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diazepam rectal

Pronunciation

Generic Name: diazepam rectal (dye AZ e pam)
Brand Name: Diastat AcuDial, Diastat Pediatric

What is diazepam rectal?

Diazepam is a benzodiazepine (ben-zoe-dye-AZE-eh-peen). Diazepam affects chemicals in the brain that may be unbalanced in people with seizures.

Diazepam rectal (for use in the rectum) is used to treat occasionally increased seizures (cluster seizures) in people with epilepsy who also routinely take other anti-convulsants. Diazepam rectal is not for long-term daily use to prevent seizures.

Diazepam rectal may also be used for purposes not listed in this medication guide.

What is the most important information I should know about diazepam rectal?

You should not use this medicine if you have untreated or uncontrolled narrow-angle glaucoma.

Not all types of seizures can be treated with diazepam rectal. If you are a patient caregiver, do not give this medication unless you know how to recognize the symptoms of a seizure episode that should be treated with diazepam rectal.

Do not start or stop using any of your seizure medications during pregnancy without your doctor's advice.

What should I discuss with my healthcare provider before using diazepam rectal?

You should not use this medicine if you are allergic to diazepam (Valium), or if you have untreated or uncontrolled narrow-angle glaucoma.

To make sure diazepam is safe for you, tell your doctor if you have:

  • glaucoma;

  • asthma, pneumonia, emphysema, bronchitis, chronic obstructive pulmonary disease (COPD), or other breathing disorder;

  • liver or kidney disease;

  • a history of depression or suicidal thoughts or behavior;

  • a history of drug or alcohol addiction;

  • if you use a narcotic (opioid) medication; or

  • if you are allergic to other benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clorazepate (Tranxene), lorazepam (Ativan), or oxazepam (Serax).

Do not start or stop taking diazepam during pregnancy without your doctor's advice. Diazepam may cause harm to an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking diazepam for seizures.

Diazepam can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

Do not give this medication to a child younger than 6 months old.

How should I use diazepam rectal?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Not all types of seizures can be treated with diazepam rectal. If you are the caregiver, do not give this medication unless you know how to recognize the symptoms of a seizure episode that should be treated with diazepam rectal.

After giving diazepam rectal to another person, stay with the person for at least 4 hours and watch for changes in his or her breathing, and any side effects from the medicine.

Get emergency medical help if:

  • the seizure has not stopped within 15 minutes after giving diazepam rectal;

  • the seizure seems to be different from the person's usual seizures;

  • the seizures seems to be closer together or more severe than the person's usual seizures; or

  • the person has breathing problems, pale or blue-colored skin, or any other serious or unusual problems.

Diazepam rectal is used in combination with other seizure medications. Use all medications as directed by your doctor. Read the medication guide or patient instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.

Diazepam rectal is not for long-term daily use to prevent seizures. Using diazepam rectal daily over long periods can actually make your seizures more frequent or more severe. You may also have withdrawal symptoms when you stop using diazepam rectal.

Diazepam may be habit forming. Never share diazepam with another person, especially someone with a history of drug abuse or addiction. Keep the medication in a place where others cannot get to it.

Do not use this medication for longer than 5 days in a row without a doctor's advice. Contact your doctor if this medicine seems to stop working as well in treating your symptoms.

Store at room temperature away from moisture, heat, and light.

After giving a dose of diazepam rectal, empty any leftover medicine from the syringe into a toilet and flush, or into a sink and rinse down the drain. Throw the empty syringe away where children and pets cannot get to it. Do not reuse a diazepam rectal syringe.

What happens if I miss a dose?

Since diazepam rectal is used on an as needed basis, you are not likely to miss a dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Overdose symptoms may include extreme drowsiness, loss of balance or coordination, limp or weak muscles, or fainting.

What should I avoid while using diazepam rectal?

Diazepam may impair your thinking or reactions. Do not drive, operate machinery, or perform other hazardous activities until you are alert and awake and you no longer feel drowsy from this medicine.

Avoid drinking alcohol. Dangerous side effects could occur.

Grapefruit and grapefruit juice may interact with diazepam and lead to unwanted side effects. Discuss the use of grapefruit products with your doctor.

Diazepam rectal side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if the person receiving this medication has:

  • worsening seizures, or seizures that seem different from the patient's other seizures;

  • pale or discolored skin, feeling like you might pass out;

  • confusion, hallucinations, unusual thoughts or behavior, unusual risk-taking behavior, decreased inhibitions, no fear of danger; or

  • hyperactivity, agitation, hostility, depressed mood, thoughts of suicide or hurting yourself.

The sedative effects of diazepam rectal may last longer in older adults. Accidental falls are common in elderly patients who take benzodiazepines. Use caution to avoid falling or accidental injury while you are using diazepam rectal.

Common side effects may include:

  • drowsiness, dizziness, headache, nervous feeling;

  • stomach pain, diarrhea;

  • flushing (warmth, redness, or tingly feeling);

  • weakness, loss of coordination; or

  • runny nose, sneezing.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Diazepam rectal dosing information

Usual Adult Dose for Anxiety:

ORAL:
2 to 10 mg orally 2 to 4 times a day

PARENTERAL:
Moderate Anxiety Disorders and Symptoms: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary
Severe Anxiety Disorders and Symptoms: 5 to 10 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Oral doses should be determined by the severity of symptoms.
-Anxiety associated with the stress of everyday life usually does not require treatment with this drug.

Use: Management of anxiety disorders and short-term relief of anxiety symptoms

Usual Adult Dose for Alcohol Withdrawal:

ORAL:
-Initial dose: 10 mg orally 3 to 4 times a day for the first 24 hours
-Maintenance dose: 5 mg orally 3 to 4 times a day as needed

PARENTERAL:
10 mg IM or IV once, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Use: Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal

Usual Adult Dose for Muscle Spasm:

ORAL:
2 to 10 mg orally 3 to 4 times a day

PARENTERAL:
5 to 10 mg IM or IV, then 5 to 10 mg IM or IV in 3 to 4 hours if necessary

Comment:
-Larger parenteral doses may be necessary for patients with tetanus.

Use: Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Adult Dose for Seizures:

ORAL:
2 to 10 mg orally 2 to 4 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment for convulsive disorders

Usual Adult Dose for Endoscopy or Radiology Premedication:

PARENTERAL:
Cardioversion: 5 to 15 mg IV once 5 to 10 minutes before the procedure

Endoscopic Procedures:
IV: Usually less than 10 mg, but some patients require up to 20 mg IV, especially when narcotics are omitted
-IV titration: The IV dose should be titrated to desired sedative response (e.g., slurring of speech) with slow administration immediately before the procedure.

IM: 5 to 10 mg IM once 30 minutes prior to the procedure

Comments:
-Narcotic dosing should be reduced by approximately 33%, and may be omitted in some patients.
-The IV route is preferred, but IM administration may be used if IV administration is not possible.

Uses:
-Adjunct prior to endoscopic procedures if apprehension, anxiety, or acute stress reactions are present and to diminish recall of the procedures
-Prior to cardioversion for the relief of anxiety and tension and to diminish the patient's recall of the procedure

Usual Adult Dose for Status Epilepticus:

PARENTERAL:
-Initial dose: 5 to 10 mg IV once, repeated at 10 to 15 minute intervals to a maximum dose of 30 mg if necessary

Comments:
-The IV route is preferred; however, the IM route may be used if IV administration is impossible.
-Treatment may be repeated every 2 to 4 hours, but active metabolites may persist during readministration.
-Patients with chronic lung disease or unstable cardiovascular conditions should be given this drug with extreme caution.

Use: Adjunct to status epilepticus and severe recurrent convulsive seizures

Usual Adult Dose for Light Anesthesia:

PARENTERAL:
Preoperative Medication: 10 mg IM once before surgery

Comments:
-The IM route is preferred when given as a preoperative medication.
-Atropine, scopolamine, and other premedications should be administered in separate syringes.

Use: Premedication for the relief of anxiety and tension in patients undergoing surgical procedures

Usual Geriatric Dose for Seizures:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

RECTAL:
-Initial dose: 0.2 mg/kg rectally, rounded downward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment:
-Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Geriatric Dose for Alcohol Withdrawal:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Anxiety:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Geriatric Dose for Muscle Spasm:

ORAL:
-Initial dose: 2 to 2.5 mg orally once to 2 times a day

PARENTERAL:
-Initial dose: 2 to 5 mg IM or IV, repeated in 3 to 4 hours if necessary

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizures:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

RECTAL:
2 to 5 years:
-Initial dose: 0.5 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.5 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

6 to 11 years:
-Initial dose: 0.3 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.3 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: 1 episode every 5 days, and no more than 5 episodes/month

12 years and older:
-Initial dose: 0.2 mg/kg rectally, rounded upward to the next available dose. A 2.5 mg rectal dose may be given as a partial replacement if patients expel a portion of the initial dose
-If necessary, a second dose of 0.2 mg/kg may be given rectally 4 to 12 hours after the first dose.
-Maximum Frequency: May be used to treat up to 1 seizure episode every 5 days, and no more than 5 episodes/month

Comment:
-Oral doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount

Uses:
-Management of selected, refractory patients with epilepsy on stable regimens of antiepileptic drugs who require intermittent use of this drug to control bouts of increased seizure activity
-Adjunctive treatment in convulsive disorders

Usual Pediatric Dose for Status Epilepticus:

PARENTERAL:
IV Injection:
30 days to less than 5 years: 0.2 to 0.5 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 5 mg. Repeat in 2 to 4 hours if needed.

5 years and older: 1 mg slow IV injection every 2 to 5 minutes, up to a maximum dose of 10 mg. Repeat in 2 to 4 hours if needed.

Comment:
-EEG monitoring may be helpful to monitor seizure activity.

Use: Adjunct in status epilepticus and severe recurrent convulsive seizures

Usual Pediatric Dose for Anxiety:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Muscle Spasm:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Seizure Prophylaxis:

ORAL:
6 months and older:
-Initial dose: 1 to 2.5 mg orally 3 to 4 times a day

Comments:
-Doses may be increased gradually as needed and tolerated, but should be limited to the smallest effective amount.
-Maintenance doses should be determined by clinical need and patient tolerance.

Uses:
-Management of anxiety disorders and short-term relief of anxiety symptoms
-Symptomatic relief of acute agitation, tremor, impending/acute delirium tremens, and hallucinations in acute alcohol withdrawal
-Adjunctive treatment for the relief of skeletal muscle spasm due to reflex spasm to local pathology, spasticity caused by upper motor neuron disorders, athetosis, and stiff-man syndrome (e.g., inflammation of the muscles/joints secondary to trauma, cerebral palsy, paraplegia)

Usual Pediatric Dose for Tetanus:

PARENTERAL:
30 days to 5 years: 1 to 2 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary

5 years and older: 5 to 10 mg IM or slow IV injection, repeated every 3 to 4 hours as necessary to control spasms

Comment:
-Respiratory assistance should be available for patients.

Use: Tetanus

What other drugs will affect diazepam rectal?

Using diazepam with other drugs that make you sleepy or slow your breathing can cause dangerous side effects or death. Ask your doctor before taking a sleeping pill, narcotic pain medicine, prescription cough medicine, a muscle relaxer, or medicine for anxiety, depression, or seizures.

Other drugs may interact with diazepam rectal, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

Where can I get more information?

  • Your pharmacist can provide more information about diazepam rectal.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 6.06.

Date modified: June 01, 2017
Last reviewed: December 14, 2016

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