Recommended Dosing for Diazepam Nasal Spray for Acute Seizure Treatment in Adults
For adults experiencing acute seizures, the recommended dose of diazepam nasal spray is 10 mg for patients weighing 50-100 kg, and 15-20 mg for those weighing >100 kg, with the option to administer a second dose if seizures persist after 4-12 hours. 1, 2
Dosing Guidelines
Diazepam nasal spray (VALTOCO®) dosing is weight-based for adults experiencing seizure clusters or prolonged seizures 1:
- 5-10 mg for adults weighing 50-100 kg
- 15-20 mg for adults weighing >100 kg
A second dose may be administered if seizures persist, but this is typically needed in less than 15% of seizure episodes 2
The pharmacokinetic profile shows peak plasma concentrations (Cmax) of approximately 164-189 ng/mL achieved within 2 hours of administration 1
Clinical Effectiveness
Diazepam nasal spray demonstrates high effectiveness as both:
- Acute cluster treatment (ACT) - preventing further seizures in a cluster
- Rapid and early seizure termination (REST) - stopping ongoing prolonged seizures 3
A single dose effectively terminates approximately 87.4% of seizure clusters without requiring a second dose within 24 hours 3
Most seizure clusters (67.3%) can be recognized and treated quickly (within 5 minutes of onset) with diazepam nasal spray 3
Administration Considerations
Intranasal administration provides comparable bioavailability to rectal diazepam gel, with treatment ratios for Cmax and AUC0-24 of 0.98 and 0.89, respectively 4
Nasal spray formulation offers a more socially acceptable and convenient alternative to rectal administration for rescue therapy 4
The epileptic state (ictal/peri-ictal vs. interictal) has minimal impact on the pharmacokinetics of diazepam nasal spray, allowing for administration during either condition 1
Safety Profile and Adverse Effects
Common treatment-related adverse effects include:
- Dysgeusia (5.3%)
- Nasal discomfort (3.5%) 1
Sedation may occur but is typically manageable; no clinically significant changes in respiratory rate have been observed 1
The safety profile is consistent with the known profile of diazepam 1
When administering diazepam, be prepared to support ventilation as there is an increased incidence of apnea when given rapidly or when combined with other sedative agents 5
Important Clinical Considerations
Diazepam should be followed immediately by a long-acting anticonvulsant (such as phenytoin/fosphenytoin) for status epilepticus, as seizures often recur within 15-20 minutes due to rapid redistribution 5
Flumazenil may be administered to reverse life-threatening respiratory depression caused by diazepam, but it also counteracts the anticonvulsant effects and may precipitate seizures 5
Monitor oxygen saturation and respiratory effort during and after administration 5