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Home Treatment with Rectal Diazepam for Cluster Seizures in Dogs
W.B. Thomas D.V.M. M.S. Dipl. ACVIM (Neurology)
The purpose of this article is to provide general information about home treatment with rectal diazepam (valium) for dogs with cluster seizures. It discusses the treatment recommended by the Neurology/Neurosurgery service at the Veterinary Teaching Hospital, College of Veterinary Medicine, University of Tennessee. Because clinical circumstances vary widely and each patient is unique, specific recommendations can only be made by the attending veterinarian.
Why is home treatment
necessary for some dogs?
Most dogs with idiopathic epilepsy suffer isolated seizures that
stop spontaneously within one to three minutes. However, some
dogs with epilepsy tend to suffer cluster seizures or status epilepticus. Status epilepticus is defined as (1) a continuous seizure
lasting at least 5 minutes or (2) two or more discrete seizures
without full recovery of consciousness between seizures. Cluster
seizures (serial seizures, acute repetitive seizures) are
two or more seizures occurring over a brief period (minutes to
hours) but with the patient regaining consciousness between the
seizures.1
While a single seizure of short duration is rarely life threatening,
status epilepticus is a medical emergency requiring prompt treatment.
Continuous seizure activity lasting 30 to 60 minutes can lead
to profound, life-threatening abnormalities and brain damage.2 Although cluster seizures do not fulfill
the definition of continuous seizure activity, they nevertheless
represent a serious condition that can progress to status epilepticus.
The goal of treatment is to quickly stop the seizure and provide
support for the patient. Typically, this involves urgent veterinary
care, including administering anti-seizure medication by vein.
The financial and emotional distress of repeated emergency treatment
is a common reason for a client to have their epileptic pet euthanized.
Why is rectal administration
of diazepam recommended?
Rectal administration of diazepam (valium) by the client is a
safe method of home treatment of cluster seizures in dogs with
idiopathic epilepsy.3 Diazepam belongs
to the class of drugs known as benzodiazepines. Benzodiazepines
are the treatment of choice for the emergency treatment of seizures
because they are safe, work quickly, and are effective against
many types of seizures. Veterinarians typically administer diazepam
by vein to quickly stop a seizure, but most clients are not adept
at intravenous injections. Absorption of diazepam after injection
into the muscle is variable and unpredictable and may cause muscle
damage.4 Giving diazepam by mouth
is difficult and hazardous when the dog is actively seizing, and
absorption after oral administration is slow and unpredictable.4
On the other hand, rectal administration of diazepam results in
higher and earlier blood levels compared with either oral or intramuscular
routes, making this route of administration ideal for home treatment
of cluster seizures.4
Which dogs are candidates
for home treatment with rectal diazepam?
This treatment is considered in dogs with a tendency to suffer
multiple seizures during a 24-hour period. A primary goal of treatment
in these dogs is to prevent the seizures with daily anti-seizure
medication. If this is not totally successful and the patient
still tends to suffer cluster seizures, then home treatment with
rectal diazepam should be considered. This treatment is not recommended
for the majority of dogs with idiopathic epilepsy that tend to
suffer single, isolated seizures.
How is the treatment
administered?
This treatment uses commercially available diazepam injectable
solution. Although this solution is intended for injection by
vein, studies have shown this product is absorbed well when given
rectally. The syringe is filled with the appropriate dose of diazepam
and then attached to a 1-inch teat cannula or similar device.
This is inserted approximately one inch (2 cm) into the dog's
rectum and the syringe's plunger is pushed, delivering the diazepam.
The first treatment is given as soon as possible after the onset
of a seizure. The same dose can be repeated for a total of
3 times within a 24-hour period. If the seizures do not stop
or if the dog appears to be having difficulty breathing, the pet
should be taken to a veterinarian for emergency treatment.
What dose of diazepam
is used?
Each patient is different, so specific recommendations can only
be made by the attending veterinarian. A dose of 2 mg per kg of
body weight is usually recommended for dogs taking phenobarbital
(phenobarbital is known to increase the dose requirement for diazepam).5 In dogs not taking phenobarbital,
the dose is usually 0.5 to 1 mg per kg.
Isn't this a high
dose of diazepam?
The rectal dose is higher than the intravenous dose in order to
obtain adequate blood levels. Also, as mentioned above, long-term
treatment of phenobarbital increases the dose requirement as well.
These doses have been found to be quite safe in experimental studies
in dogs.5
What about diazepam
suppositories?
Some pharmacists can compound diazepam suppositories. Also, a
gel formulation of diazepam (Diastat) has recently become available
for rectal administration in human patients.6 However, these are not currently recommended because the absorption
of these products has not been studied in dogs.
Is it legal for me
to have diazepam?
In the United States, diazepam is a prescription drug. Clients
need to obtain the diazepam from their veterinarian or have a
prescription from their veterinarian in order to obtain diazepam
from a pharmacy. Diazepam is also a controlled substance, as is
phenobarbital. This means there are certain additional requirements
the veterinarian must follow when writing a prescription or dispensing
the drug. The purpose of controlled substance regulations is to
minimize inappropriate use of these drugs, not prevent their beneficial
use in patients that need such therapy. Because injectable diazepam
solution is mostly used in hospitals, many pharmacies do not carry
this product. However, it can usually be obtained from hospital
pharmacies or ordered by a pharmacist or veterinarian.
Address questions or
comments to:
W.B. Thomas DVM, MS, Dipl. ACVIM (Neurology)
Wthomas@utk.edu
References:
- 1. Lowenstein DH, Alldredge BK. Status epilepticus. New Engl.J.Med. 1998; 338:970-976.
- 2. Lothman EL. The biochemical basis and pathophysiology of status epilepticus. Neurology 1990; 40(suppl 2):13-23.
- 3. Podell M. The use of diazepam per rectum at home for the acute management of cluster seizures in dogs. J.Vet.Int.Med. 1995; 9:68-74.
- 4. Papich MG, Alcorn J. Absorption of diazepam after its rectal administration in dogs. Am.J.Vet.Res 1995; 56:1629-1636.
- 5. Wagner SO, sams RA, Podell M. Chronic phenobarbital therapy reduces plasma benzodiazepine concentrations after intravenous and rectal administration of diazepam in the dog. J.Vet.Pharmacol.Therap. 1998; 21:335-341.
- 6. Dreifuss FE, Rosman NP, Cloyd JC, Pellock JM, Kuzniecky RI, Lo WD, et al. A comparison of rectal diazepam gel and placebo for acute repetitive seizures. New Engl.J.Med. 1998; 338:1869-1875.
Page last update: 05/30/2011
