleep-inducing, anxiolytic, anticonvulsant and muscle relaxant properties. Nayzilam was first approved by the FDA in 2019. As it's not a hydantoin anti-seizure medication like Valtoco (Diazepam), it does not work by desensitising sodium channels to stabilize neuronal membranes and decrease seizure activity. Its mechanism of action means its side-effect profile is also different to that of hydantoins; for instance, it may cause drowsiness but is less likely to cause nausea and vomiting - common side effects with hydantoins such as Valtoco. The impact on GABA can be beneficial for rapidly stopping ongoing seizure episodes especially when patients do not respond well to 'typical' hydantoin anti-seizure medications such as Valtoco.
What conditions is Nayzilam approved to treat?
Nayzilam is a nasal spray approved by the FDA to treat:
-
Seizure clusters, also known as acute repetitive seizures (ARS), in patients 12 years of age and older. This condition can occur in people with epilepsy.
-
Rescue treatment during periods of increased seizure activity for those who have a well-established seizure disorder that has been previously diagnosed by a healthcare provider.
How does Nayzilam help with these illnesses?
Nayzilam, like Valtoco, is designed to treat acute seizure episodes in people with epilepsy. Nayzilam acts on the GABA neurotransmitter system in the brain. This system plays a crucial role in reducing neuronal excitability and thus helps control seizures by calming excessive electrical nerve activity that leads to seizures. It's also involved in muscle tone regulation, stress response, and sleep patterns among other processes.
Nayzilam works by increasing the effect of GABA, effectively slowing down neural communication and lessening seizure severity or stopping them altogether. Its unique nasal spray delivery method allows it to be administered quickly during an emergency when oral medication may not be possible due to ongoing seizure activity. Like Valtoco, Nayzilam does not prevent future seizures but rather is used for immediate relief of acute symptoms associated with a seizure episode.
How effective are both Valtoco and Nayzilam?
Both diazepam nasal spray (Valtoco) and midazolam nasal spray (Nayzilam) are FDA approved for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity. Nayzilam was approved by the FDA in 2019 while Valtoco received approval only a year later in 2020. Both drugs act on GABA receptors, increasing inhibitory effects to reduce overactivity in the brain that can lead to seizures.
The effectiveness of Valtoco and Nayzilam has been evaluated through various clinical trials demonstrating each drug's efficacy at stopping or reducing active seizures as well as their safety profiles. In these trials, neither medication showed significant differences in terms of primary outcomes; both effectively stopped seizures within designated timeframes.
A review published in 2021 confirmed that both medications were effective at halting ongoing seizure activities when compared with placebo groups. This same study also noted that they were generally tolerated well even among different age groups and across varied health demographics.
However, it is important to note that these two medications may be chosen under different circumstances due to variances such as absorption rates, onset times, durations of action and potential side effects. For instance, some studies suggest that midazolam might have a faster onset time but shorter duration than diazepam.
While there has not been an extensive comparative study between these two drugs yet due to their relatively recent approvals, what we know from existing data suggests no major superiority between them for treating acute repetitive seizures or seizure clusters.
At what dose is Valtoco typically prescribed?
Dosages of Valtoco nasal spray typically range from 5-20 mg per application. Adults and adolescents over the age of 12 usually start with a dosage of 10 mg, which can be increased based on individual response to treatment. In contrast, Nayzilam is administered via a single-dose nasal spray unit that delivers 5 mg per actuation. The initial dose for adults and adolescents aged 12 years or older is one spray into one nostril; if seizure activity persists after approximately ten minutes, a second dose may be administrated in the opposite nostril. Both medications should only be taken as needed for acute treatment of seizures, not exceeding more than two doses in any twenty-four-hour period.
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At what dose is Nayzilam typically prescribed?
Initiation of Nayzilam treatment typically begins with a single dose, which is 5 mg administered into the nose. This can be repeated once after 10 minutes if seizure activity continues, not exceeding a total dosage of 10 mg in any given day. The maximum daily dose is established at this level to prevent potential complications and adverse reactions associated with overuse. It should be noted that another dose should not be taken within any subsequent 24-hour period without consulting with your healthcare provider first.
What are the most common side effects for Valtoco?
Common side effects of Valtoco include:
- Somnolence (sleepiness/drowsiness)
- Headache
- Nasal discomfort or inflammation
- Throat irritation
On the other hand, Nayzilam may cause:
- Somnolence (sleepiness/drowsiness)
- Headache
- Nasopharyngitis (inflammation of the throat and nasal passages)
It's important to note that these lists are not exhaustive and different people may experience different side effects. Always consult your healthcare provider if you're experiencing any unusual symptoms after taking either Valtoco or Nayzilam.
Are there any potential serious side effects for Valtoco?
In rare cases, Valtoco can cause potentially serious side effects. It's important to seek medical attention immediately if you experience:
- Increased thoughts about suicide or self-harm
- Signs of allergic reaction: hives; difficult breathing; swelling in your face, lips, tongue, or throat
- Vision changes: blurred vision, double vision
- Cardiovascular symptoms: rapid heart rate (tachycardia), palpitations
- Low sodium levels in the body - headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination and balance.
- Severe nervous system reactions such as agitation or restlessness
Similarly for Nayzilam:
Nayzilam has a low risk of serious side effects but they could still occur. If any of these happen while using Nayzilam:
- Suicidal thoughts or actions
- Allergic reaction signs like skin rash and facial swelling
- Changes in eyesight including blurred or double vision
- Signs of cardiovascular issues like chest pain and irregular heartbeat Hyponatremia with symptoms such as nausea accompanied by headache and malaise. Severe nervous system response characterized by extreme muscle stiffness (rigidity)
If you experience any unusual physical or behavioral symptoms after taking either Valtoco or Nayzilam it is crucial to reach out to a healthcare professional promptly.
What are the most common side effects for Nayzilam?
Nayzilam may have the following side effects:
- Drowsiness or sleepiness
- Headache
- Stuffy nose, sore throat, and other upper respiratory symptoms
- Fatigue
- Nausea or vomiting
- Abdominal discomfort or pain
- Changes in vision including blurred vision
- Increased salivation
- Coughing, wheezing or shortness of breath
While not as common, some people experience more serious adverse reactions such as agitation, confusion, hallucinations and changes in heart rate. Always consult with your healthcare provider for any concerns about medication side effects.
Are there any potential serious side effects for Nayzilam?
Though Nayzilam is typically well-tolerated, it can occasionally cause serious side effects. If you notice any of the following symptoms after taking Nayzilam, seek immediate medical attention:
- Signs of an allergic reaction such as hives; difficulty breathing or swallowing; swelling of the face, lips, tongue, or throat
- Changes in mood or behavior like confusion and unusual thoughts or behavior
- Severe sedation where you could struggle to stay awake
- Symptoms that suggest dependence like cravings or withdrawal symptoms upon discontinuation
- Extreme dizziness and loss of coordination
- Difficulty with vision including blurred vision or double vision New-onset seizures
These are not all the possible side effects from Nayzilam. Always consult your healthcare provider for medical advice if these conditions occur.
Contraindications for Valtoco and Nayzilam?
Both Valtoco and Nayzilam, along with most other anti-seizure medications, may worsen symptoms of seizures in some people. If you notice an increase in frequency or severity of seizures, or new types of seizures occurring, please seek immediate medical attention.
Neither Valtoco nor Nayzilam should be taken if you are taking, or have recently been taking certain classes of antidepressants like selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs), as these drugs can lower the seizure threshold. Always inform your doctor about all the medications you're currently using; SSRIs and TCAs may require a period for clearance from your system to prevent harmful interactions with Valtoco and Nayzilam.
Valtoco is administered nasally while Nayzilam is administered rectally - this could make a difference depending on patient comfort levels or their ability to administer medication in different ways. It's also important to note that both medications are intended for short-term treatment of acute seizure episodes rather than long-term management.
How much do Valtoco and Nayzilam cost?
For the brand-name versions of these drugs:
- The price of a single-use nasal spray device of Valtoco (5 mg) averages around $350, which works out to be approximately $350 per seizure event. It's important to note that this medication is used on an as-needed basis for acute treatment of epileptic seizures and not taken daily.
- The price for Nayzilam (5 mg), another drug also used on an as-needed basis for acute treatment of epileptic seizures, costs about $675 for two single-use nasal spray devices, working out to approximately $337.50 per seizure event.
Thus, if you are comparing the cost per use between these two medications, Nayzilam offers a slightly more affordable option than Valtoco. However, it's crucial to remember that cost should not be the primary consideration in determining which one is right for you; effectiveness and how well each drug is tolerated by your body are equally essential factors.
As these are relatively new medications specifically designed for emergency use during seizure episodes rather than daily management of epilepsy symptoms, there aren't generic forms available yet. Consequently their prices remain high compared with many other prescription drugs.
Popularity of Valtoco and Nayzilam
Valtoco and Nayzilam are both rescue medications that have recently been approved by the FDA for treating acute repetitive seizures or seizure clusters in epilepsy patients. Both drugs have similar mechanisms of action as they deliver a form of benzodiazepine; Valtoco contains diazepam while Nayzilam contains midazolam.
Nayzilam was prescribed to around 10,000 people in the United States within its first year on the market in 2020. Its use has been gradually increasing since its introduction due to its effective control of seizure episodes and ease of nasal administration.
Valtoco had fewer prescriptions than Nayzilam with approximately 5,000 prescriptions filled within the same timeframe (2020). However, it is also gaining acceptance among healthcare providers because it offers an alternative route of administration through intranasal delivery which can be advantageous over other methods during a seizure episode. The prevalence trends for both these medications will need further follow-up as more data becomes available over time.
Conclusion
Both Valtoco (diazepam nasal spray) and Nayzilam (midazolam nasal spray) are used for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity in patients with epilepsy. Both medications have been proven effective through numerous clinical studies and they offer an alternative to rectal or intravenous administration routes which may not be practical during a seizure event.
The choice between these two drugs often comes down to their slightly different mechanisms of action: while both are benzodiazepines that enhance the effect of gamma-aminobutyric acid (GABA), a neurotransmitter that slows brain activity, midazolam is generally considered faster acting than diazepam, but its effects may also wear off more quickly. As such, Nayzilam might be chosen over Valtoco when rapid intervention is necessary.
Neither drug is currently available in generic form which could represent higher costs especially for those paying out-of-pocket. The onset time can vary from person to person; some people experience relief within 10 minutes while others may need up to half an hour.
As far as side effects go, both drugs have similar profiles including drowsiness, headache and rhinorrhea. It's crucial for individuals using these medications or caregivers administering them to monitor closely for any signs of respiratory distress or altered mental status following use.