Valtoco (Diazepam Nasal Spray) Dosing and Usage for Seizure Treatment
Valtoco (diazepam nasal spray) is recommended for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity (seizure clusters) in patients with epilepsy aged 6 years and older, with age- and weight-based dosing of 5,10,15, or 20 mg. 1
Dosing Guidelines
The dosing of Valtoco follows these parameters:
- Age-based and weight-based dosing: 5,10,15, or 20 mg 2, 1
- Administration schedule: A second dose may be administered 4-12 hours after the first dose if needed 2
Specific Dosing Recommendations:
- For children 6 years and older: Weight-based dosing
- For adults: Typically 10-20 mg based on weight
- The intranasal administration makes it ideal for self-administration outside hospital settings 1
Clinical Applications
Valtoco is specifically indicated for:
- Acute treatment of intermittent seizure clusters
- Stereotypic episodes of frequent seizure activity
- Seizure patterns distinct from the patient's usual seizure pattern
Advantages Over Other Formulations
Valtoco offers several advantages compared to other diazepam formulations:
- Less variability in plasma concentration compared to rectal diazepam 1
- More convenient and less invasive than rectal or IV diazepam 1
- Suitable for self-administration in appropriate patients 3
- No evidence of tolerance development with long-term intermittent use 2
Safety Considerations
The safety profile of Valtoco is generally favorable:
- Most common side effects include mild nasal irritation and lacrimation 1
- No increased safety risks compared to traditional forms of diazepam 1
- Can be used safely in patients taking concomitant benzodiazepines 4
- No reports of cardiorespiratory depression in clinical studies 4
Patient Selection for Self-Administration
Self-administration is feasible for select patients:
- Patients must be able to recognize their seizure clusters
- Patients should be capable of administering the medication during the early phase of a seizure cluster
- Training for proper administration technique is essential
Emergency Management Context
While not specifically addressing Valtoco, guidelines for emergency seizure management suggest:
- Lorazepam 0.05 mg/kg IV (maximum 4 mg) is typically first-line for acute seizures 5
- Levetiracetam 40 mg/kg IV or valproate 20-30 mg/kg IV are second-line options 5
- Valtoco represents an alternative rescue therapy option for outpatient management
Monitoring and Follow-up
After Valtoco administration:
- Monitor for resolution of seizure activity
- Observe for potential side effects
- Regular follow-up every 3-6 months is recommended to assess overall seizure control and medication effectiveness 5