Diazepam Rectal Gel

Important information about diazepam rectal gel:

What is diazepam rectal gel?
Diazepam rectal gel is also known as Valium^®. Diazepam stops seizures by preventing the nerve cells in the brain from firing abnormal electrical signals.  

Why is diazepam given rectally?
When diazepam is given into the rectum, it is quickly absorbed and usually stops a seizure within 15 minutes. Diazepam rectal gel is easy to give. It is safe and painless for your child to receive.  

How is diazepam rectal gel supplied?

• Diazepam rectal gel comes in a pre-filled syringe (for 2.5mg dose) or in an adjustable dose syringe (for higher doses).

• The gel is clear to slightly yellow in color.

• If you are using an adjustable dose syringe, the pharmacist sets and locks the correct dose in the syringe before giving it to you. You will receive one case which includes 2 pre-filled syringes of the medicine, lubricating jelly, and instructions that show you how to give the diazepam rectal gel. The syringe is used one time and then thrown away.

If your doctor prescribed an adjustable dose syringe, check these things before you leave the pharmacy:

• Remove each syringe from the case.

• Check that the dose prescribed by your healthcare provider is visible on the syringe in the Dose Display Window.

• Confirm that the green “READY” band is visible on the syringe.

• Return the syringe to the case.

There will be an expiration date on the box and syringes.

• Refill your prescription before the expiration date on the syringe.

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

How should I store the diazepam rectal gel?
The temperature range for diazepam rectal gel is 59°F to 86°F. Diazepam rectal gel should not be refrigerated or left in your car where it may get too cold or too hot.  

Instructions for giving diazepam rectal gel:

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

Seizure first aid includes:

• 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, put something soft under their head to prevent injury.

• Remove any eyeglasses and loosen anything tight around the neck, for example, a necktie.

• Do not hold down or restrain your child.

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

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

• Stay with your child until the seizure ends.

• Call EMS (911) if you are concerned about your child’s color or breathing, the seizure is not stopping after 1st or 2nd dose of diazepam rectal gel (as directed by your healthcare provider), or they are injured during the seizure.

When do I give my child the diazepam rectal gel?
Your healthcare provider will tell you when to give the diazepam rectal gel.  Information will be in the prescription.

Steps to administer diazepam rectal gel:

1. Begin with seizure first aid as outlined above.

2. Get the diazepam rectal gel. Remove the cap from the medicine syringe and lubricate the tip with lubricating jelly.

3. With your child facing you, bend their upper leg towards you and separate buttocks.

4. Gently insert syringe tip into rectum until rim fits snug against rectal opening.

5. Slowly count to 3 while pushing plunger until it stops. Count to 3 with the syringe in place. Remove the syringe.

6. Hold buttocks together for 3 additional seconds to prevent medicine from leaking out of rectum.

7. Keep your child on their side if possible.

8. Stay with your child and monitor their color and breathing for 30 minutes after giving the medicine. If you notice problems, call EMS (911).

What if the diazepam rectal gel leaks as I’m administering it or immediately after?
If the diazepam rectal gel leaks from the rectum or if your child has a bowel movement when you are giving the medicine and the seizure is ongoing, then give the second dose of diazepam rectal gel included in the kit.

What if the seizure doesn’t stop? Should I give a second dose?
Follow directions provided by your healthcare provider. If the seizure continues 5 minutes after the initial dose of the diazepam rectal gel is administered, then your healthcare provider may recommend administering a second dose of diazepam rectal gel.

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 experiences any unexpected side effects.

If diazepam rectal gel stops my child’s seizure, then do I still need to give my child their other seizure medicines?
Yes. Diazepam rectal gel is given in addition to your child’s usual anti-seizure medicine(s). Keep giving the usual anti-seizure medicine(s) and the usual dose(s).

What should I do after I give diazepam rectal gel?
Ask your healthcare provider what to do next. They may tell you to call EMS (911), the on-call neurologist, or your neurology provider.

Reviewed June 2024 by Dennis Dlugos, MD, MSCE