Nasal Diazepam: A New Era in Emergency Seizure Treatment for Kids

Nasal Diazepam: A New Era in Emergency Seizure Treatment for Kids

Introduction

Seizure emergencies in children — especially seizure clusters — can be frightening, unpredictable, and life-threatening if not managed quickly. Traditionally, caregivers had to rely on rectal diazepam or wait for hospital intervention. But with the development of nasal diazepam spray (Valtoco), a new chapter in at-home seizure management has begun.

What is Nasal Diazepam (Valtoco)?

Valtoco is a nasal spray formulation of diazepam, a benzodiazepine used to treat acute, intermittent, stereotypic episodes of seizures — often referred to as seizure clusters.

Manufacturer: Neurelis, Inc.
FDA Approval: Initially approved in 2020 for ages 6+, then expanded in April 2025 to include children aged 2 to 5 years.
Indication: Acute treatment of seizure clusters in pediatric patients with epilepsy.

How It Works

Nasal diazepam is delivered through the nasal mucosa, enabling rapid absorption into the bloodstream, bypassing the need for IV or rectal administration.

Onset of action: ~15–30 minutes
Peak plasma concentration: ~1.5 hours
Duration: Short-acting but effective for stopping acute seizures

This formulation is both fast and caregiver-friendly, offering an easy-to-use alternative during emergencies.

Why It’s a Game-Changer for Children

Non-invasive Delivery
No need to remove clothing or perform rectal administration, which may be traumatic or impractical in public settings.
Caregiver Empowerment
Parents and school staff can administer it without medical supervision, enabling faster response times.
Improved Quality of Life
Reduces emergency room visits and anxiety around seizures.
Expanded Age Range (2–5 years)
The 2025 FDA approval allows younger children to benefit from this treatment — a major step forward in pediatric seizure care.

Dosage Guidelines

Dosing is based on age and weight and comes in prefilled nasal spray units:

Age Group	Weight-Based Dose	Available Strengths
2–5 years	0.5 mg/kg	5 mg, 10 mg
6–11 years	0.3 mg/kg	10 mg, 15 mg
12+ years	0.2 mg/kg	15 mg, 20 mg

Maximum: 2 doses per seizure event, separated by at least 4 hours.
Do not use more than 5 times per month or once every 5 days.

Safety and Side Effects

Clinical studies have demonstrated Valtoco to be safe and well-tolerated in children:

Common side effects: Nasal discomfort, drowsiness, headache.
Serious risks: Respiratory depression (especially with other CNS depressants).
No significant cardiac or systemic toxicity when used as directed.

A 2022 long-term study in pediatric patients (ages 6–17) showed:

Only 11% needed a second dose.
No withdrawals due to adverse effects.
No cases of overdose or death were reported.

Comparisons to Other Rescue Medications

Medication	Route	Pros	Cons
Rectal Diazepam	Rectal gel	Effective, long-used	Invasive, socially difficult
Midazolam (Nayzilam)	Nasal spray	Also fast-acting	Approved only for age 12+
Diazepam (Valtoco)	Nasal spray	Effective, non-invasive, age 2+	Requires caregiver training

Conclusion

Nasal diazepam (Valtoco) has revolutionized emergency seizure management in children, providing a safe, fast, and user-friendly option for families and caregivers. With its recent FDA approval for children as young as two, Valtoco represents a major advancement in pediatric epilepsy care — allowing treatment to start where seizures happen: at home, at school, or anywhere.

References

Neurelis, Inc. (2025). FDA Approves Valtoco for Use in Children Aged 2–5. Retrieved from: https://www.neurelis.com
Hogan, R. E., et al. (2022). Long-term safety of diazepam nasal spray in pediatric patients with epilepsy. Epilepsy & Behavior, 134, 108804. DOI: 10.1016/j.yebeh.2022.108804
Drugs.com. Valtoco Dosage Guide. Retrieved from: https://www.drugs.com/dosage/valtoco.html
Medscape. Diazepam (Valtoco) Drug Profile. Retrieved from: https://reference.medscape.com/drug/valium-valtoco-diazepam-342902