The Use of Rectal Valium for the Emergency Management of Seizures

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What is Valium (diazepam)?

Valium is also known as diazepam, and belongs to the benzodiazepine group of medications. Its main use is as a sedative muscle relaxant and as an antiepileptic medication. Valium (diazepam) is available in several forms: as a tablet, in liquid for intravenous or intramuscular administration and in a preparation suitable to administer rectally. Rectal administration can be an effective way to deliver the Valium (diazepam) during a seizure; however, another drug called midazolam has become the preferred prescribed
emergency medication due to its ease of administration and rapid action.

Why is rectal valium (diazepam) use for some people with epilepsy?

Most seizures are spontaneous, brief and self-limiting but some people with epilepsy can have seizures that continue unless there is emergency intervention. These seizures may be referred to as clusters, prolonged seizures or status epilepticus. Rectal valium (diazepam) is used for emergency management of seizures because it has the ability to stop seizures reasonably quickly. It may be
prescribed for someone with epilepsy when:

  1. A person has seizures that last longer than 5 minutes
  2. A person has a pattern of cluster seizures – seizures that recur close together
  3. A person has a history of status epilepticus
  4. A person lives in a rural area and emergency services are unable to respond quickly

How is rectal valium (diazepam) given for seizure management?

Non-medical people can be trained to administer rectal valium (diazepam). The medication is squirted in the bowel through the anus. The blood vessels in the bowel absorb the valium (diazepam) and the medication should stop the seizure within 5 to 10 minutes. If ambulance officers attend they will inject midazolam intramuscularly (into the muscle) if the seizure hasn’t ceased.

How is rectal valium (diazepam) packaged?

Rectal valium (diazepam) is a clear, colourless liquid and is available for administration by non-medical people. A package will include a pharmaceutically prepared enema vial containing 5mg of valium (diazepam) in 5ml of gel-like solution and a sachet of lubricant.

Possible side effects of rectal valium (diazepam)

  • Breathing difficulties such as shallow and slow breathing
  • Drowsiness, tiredness, weakness
  • Puncturing the wall of the rectum (very rare)
  • Loss of dignity and embarrassment on recovery
  • On rare occasions it may provoke status epilepticus in children with Lennox_Gaustaut
    sydrome.

A test dose under medical supervision may be recommended or the ambulance can be called prior to the administration of the first dose. This issue should be discussed with the prescribing doctor before the medication is used for the first time.

Storage

  • Keep out of reach of children
  • Protect from light and store at room temperature (below 25°C)
  • Regularly check the expiry date.

What information do you need from the doctor if rectal valium (diazepam) is prescribed?

The Epilepsy Foundation has an Emergency Medication Management Plan for the prescribing doctor to complete. This should be signed and dated and include the following essential information:

  1. How much to give – dose will be written as_________mg_________ml
  2. When to give the first dose and for which seizure type
  3. If a second dose can be given, the dose and when it is to be given must be specified
  4. How many doses can be given in a 24-hour period
  5. When to call an ambulance.

If you are required to give rectal valium (diazepam) consider the following:

For families, carers and support workers:

  1. Training should be person or client specific
  2. It is important you understand and follow the Emergency Medication Management Plan; you must know the dose and for which seizure type and at what time you are instructed to give the medication
  3. You know when to call the ambulance
  4. You know how to do CPR.

Additional considerations for workers:

  1. Your CPR first aid certificate is current
  2. You understand and follow your workplace policies in relation to managing epilepsy and administering medication
  3. Your workplace should arrange training for you prior to administering midazolam for the first time

Training and support

The Epilepsy Foundation provides training in the administration of rectal valium (diazepam) and the development of Emergency Medication Management Plans for family or staff supporting a person with epilepsy. Contact the Epilepsy Foundation for further information about training and any costs involved.