What is the method of administration for rectal diazepam?

From the Guidelines

Rectal diazepam should be administered by inserting the medication directly into the rectum using a specialized delivery device, as recommended for situations where intravenous access is not available 1. The patient should lie on their side with knees drawn toward the chest.

• The rectal tip of the device should be gently inserted into the rectum,
• The plunger fully depressed to deliver the medication,
• The buttocks should be held together for a few minutes after administration to prevent leakage. For children, the dose is typically weight-based, while adults usually receive 10-20 mg. The medication should be administered at the first sign of a seizure or as directed by a healthcare provider. Rectal diazepam works by enhancing the effect of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain, which helps stop seizure activity. This route is particularly useful when oral administration is not possible during a seizure and when intravenous access is unavailable, as stated in the guidelines for management of epilepsy 1. The medication typically takes effect within 5-15 minutes and can prevent progression to status epilepticus. It is essential to follow the guidelines and recommendations for the administration of rectal diazepam, as outlined in the evidence-based guidelines for mental, neurological, and substance use disorders 1.

From the Research

Method of Administration for Rectal Diazepam

The method of administration for rectal diazepam involves inserting the medication into the rectum using a syringe or suppository.

• The dosage is typically 0.5 mg/kg, administered when convulsions last over 5 minutes or more 2.
• Rectal administration of diazepam can be effective in stopping convulsions within 2 to 5 minutes in most cases 2.
• The use of a 1 mL insulin syringe to administer liquid diazepam through the rectum has been shown to be a useful and secure method for preventing prolonged convulsions and epileptic status 2.
• Different preparations of diazepam, such as solutions and suppositories, can have variable rates of absorption when administered rectally 3.
• Rectal administration of diazepam in solution has been found to result in anticonvulsant plasma values within 4 minutes, making it a useful option for the acute treatment of febrile convulsions 4.
• The technique of administration involves inserting the medication into the rectum, and undiluted diazepam intravenous solution administered per rectum is an excellent alternative when intravenous access is difficult 5.

Administration Techniques

• Parents or caregivers can be taught to administer rectal diazepam at home using a syringe or suppository 2.
• The administration of rectal diazepam can be done in any circumstance, reducing the need for hospital care and providing parents with security and tranquility 2.
• The use of rectal diazepam has been found to be effective in the acute treatment of convulsions in infants and children, with a success rate of 80% in one study 6.
• Early treatment with rectal diazepam is crucial, with a significant correlation between the duration of convulsions before treatment and the therapeutic effect 6.