Intrarectal Diazepam in Epileptic Adults

Abstract

Intrarectally (i.r.) administered diazepam (DZP) solution at doses of 20 and 30 mg in the treatment of serial seizures was studied in 39 adult patients with refractory partial epilepsy. Patients were randomly distributed into two groups (20 mg, n = 21; 30 mg, n = 18). Plasma levels of DZP were assessed over 24 h following i.r. injection. The efficacy of i.r. DZP in the treatment of serial seizures in adults was confirmed; onset of effect was noted approximately 10 min after the injection, and the effective dose was 0.50 mg/kg. Tolerance and acceptability were good. Intrarectal injection of DZP can be performed even by unskilled personnel and may be recommended in patients with serial seizures in the hope of preventing development of status epilepticus.

A Single‐Blind, Crossover Comparison of the Pharmacokinetics and Cognitive Effects of a New Diazepam Rectal Gel with Intravenous Diazepam

“…Mean bioavailability for rectal solutions ranged from 81 to 102%, and t , , ranged from 17 to 65 min. With both dosage forms, there was substantial intersubject variability (8)(9)(10)22). The proprietary rectal formulation used in this study is a viscous gel with a composition different from the DZP formulations used in previous investigations.…”

Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society

“…Nine RCTs (three class I [22][23][24], one class II [25], and five class III [26][27][28][29][30]) addressed the efficacy of initial therapy. The 1998 Veteran's Affairs status epilepticus study was a multicenter randomized comparison of four different IV treatments: lorazepam (0.1 mg/kg), diazepam (0.15 mg/kg) followed by phenytoin (18 mg/kg), phenobarbital (18 mg/kg), and phenytoin alone (18 mg/kg) in adults with either overt or subtle status epilepticus (22).…”

Symptom control in cancer patients: the clinical pharmacology and therapeutic role of suppositories and rectal suspensions

“…Peak concentrations occur within 20 min, and parenteral diazepam thus has a distinct advantage for treatment of uncontrolled seizures over standard antiseizure medications given by rectum, which require several hours to peak concentrations [26,33,67,145,155]. A dose of 0.5 mg/kg by rectum is the usual dose [67,145]. A sensation of rectal burning can ensue in many patients (60%) and is unrelated to rectal pathology [178].…”

“…Parenteral preparations of diazepam given by rectum are rapidly and completely absorbed [9,26,33,145,155,173]. Peak concentrations occur within 20 min, and parenteral diazepam thus has a distinct advantage for treatment of uncontrolled seizures over standard antiseizure medications given by rectum, which require several hours to peak concentrations [26,33,67,145,155].…”