Diazepam Nasal Spray (Valtoco^®)

Important information:

What is diazepam nasal spray?
Diazepam nasal spray (Valtoco^®) is also known as Valium. Diazepam calms the brain and stops seizures by preventing the nerve cells in the brain from firing abnormal electrical signals. Diazepam nasal spray is easy to give, safe, and painless for your child.

Why is diazepam given into the nose?
When diazepam is given into the nose, it is quickly absorbed and usually stops a seizure within 5 minutes.

How is diazepam nasal spray supplied?
Diazepam nasal spray comes in a pre-filled device. It is available in 5 mg, 10 mg, 15 mg, and 20 mg doses. When you pick up your prescription, you will receive one box. One box contains enough devices to give two doses of the medicine.

• The 5mg and 10mg doses come with two devices in the box. One device gives a full dose of medicine.  Your provider may instruct you to give one dose (first device), wait to see if the seizure stops, and then give a second dose (second device) if needed.

• The 15mg dose comes with four 7.5 mg devices in the box. Use two devices to give the full dose (7.5 mg + 7.5 mg = 15 mg). Use one device in each nostril. Your provider may instruct you to give one dose (two devices), see if the seizure stops, and then give a second dose (two devices) if needed.

• The 20mg dose comes with four 10 mg devices in the box. Use two devices to give the full dose (10 mg + 10 mg = 20 mg). Use one device in each nostril. Your provider may instruct you to give one dose (two devices), see if the seizure stops, and then give a second dose (two devices) if needed.

Patient instructions:

• Use each device once, and then throw it away. There is no extra medicine in the device, so do not do any “test” sprays. Do not press the plunger until the device is in your child’s nose.

• Your child does not need to inhale or breathe deeply for the medicine to work. It is absorbed in the nose.

• There will be an expiration date on the box and device packages. Refill your prescription before the expiration date on the device.

• Your child’s dose is based upon his weight. As your child grows, their dose may need to be increased by your healthcare provider.

How should I store the diazepam nasal spray?
The temperature range for storing diazepam nasal spray is 59°F to 86°F (15°C to 30°C). It is best to store it at room temperature whenever possible, which is 68°F to 77°F (20°C to 25°C). Do not refrigerate this medication or leave it in your car where it may get too hot or too cold.

What do I do when I see my child having a seizure?

• Begin seizure first aid as instructed below.

• Note the time that the seizure starts so you will know when to give the diazepam nasal spray.

• Pay attention to what the seizure looks like and how long it lasts.

Seizure first aid includes these steps:

• Lower your child to the floor and move anything away from them that could be harmful such as a coffee table, toys, or sharp objects.

• If your child’s head is jerking or banging, then put something soft under their head to prevent injury.

• Remove eyeglasses and loosen anything tight around the neck, such a necklace or necktie.

• Do not hold down or restrain your child.

• Place your child on their side to allow saliva to drain out if possible.

• Do not place anything into the mouth. Your child cannot swallow his tongue.

• Stay with your child until the seizure ends.

Call 911 if:

• You are concerned about your child’s color or breathing.    

• The seizure does not stop after the 1st or 2nd dose of diazepam nasal spray (as directed by your healthcare provider).

• Your child is not returning to baseline within about 5 minutes of the end of the seizure.

• Your child is injured during the seizure.

When do I give my child the diazepam nasal spray?
Your healthcare provider will tell you when to give the diazepam nasal spray. Information should be on the prescription. For example, it may say “Administer Valtoco for a seizure lasting longer than 5 minutes.”

To administer diazepam nasal spray:

• Begin with seizure first aid as outlined above.

• Open the diazepam nasal spray box and remove the device (or devices depending on the dose) from its package.

• Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.  Do NOT press the plunger yet. There is no extra medicine, so do not do any test sprays.

• Insert the tip of the nozzle into one nostril until your fingers are against the bottom of the nose. Most of the nozzle should be inside the nose.

• Press the bottom of the plunger firmly with your thumb to give the medicine.

• Your child does not need to inhale or breathe deeply. The medicine is absorbed by the nose.

• For 5 mg and 10 mg doses, you have now given the full dose.

• For 15 mg and 20 mg doses, you have only given half the dose. Immediately repeat the steps above using a second device in the other nostril.

• Note the time that you gave the diazepam nasal spray.

• Stay with your child and monitor their color and breathing for 30 minutes after giving the medicine. If you notice the problems listed above, then call 911.

What if the seizure doesn’t stop? Should I give a second dose?

• Follow directions from your healthcare provider. If the seizure continues after the first dose of the diazepam nasal spray, then your healthcare provider may recommend giving a second dose.

• Your healthcare provider will tell you how long to wait before giving a second dose.

• One box contains enough devices to give two doses of the medicine.

• The 5 mg and 10 mg doses contain two devices in the box. Each device gives a full dose of medicine. If instructed by your provider, then use the other device to give the second dose if needed.

• The 15 mg dose contains four 7.5 mg devices in the box. You need to use two devices to give the full dose (7.5 mg + 7.5 mg = 15 mg) of medicine. If instructed by your provider, then use the two remaining devices to give a second dose if needed.

• The 20 mg dose comes with four 10 mg devices in the box). You need to use two devices to give the full dose (10mg + 10mg = 20mg) of medicine. If instructed by your provider, then use the two remaining devices to give a second dose if needed.

What kinds of side effects can I expect?
The most common side effect is sleepiness which wears off over several hours. Other less frequent side effects include headache, diarrhea, skin rash, dizziness, pain, stuffy nose, abdominal pain, nervousness, feeling unsteady or clumsy, and wheezing. Tell your healthcare provider if your child has any unexpected side effects.

If diazepam nasal spray stops my child’s seizure, then do I still need to give my child their other seizure medicines?
Yes. Diazepam nasal spray is given in addition to your child’s usual anti-seizure medicines. Keep giving the usual anti-seizure medicines as prescribed.

You will receive a copy of diazepam nasal spray (Valtoco) instructions with your prescription. You should read and understand these instructions before you give your child diazepam nasal spray. You can also find these instructions on the manufacturer’s website valtoco.com/how-to-use.

Ask your healthcare provider what you should do after you give your child diazepam nasal spray. They may tell you to call 911, the on-call neurologist, or your neurology provider.

If you have questions or concerns not answered here, then please talk with your healthcare provider or pharmacist.

Reviewed July 2024 by Dennis Dlugos, MD, MSCE