Diazepam (Rectal)

Rectal diazepam is a form of epilepsy medication which is used to treat seizures once they have begun and if they have lasted more than five minutes.

Overview

Rectal Diazepam, sometimes known as a diazepam kit, is a very specific treatment prescribed under particular circumstances. It is only usually prescribed to patients who suffer from epilepsy or seizures, and who are already taking other medication to control and treat their seizures. Rectal diazepam is a medication which acts in the short-term in order to stop a seizure once it has already begun. It must be administered by a caregiver, as the patient will not be able to administer the medication themselves. The rectal method is used as it allows the drug to be absorbed into the bloodstream quickly to have a fast effect. It can also be difficult for caregivers and medical staff to gain access to the mouth while a patient is having a seizure, when there is an increased chance of choking. Rectal administration is, therefore, a preferred method.

Before administering the drug, it is important to check that the dosage is correct. The dose should have been set by the pharmacist as prescribed by the doctor. The syringes provided should come locked in a ready position to make it as easy as possible to administer the drug.

It is not a cure for epilepsy, nor should it be used every day as a preventative measure. Instead, it is given to a patient when they are having a seizure to ensure that this seizure comes to an end quickly and safely. It is not recommended for use more than five times within a month. If the patient is experiencing cluster seizures more than five times a month, they should get in touch with their doctor immediately, as they may require a change in their medication or treatment plan.

When administering rectal diazepam, if the patient does not respond to the medication and is still having the seizure 10 to 15 minutes after the rectal diazepam was given, another dose is sometimes recommended to help bring the seizure to a close. If this still does not work, emergency help should be sought immediately.

Diazepam works by reducing the abnormal activity in the brain which takes place during a seizure.

Conditions Treated

  • Cluster seizures caused by epilepsy

Type Of Medicine

  • Benzodiazepines

Side Effects

Although medications are prescribed in order to treat symptoms or conditions, sometimes the chemicals in the drug can cause side effects in the form of different symptoms. Doctors and pharmacists will be aware of these potential side effects when they prescribe the medication, but if they do prescribe the drug, it is because they believe that the potential benefits of taking the medication outweigh the impact of the side effects. Most people who are given rectal diazepam do not experience serious side effects.

There are only a few serious side effects which have been associated with rectal diazepam, and these are very rare. These include:

  • Difficulty breathing
  • Hallucinations
  • Severe rage
  • Extensive rash

If the patient experiences any of these symptoms after being given rectal diazepam, they should seek medical attention and make sure that the doctor is aware of their condition and that they have recently taken rectal diazepam.

There are a few less serious side effects associated with taking rectal diazepam to control seizures. These can usually be treated or managed without the need to seek medical attention. The following symptoms have been associated as side effects of rectal diazepam:

  • Dizziness
  • Headaches
  • Drowsiness
  • Stomach cramps
  • Unexplained pain
  • Difficulty balancing
  • Mood changes
  • Difficulty walking
  • Difficulty sleeping
  • Diarrhea
  • Anxiety
  • A runny nose
  • Insomnia

If patients experience any of the above after taking rectal diazepam and they are particularly severe or persistent, call a doctor to discuss it with them. There may be something that they can do to help manage or treat these symptoms.

Dosage

When administered rectally, doses of diazepam gel are given to the patient by filling a plastic syringe with a pre-measured dose and inserting this into the rectum. The dose will vary according to the age and weight of the patient, as well as the severity of their condition. Doctors will work with specific patients in order to find the right dose for them, and this should be written on the outer packaging of the medication.

For neonatal patients, an initial dose of 1.25 ' 2.5 mg is usually given, with another dose of 1.25 '2.5 mg to be given after 10 minutes if necessary.

For young children aged between one month and one year old, an initial dose is usually set at 5 mg, with a further 5 mg to be administered 10 minutes later if needed.

For children aged between two and 11 years old, 10-20 mg of diazepam is usually prescribed as an initial dose, with the same dose to be repeated 10 minutes later if required.

For children, adolescents and adults aged 12 years and over, an initial dose of between 10 and 20 mg is usually prescribed, with another dose to be given after a quarter of an hour if necessary.

The dose may be reduced back down to 10 mg in the case of elderly patients.

Overdose

It is possible to overdose on diazepam, so care should be taken not to administer too much of the drug at once. If patients experience any of the following symptoms after taking rectal diazepam, they could be a sign of an overdose:

  • Confusion
  • Severe drowsiness
  • Vomiting
  • Slow reflexes
  • Coma

If any of the above symptoms are experienced, medical help should be sought straight away. When seeking medical help, make sure that the healthcare professionals are aware that an overdose on diazepam is a possibility.

Interactions

Whenever more than one pharmaceutical is consumed by a patient, there is always the possibility of an interaction between these chemicals. Interactions between different drugs can stop either, both or all of the medications from working as effectively against the condition they are being used to treat. Interactions can also have an effect on side effects, in some cases increasing the possibility or severity of certain side effects, or bring about new ones are not associated with either drug in isolation.

In the case of rectal diazepam, this drug can increase the probability of patients having serious, and potentially life-threatening, breathing difficulties, can cause patients to become fatigued or sedated, and can even cause patients to enter a coma in rare circumstances. The following drugs are all known to interact with rectal diazepam, and patients should, therefore, double check with their doctor or healthcare professional if prescribed rectal diazepam while taking:

  • Tramadol
  • Methadone
  • Oxycodone
  • Morphine
  • Fentanyl
  • Meperidine
  • Hydromorphone
  • Codeine
  • Anticoagulants
  • Antidepressants
  • Antifungal medication
  • Antihistamines
  • Tranquilizers
  • Cyclosporine
  • Dexamethasone
  • MAO inhibitors
  • Phenobarbital
  • Quinidine
  • Sleeping pills
  • Troleandomycin

Interactions can sometimes be controlled by adjusting the doses of the medications being taken, by swapping one drug for an alternative treatment or by using other medication to treat any potential symptoms.

It is not just prescription medications which can react with diazepam. Alcohol and recreational drugs can also change the way in which the diazepam works within the body and can cause serious and potentially life-threatening symptoms. Patients should not drink alcohol or take street drugs during the period in which they are receiving rectal diazepam treatments.

It is not just medications and dietary supplements which can interact with rectal diazepam. Grapefruit and grapefruit juice can interact with the function of the drug, and should, therefore, be avoided while taking rectal diazepam. Alcohol and recreational drugs can also interact with the drug and should also be avoided while taking rectal diazepam. As rectal diazepam is a drug which is administered when needed, and not on a regular basis, it is recommended for patients to avoid these foodstuffs and substances at all times, just in case a dose of rectal diazepam is required.

Warnings

Due to the nature of medications and the chemical changes they can have on the body, there are certain conditions in which they can cause harm. Some underlying medical conditions can be exacerbated by drugs which are intended to treat other illnesses. Patients should always make sure that their doctor has an accurate and fully updated medical history at all times, making sure to list any medications they are taking and any allergies they might have. When being prescribed with rectal diazepam, it is particularly important to let your doctor know if any of the statements below are true:

  • You have ever had an allergic reaction to diazepam or Valium or any of their constituent ingredients
  • You have ever had an allergic reaction to any other medication
  • You are currently taking any herbal supplements, especially St John's Wort
  • You have ever had a dependency on alcohol or street drugs
  • You have a visual impairment or eye condition eg. Glaucoma
  • You have lung problems, asthma, pneumonia or regular difficulty breathing
  • You currently have, or have ever had, liver or kidney disease
  • You are aged 65 or above
  • You are currently pregnant, or plan to become pregnant soon
  • You are currently breastfeeding, or plan to breastfeed soon
  • You have recently had, or are scheduled to have, dental surgery

Rectal diazepam may cause harm to unborn babies, and is therefore not always recommended by doctors for treating pregnant women. However, in many cases, the risk of harm presented by untreated seizures to both mother and child can outweigh the risk of harm from the drug. Speak to your doctor before continuing to take rectal diazepam while pregnant. Similarly, the active ingredients in the drug may pass into breast milk which can cause harm to infants and small children. It is therefore not recommended to breastfeed while receiving treatment with rectal diazepam.

Rectal diazepam can make you drowsy or sleepy for the rest of the day. You should not operate machinery, drive a vehicle or ride a bike until well after the drowsiness has worn off.

Diazepam is a drug which leaves patients susceptible to addiction. The risk of addition is particularly high in patients who have previously experienced difficulties with substance abuse. The prescribed dose should not be exceeded, and the drug should not be used regularly for long periods of time. Using the drug regularly can lead to dependence and can cause withdrawal symptoms if treatment is stopped.

Storage

This medication should be stored in the container in which it was provided by the hospital or pharmacy. It should be clearly labelled, so as not to be confused with other drugs or chemicals. Diazepam should be stored at room temperature, in a place which is not exposed to extreme swings in temperature. The medication should also be kept away from moist conditions, and therefore should not be stored in a bathroom or kitchen. This medication can be harmful if consumed when not needed - containers should be kept well out of the reach of pets and children.

Empty syringes should be disposed of safely and hygienically. As the medication is administered rectally, there is a risk of infection from used syringes if not disposed of in the correct manner. If you are left with excess diazepam which is no longer required or has gone past its expiry date, it should not be disposed of along with general household waste. Talk to your pharmacist about the best way of disposing of the drug, which may be as part of a medicine take-back program.

As rectal diazepam is an emergency treatment, it can be necessary to carry it around in case it is required whilst the patient and the caregiver are out of the house. The same guidelines for storing the medication also apply when carrying it whilst out and about. It should still be kept at room temperature somewhere dry and out of direct sunlight. It should also remain correctly labelled in its original packaging, and care should be taken to keep the drug out of the reach of children and pets.

Summary

Rectal diazepam is a form of treatment used to help epileptic patients. It is an emergency medication, delivered at home by a caregiver or healthcare professional. It is used to treat epileptic seizures which are already in progress. It is not a form of medication which is supposed to prevent the seizures from occurring but is an in-the-moment drug which is used to bring the seizure to a stop after it has begun. Rectal diazepam is therefore only used as part of a wider treatment plan for patients with epilepsy and is prescribed alongside medication to reduce the frequency and severity of seizures.

Diazepam is a substance which can be addictive for some patients. It is, therefore, necessary to understand that it should not be used too regularly, and its use should frequently be reviewed in appointments with doctors.

There are many different drugs which may have an interaction with diazepam, and it is, therefore, necessary to keep an up-to-date and accurate list of all of the medication the patient is currently taking, in order for the doctors and pharmacists to make sure that there are no contraindications.

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