Valtoco
Valtoco (diazepam) is a prescription medication that's used for short-term treatment of seizure clusters, also called acute repetitive seizures, in adults and children 6 years of age and older. It comes as a ready-to-use nasal spray device, but the person giving the medication must know when and how to give it correctly. Common side effects of Valtoco (diazepam) include feeling sleepy, headache, and nasal discomfort.
What is Valtoco (diazepam)?
What is Valtoco (diazepam) used for?
Seizure cluster in people with epilepsy who are 6 years of age and older
How Valtoco (diazepam) works
Valtoco (diazepam) is a benzodiazepine. It slows down activity in your brain to help stop seizures.
Drug Facts
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What are the risks and warnings for Valtoco (diazepam)?
Valtoco (diazepam) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Sedation and difficulty breathing
Risk factors: Taking Valtoco (diazepam) with opioid medications or alcohol
Valtoco (diazepam) can cause serious drowsiness, tiredness, trouble breathing, and low blood pressure. If you are also taking opioid medications, these effects are more likely to happen and can even result in death. Some people with long-term pain might already be taking opioids when prescribed Valtoco (diazepam). If this is you or someone you know, talk to your provider to make sure the combination is safe, or to see if other medication options are available. If you develop difficulty breathing or have trouble waking up easily, get medical help right away.
Risk of misuse and addiction
Risk factors: History of substance of alcohol use disorder | Taking higher than recommended doses of Valtoco (diazepam)
Valtoco (diazepam) has risks of misuse and addiction, which can potentially lead to overdose and death. Misuse often involves using higher than recommended doses of Valtoco (diazepam). Your provider will ask you questions before you start Valtoco (diazepam) to assess your risk of misuse and addiction. To lower your risk, take Valtoco (diazepam) exactly as prescribed to you.
Dependence and withdrawal
Risk factors: Taking with alcohol or other medications | Taking Valtoco (diazepam) for a long time or using higher doses | Stopping Valtoco (diazepam) suddenly
If you're taking Valtoco (diazepam) for a long period of time or at a high dose, you might become physically dependent on the medication. If you suddenly stop taking it, you could potentially have serious medical problems, including seizures. Don't stop taking this medication without first talking to your provider. Valtoco (diazepam) can be habit-forming; take only as prescribed to lower your risk of dependence and overdose. Valtoco (diazepam) should be taken only as needed for seizure attacks, no more than once every 5 days or 5 times in a month.
Difficulty with concentration and focus
Risk factors: Taking with alcohol | Taking other medications that cause drowsiness
Taking Valtoco (diazepam) can make you feel sleepy and affect your concentration and focus. Avoid activities that require you to be alert, like riding a bike or operating machinery, until you know how the medication affects you. If you have had a seizure attack, remember that it might be against the law to drive for a few months afterwards, even if you feel back to normal after getting a dose of Valtoco (diazepam).
Suicidal thoughts or behaviors
Antiseizure medications like Valtoco (diazepam) can raise your risk of suicide or thoughts of suicide. Watch for any new or worsening depression and any unusual changes in mood, and report anything concerning to your provider. If you have thoughts of hurting yourself, call 911 or seek medical attention right away.
Rise in eye pressure in people with glaucoma
Risk factors: Glaucoma
Benzodiazepines can raise eye pressure in people who have glaucoma. If you have open-angle glaucoma (the most common type of glaucoma), make sure you are taking appropriate medications for it before you use Valtoco (diazepam). If you have been diagnosed with narrow-angle glaucoma, talk to your provider before using Valtoco (diazepam) since the effects can be dangerous to your eyesight.
Do not give to babies
Valtoco (diazepam) is not approved for use in babies with seizures. Small babies can get a life-threatening reaction from benzyl alcohol, a preservative in Valtoco (diazepam). If your baby is having seizure-like activity, call 911 or get medical help right away.
What are the side effects of Valtoco (diazepam)?
Common Side Effects
- Feeling sleepy or drowsy (23%)
- Nasal discomfort (6%)
- Headache (5%)
- Diarrhea (4%)
- Changes in taste (3%)
Other Side Effects
- Nosebleed
- Coordination and balance problems
- Dizziness
- Agitation or confusion
- Rash
- Asthma
- Change in mood
- Speech problems
- Room spinning sensation
- Hiccups
Serious Side Effects
- Extreme Drowsiness
- Difficulty breathing
- Thoughts of hurting yourself or suicide
Source: FDA
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- CNS depression—slow or shallow breathing, shortness of breath, feeling faint, dizziness, confusion, trouble staying awake
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Dizziness
- Drowsiness
- Dryness or irritation inside the nose
- Headache
Pros and cons of Valtoco (diazepam)
Pros
Approved for people 6 years of age and older who have seizure clusters
Works quickly treat seizure clusters typically within 4 minutes
Might help prevent another seizure attack from happening within 24 hours
Easy for someone to give the medication as a nasal spray
Good option for someone who can't take anything by mouth, such as in the middle of a seizure attack
Cons
Can cause sleepiness, headache, and nasal discomfort
Might not be the safest option during pregnancy or breastfeeding
Only for treatment of seizure clusters, not for long-term seizure control
Care partners need special training to know when and how to give it correctly
Potentially interact with many medications
Pharmacist tips for Valtoco (diazepam)
Valtoco (diazepam) should only be used for seizure attacks, which is a bunch of seizures in a row that are different from typical seizure activity.
It's important for caregivers to feel confident about when and how to give this medication properly. It's also important to know what to watch for afterwards and when to get medical help. If you have any questions or feel unsure about using Valtoco (diazepam), talk to your provider beforehand. You might need to teach this information to other people in case you or your child has a seizure attack.
Valtoco (diazepam) comes with an instruction manual with helpful images that you'll want to read and review with other caregivers.
The nasal spray is ready to use as soon as you take it out of the blister pack. Do not "prime" it or play around with the plunger before it's time to give the dose and the tip is inside the nostril. Otherwise, you'll lose the dose of medication.
After the dose is given, keep the person on their side, since this position makes it easier to breathe while recovering from a seizure. Stay with the person for at least 4 hours and watch for continued seizure activity or changes in breathing or skin color. Write down the date and time of the seizure attack, the type and number of seizures that you observe, and the time(s) that you gave since Valtoco (diazepam); all of this information is important to share with the provider later on.
Your provider might recommend a second dose if needed. The second dose should be given at least 4 hours after the first dose. Do not give a second dose if the person with seizures is having trouble breathing or is sleepier than usual.
Each nasal spray device is for one-time use only. You won't be able to reuse the spray. Throw away the used device in a safe place away from children or pets.
The dose of Valtoco (diazepam) is calculated based on body weight. If you or your child has gained or lost a lot of weight, let your provider know. If your weight has changed a lot, the dose that you have at home might not be correct and you might need a new prescription.
Seizure attacks can happen at any time, so it's best to have Valtoco (diazepam) with you or your child at all times.
Keep Valtoco (diazepam) in the blister pack and away from light until you need to use it. Leaving the blister pack open or exposing it to too much light for too long can make the medication not work as well. Keep the nasal spray at room temperature.
Make sure to check the expiration date on your medication regularly and replace it if it's about to expire. Expired medication might not work as well. It's important that you get the full effect from Valtoco (diazepam) when you have a seizure attack.
Frequently asked questions about Valtoco (diazepam)
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Valtoco (diazepam) dosage forms
Typical dosing for Valtoco (diazepam)
Valtoco (diazepam) comes in 4 different doses: 5 mg, 10 mg, 15 mg, and 20 mg. Your prescriber will decide what the right dose is for you based on your age and weight.
For 5 mg or 10 mg doses: Give 1 spray into one nostril for one time only. Each blister pack will have 1 spray that contains the full dose.
For 15 mg or 20 mg doses: Give 1 spray into each nostril for one time only. Each blister pack will come with 2 sprays; you will need both of them to get the full dose, and the sprays should go into separate nostrils.
The maximum dose is 20 mg. Your provider might prescribe a second dose to use at least 4 hours after your first dose, if needed.
Valtoco (diazepam) shouldn't be used more than once every 5 days or more than 5 times in a month.
How much does Valtoco (diazepam) cost?
Valtoco (diazepam) contraindications
Sudden onset of narrow-angle glaucoma (a type of eye condition)
What are alternatives to Valtoco (diazepam)?
Seizure cluster in people with epilepsy who are 6 years of age and older
Seizure attacks in people with epilepsy who are 12 years of age and older
Seizure clusters in people ages 2 years and older with epilepsy
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