Back in the early 2000s—after Sept. 11, the anthrax attacks, and the rumors of chemical weapons in Iraq—the U.S. government began stockpiling drugs that could be used as antidotes for deadly nerve agents. To spur pharmaceutical companies to develop new and improved drugs, despite their limited profitability, Congress passed Project BioShield, a multibillion-dollar program that’s helped fund more than a decade’s worth of research and development.
Last week’s mass sarin attack in Syria, as well as February’s assassination of North Korea’s Kim Jong Nam with VX poison, served as grim reminders that the threat hasn’t gone away.
Dr. William Meurer, IHPI member with the University of Michigan’s Department of Emergency Medicine, led a recent study that found that ambulances increasingly began using midazolam “off label” for seizure control after the 2012 clinical trial was published.
“Midazolam is now known by the medical community to be superior, even though it’s not approved by labeling yet,” Meurer said. Before the clinical trial, intravenously administered lorazepam (a cousin of diazepam) was the gold standard for seizure treatment in emergency situations, he said. In 2010, midazolam was used in about 26 percent of pre-hospitalization seizure patients; by the end of 2014, however, it was used in 62 percent of those cases. “It’s a grand slam,” Meurer said. “It’s very unusual for us to find something that’s cheaper and better and easier to store.”
Although Meurer suspects that more ambulances will begin replacing their stores of lorazepam in favor of midazolam, this doesn’t necessarily mean that newly approved indications for the drug will be a boon to midazolam manufacturers. Because it’s already used in many other medical situations and is produced by several manufacturers, the financial impact could be buffered.