Rectal Use of Benzodiazepines


2 Neurology Division, IWK Grace Health Centre, 5850 University Avenue, 8th Floor, P.O. Box 3070, Halifax, Nova Scotia B3J 3G9, Canada.


Summary: A number of antiepileptic drugs (AEDs) can be given rectally for either acute seizure control or maintenance therapy. In particular, rectal AED therapy may enable physicians who are not expert in the treatment of status epilepticus (SE) to administer appropriate early therapy. It can also empower parents to provide emergency care when medical help is not available. Rectal administration of parenteral diazepam (DZP) or of specific rectal formulations has been reported effective for aborting and preventing seizures. Adverse events associated with this treatment tend to be rare and mild, although it is important to note the risk for respiratory depression. Lorazepam can also be administered rectally and can produce rapid seizure cessation. It is also associated with fewer side effects than DZP. Although valproate is relatively slowly absorbed after rectal administration, this route has been used to treat SE and for maintenance therapy when oral therapy is not possible. Other AEDs that may be administered rectally include clonazepam, paraldehyde, and carbamazepine.