Diazepam Nasal Spray


Diazepam Nasal Spray is a seizure medicine that is often prescribed as a rescue medication for acute treatment of seizures outside of a hospital setting and can be administered by laypersons (people who are not healthcare professionals). This medication is meant to be used to prevent seizure emergencies, either by stopping a prolonged seizure or stopping a seizure cluster.

Diazepam Nasal Spray is one of these rescue medications. This medication is FDA approved for use in persons aged 6 years and older. 

The prescribed dose is based on the person's age and weight.  

Valtoco (diazepam) nasal spray comes in:

  • 4 doses of 5 mg, 10 mg, 15 mg, and 20 mg.
  • 5 mg and 10 mg have one nasal spray; 15 mg and 20 mg have two nasal sprays (7.5 mg x 2 for the 15 mg dose and 10 mg x 2 for the 20 mg dose)
    • The 5 mg and 10 mg doses are given as a single nasal spray into one nostril.
    • A 15 mg dose is given with two (2) 7.5 mg nasal devices. Spray one (1) into each nostril.
    • A 20 mg dose is given with two (2) 10 mg nasal devices. Spray one (1) into each nostril.  
    • The dose is based on the age and weight of the patient. 

Updated: 03/04/2024

Brand Name(s)


Used to Treat

Prolonged Seizures of Various Seizure Types
Seizure Clusters


Intranasal Spray

Package Insert

Frequently Asked Questions

    How to take and store Diazepam Nasal Spray?

    How to take:

    • Each device can be used once.
    • Most commonly, this medication will be administered by a family or care partner. However, a person can give the nasal spray to themselves if they are not having a seizure at the time. Hold the nasal spray with one finger on each side of the nozzle. Do not prime the pump or push it in until it is ready to be used.  
    • Place the nozzle in one nostril or side of the nose and push the plunger in to give the medicine. Remove the nasal spray device.
      • If 2 nasal sprays are needed for the 15 mg or 20 mg doses, give one spray into each side of the nose.  
    • ​Follow the providers orders for observing the person afterwards. Watch for continued seizures and side effects.  
    • If a second dose is needed due to the onset of more seizures, it can be given 4 hours or more after the first dose.
    • Do not use more the 2 doses of Valtoco for one seizure cluster.  
    • It is recommended that Valtoco not be used more often than every 5 days or more than 5 times a month.  
    • Talk to your provider if more frequent use seems needed.

    How to store:

    • Keep the medicine in a place that is easy to get when it is needed.  
    • Keep them in their original container tightly closed, away from light, and out of reach of children.  
    • Store your prescription at room temperature away from excess heat and moisture (i.e. not the bathroom).  
    • Throw away any medication that is outdated or no longer needed. 
    What if I forget?

    These medicines are designed to be used only if needed as a rescue treatment. They are not designed to be used daily and should not replace a person’s daily anti-seizure medication. Do not take an extra dose unless prescribed by your doctor. 

    How does Diazepam Nasal Spray affect the brain?

    The exact way that diazepam nasal spray works to stop seizures is not known. It appears to suppress or stop seizure activity by affecting a substance in the brain called GABA (gamma-aminobutyric acid). 

    How does the body digest Diazepam Nasal Spray?
    • Valtoco is well absorbed from the nose. It reaches peak or highest amounts in the bloodstream in 1.5 hours but starts working sooner.  
    • Diazepam nasal spray has a half-life in adults of about 49 hours. This means that it may stay at a level in the body that can help seizures for about 2 days.
    • In children, diazepam nasal spray has a half-life of 15 to 21 hours.
    • Most of the diazepam nasal spray is bound to proteins in the bloodstream.
    • Diazepam nasal spray is broken down in the liver to metabolites or breakdown products that can also have effects on seizures.  
    How well does the Diazepam Nasal Spray work?
    • Diazepam nasal spray (Valtoco) appears to be as effective as Diastat (rectal diazepam) at stopping seizures. In a study that evaluated how well people did taking Valtoco, the majority of people only needed one dose of Valtoco.  
      • 96% of people by 4 hours  
      • 94% of people by 6 hours
      • 91% of people by 12 hours
      • 86% of people over 24 hours

    Approval of Valtoco was based primarily upon the drug’s bioavailability (how quickly it works and on the drug levels achieved in the blood, which were similar to Diastat. The safety of Valtoco in children ages 6 and older was also confirmed in open-label studies.  

    What are the most common side effects of Diazepam Nasal Spray?

    Some common side effects of Valtoco include:

    • Feeling sleepy or drowsy
    • Headache
    • Nose discomfort or congestion

    Nose bleeds and a bad taste after use have also been reported. This nasal formulation has benzyl alcohol which might cause CNS depression, excessive build-up of acid levels in the blood (metabolic acidosis) and breathing difficulties in newborns and infants. This product is licensed only for children aged 6 and older. 

    What are the most serious side effects of Diazepam Nasal Spray?
    • Usually, the benefits of diazepam nasal spray far outweigh the mild to moderate side effects.
    • Side effects generally go away within hours, and with no lasting harm.  
    • Serious problems are very rare.

    Breathing Problems:

    • People given diazepam nasal spray by injection rarely need help with breathing, especially if they have other breathing problems or have taken sedating medicines. The risk is slightly higher when more than one dose is given.
    • Caregivers should watch for signs of breathing problems (for example, slowed breathing or a change in the color of the skin) and call for help if needed.  

    Central Nervous System Depression:

    All benzodiazepines can cause CNS depression which means it affects how the brain may work.

    • For example, the medicines may cause drowsiness, affect alertness and thinking.  
    • If a person feels very sleepy, dizzy, or uncoordinated for a period after using one of these medicines, they should avoid activities where they could get injured.

    Suicidal Thoughts and Behavior:

    Taking anti-seizure medicines may increase the risk of having suicidal thoughts or actions. However, this is very rare with the use of rescue Valtoco:

    • Do not make any changes to the medication regimen without first talking with the responsible healthcare professional.
    • Pay close attention to any day-to-day changes in mood, behavior, and actions. These changes can happen very quickly, so it is important to be mindful of any sudden differences.

    Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:

    • Talking or thinking about wanting to hurt yourself or end your life.
    • Withdrawing from friends and family
    • Becoming depressed or having your depression get worse.
    • Becoming preoccupied with death and dying
    • Giving away prized possessions

    We again urge patients and families to contact their doctor before stopping anti-seizure medication because this may possibly lead to seizures and worsening of mood.

    Changes in Vision (Glaucoma):  

    Diazepam nasal spray may rarely cause an increase in eye pressure in people with open-angle glaucoma.  

    Other potentially serious side effects: Increased seizure tolerance

    • Some people with epilepsy who take diazepam nasal spray or other benzodiazepines on a daily basis may have more frequent or severe seizures if the medicine is lowered or stopped.  
    • Developing tolerance and needing a higher dose to get the same effect could also be a problem with daily diazepam nasal spray.  
    • Since Diastat and Valtoco are not used daily, these concerns are much less likely to arise.  
    Who should not take Diazepam Nasal Spray?
    • People with a known sensitivity to diazepam nasal spray.
    • People who have an eye condition called acute narrow angle glaucoma. People with open angle glaucoma may use it.
    • Children aged 5 years or younger. 
    What are the effects of Diazepam Nasal Spray on Seniors
    • Extra caution is needed when diazepam nasal spray is used in older adults or those with liver or kidney disease. The medicine may last longer in their body and could lead to higher amounts of medicine in the body. They may be more likely to develop side effects like drowsiness, unsteadiness, or breathing problems.
    • See package insert. 
    Read the package insert of Diazepam Nasal Spray

    In the United States, companies that manufacture medicines are required to publish certain kinds of information about each product. This document is commonly known as a “package insert” because it is usually included with each package of the medicine.

    The U.S. package insert for Valtoco (diazepam nasal spray) is found at:

    Some of the information may differ in other countries.

    To learn how to read and understand a package insert, see "How to read a package insert."


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