Published July 1, 2026
As predicted, the use of similar-looking nasal spray devices resulted in confusion. In an ambulatory care clinic, a young adult male was scheduled to meet with a pharmacist to learn about his seizure rescue medicine. He had been prescribed Nayzilam (midazolam) (Figure 1), a nasal spray to use if he had a seizure. The young man also had naloxone, a nasal spray used to reverse opioid overdoses, due to his previous use of oxycodone (a powerful pain medicine).
When the pharmacist asked to see the seizure medicine, the young man handed over the nasal spray device—believing it to be Nayzilam. However, after reading the label on the device, the pharmacist discovered it was actually the naloxone nasal spray device. The young man had mistaken it for his seizure medicine. This mix-up highlighted the potential for serious errors, which we previously warned about, when devices for different emergency purposes look alike.
The confusion stems from the recent introduction of several new nasal sprays, including Narcan (naloxone); Neffy (epinephrine), a medicine used to treat severe allergic reactions; Nayzilam; and Valtoco (diazepam), another medicine used to treat seizures. All these nasal spray devices are similar in shape and size. And some are not clearly labeled with what they should be used for on all sides of their packaging. This design makes it difficult, especially in emergency situations, to tell the difference between the devices and to select the correct medicine.
Here’s what you can do: To prevent future errors, it is recommended to redesign or improve the labeling of these devices so they can be easily distinguished from one another. People may have to carry multiple emergency nasal sprays—seizure rescue, opioid reversal, and epinephrine—all at once, which increases the risk of confusion in emergency situations. Family members, friends, or even bystanders may need to administer these medicines if the person cannot do it themself, so clear labeling is critical. Adding the intended use (what the medicine is used to treat) to the packaging label could reduce the risk of accidental misuse.
To prevent mix-ups with these medicines, be sure to store look-alike sprays in different places, up and out of reach from children. Make sure you know what each one is for and how to use it. Always check the label before using it. Teach your family members or those who may need to give the medicine about the differences. It may be helpful to add a visual clue to help identify the correct medicine. For example, place each product in a separate baggie and write what it should be used to treat across the front: “seizure medicine,” “allergic reaction,” or “overdose.” Never store these medicines (or any medicine) in a car where they can get too hot or too cold.
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