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Rectal diazepam

  • Most seizures are brief and cease spontaneously within 5 minutes. If a seizure does not stop by itself within 10-15 minutes it becomes a medical emergency. Seizures lasting greater than 30 minutes may lead to brain and bodily injury.

    For prolonged seizures, doctors usually use an intravenous injection of diazepam or similar anticonvulsant medication. In young children, doctors sometimes prefer to administer diazepam rectally rather than into a vein. This is a technique that parents and carers can learn to use, if necessary.

    Indications for home use of rectal diazepam

    A neurologist or paediatrician may consider rectal diazepam in the following situations:

    • a child with a pattern of prolonged seizures (usually >10 mins.) which have previously responded to intravenous or rectal diazepam
    • a child with clusters of repeated seizures in whom oral treatment is inappropriate
    • a child with severe epilepsy who is remote from emergency services.

    Rectal diazepam is not necessary for children with mild or well-controlled forms of epilepsy.

    Rectal diazepam preparation

    Rectal diazapam kit

    The pharmacies at the Royal Children's Hospital (RCH) and some other Melbourne hospitals supply 'rectal diazepam kits'.

    The RCH kit contains:

    • a 25ml bottle of diazepam mixed with a stabilising solution, containing 1mg of diazepam in each 1ml
    • a reusable 10ml syringe
    • a reusable soft plastic tube to attach to the syringe for drawing up and injecting the diazepam
    • a sachet of lubricant jelly

    Risks of rectal diazepam administration

    Diazepam, if given in excess or in addition to certain other drugs, may cause depression or brief cessation of breathing. Therefore, it is recommended that an ambulance be called before proceeding with the rectal diazepam injection. Parents and carers should consider learning basic first aid and resuscitation skills.

    Injury to the rectum is possible with rectal diazepam injection but the risk is small with the soft plastic tube supplied with the RCH kit.

    The risk of a child having brain damage after a very prolonged seizure is greater than the risks associated with administration of rectal diazepam.

    Instructions for use of rectal diazepam

    If a child is having a seizure in which he/she is convulsing or is unconscious, it is important to follow simple first aid measures ie. protection from injury, positioning on their side to assist breathing.

    Phone for an ambulance, or other medical help to attend, unless you have been instructed otherwise.  Indicate to the operator that you are going to administer rectal diazepam as instructed by your child's doctor.  Parents and carers who are familiar with rectal diazepam administration and their child's response to rectal diazepam may not need to call for an ambulance.

    Instructions for use of Rectal diazapam 1

    The doctor will have given instructions on when to give rectal diazepam (what type of seizure, what duration) and how much to give. The usual dose is 0.3 - 0.5mg per kg body weight (max. 10mg).

    1. Put on gloves.
    2. Attach the soft plastic tube to the syringe and draw up the number of mls that the doctor has prescribed.

      Instructions for use of Rectal diazapam 2
    3. Lubricate the tip of the soft plastic tube with lubricating gel supplied.
    4. If the seizure or cluster has not ceased, administer the diazepam into the rectum. With the child on his/her side, separate the buttocks and gently insert the lubricated plastic tube through the anus for a distance of approximately 5cm, so that there is 2-3cm of the tube still in view.

      Instructions for use of Rectal diazapam 4
    5. Inject the prescribed dose.

      Instructions for use of Rectal diazapam 5
    6. Remove the tube from the anus and hold buttocks together so that the diazepam does not leak out.

      Instructions for use of Rectal diazapam 6
    7. Rectal diazepam may take 5-10 minutes to work. Do not repeat the dose unless previously advised.
    8. Lie the child on his/her side while waiting for the seizure to stop or for the child to recover from the seizure.

    Rectal diazepam video demonstration

    Prepared in accordance with a position statement on the use of rectal diazepam in epilepsy by Somerville ER and Anthony JH (Medical Journal of Australia 1995;163:268-269) and a National Prescribing Service review by O'Sullivan C and Harvey AS in Australian Prescriber 1998;21:35-36.

    The efficacy and safety of rectal diazepam was demonstrated in a double-blind, placebo-controlled trial in the USA in 1998, published in the New England Journal of Medicine.

    Rectal diazepam is also available in pre-prepared enema-like kits for easy administration of single doses.  None are presently marketed in Australia, though some public hospitals supply such preparations with a hospital prescription.  Such products are marketed in the USA ( Diastat) and in the UK (Stesolid).