Diazepam (Rectal)

How it works

It enhances GABA-A receptor-mediated chloride conductance, increasing inhibitory neurotransmission to terminate seizure activity; the rectal route gives rapid absorption when intravenous access is unavailable.

Prescribing in practice

• The main hazard is respiratory and CNS depression, so administer with attention to airway and breathing and provide carers with a clear rescue protocol including when to call emergency services.
• Effect is potentiated by alcohol, opioids and other CNS depressants, which compound respiratory depression.
• Use cautiously in respiratory insufficiency; for children, a children's formulary should be consulted and a written individualised emergency care plan provided to carers.

Monitoring

Monitor conscious level, respiration and seizure response after administration, observing for sedation and the need for further emergency care.

Counselling the patient

• Carers should be trained on technique, dosing and exactly when to seek emergency help.
• Watch for excessive drowsiness or slowed breathing after a dose.
• Record the time and response of each administration.

Evidence & guidelines

Rectal diazepam is an established option for terminating prolonged convulsive seizures when intravenous access is not available, reflected in UK status epilepticus guidance, where buccal midazolam is often now preferred in the community.