Section 01 · Monograph
Diazepam nasal
Reviewed Nov 2026FDA label
ValtocoBenzodiazepine · rescue
- Forms
- NS: 5, 7.5, 10mg/0.1mL devices (5-20mg doses)
- Dose
- Age-based: 0.2mg/kg (12+), 0.3mg/kg (6-11), 0.5mg/kg (2-5); may repeat x1 after 4h
- MOA
- ↑GABA-A Cl- channel frequency
Black Box Warning
- Concomitant use of benzodiazepines and opioids may result in profound sedation, respiratory depression, coma and death
- Abuse, misuse and addiction risk
- Dependence and withdrawal reactions
Indications
- Acute treatment of intermittent, stereotypic episodes of frequent seizure activity (seizure clusters) in patients 2 years of age and olderFDA-labeled
Mechanism of Action
- Benzodiazepine that enhances GABA-A receptor chloride channel opening frequency
Full Dosing
Adult / usual
- Age and weight based: age 2-5 years 0.5mg/kg; 6-11 years 0.3mg/kg; 12 years and older 0.2mg/kg; supplied as 5, 10, 15 and 20mg dose devices
- A second dose may be given at least 4 hours after the first if needed; do not treat more than one episode every 5 days or more than five episodes per month
Contraindications
- Acute narrow-angle glaucoma
- Known hypersensitivity to diazepam
Drug Interactions
- Opioids and other CNS depressants: profound sedation and respiratory depression
- CYP2C19 and CYP3A4 inhibitors increase diazepam levels
Adverse Effects
- Somnolence, headache
- Nasal discomfort
- Respiratory depression
- Dependence and withdrawal
Monitoring Parameters
- Respiratory status and sedation
- Frequency of use
- Misuse risk
Pregnancy & Lactation
- Late-pregnancy exposure can cause neonatal sedation or withdrawal
- Present in milk; monitor infants