What Is Diastat?
What Diastat (diazepam rectal gel) is, what it is used for, how it treats seizure emergencies, and important safety information.
Clinically reviewed by Dr. Ponlawat Pitsuwan, Physician and Addiction Medicine Specialist, Phuket Island Rehab.
Diastat is a brand name for diazepam rectal gel, a medication used to treat certain seizure emergencies. Diazepam is a benzodiazepine, and Diastat is a special gel form of it that is given rectally (into the rectum) using a pre-filled applicator (syringe). It is used to stop or reduce clusters of seizures (also called acute repetitive seizures or seizure clusters), episodes of increased seizure activity that are different from a person’s usual seizure pattern, in people with epilepsy. Diastat is designed to be given by a caregiver (such as a family member) outside of a hospital, at home or in the community, to quickly deliver the medication and help stop a seizure emergency, because the rectal route allows fast absorption when a person cannot take medication by mouth during a seizure. It is prescribed for specific patients as part of a seizure action plan, with the caregiver trained by a healthcare professional on when and how to use it. Like all benzodiazepines, Diastat can cause side effects (such as drowsiness) and carries the class’s considerations, and it must be used exactly as directed, following the doctor’s instructions and seizure plan. If you care for someone prescribed Diastat, make sure you understand how and when to use it, and always follow medical guidance.
What is Diastat?
Diastat is a brand name for diazepam rectal gel, a medication used to treat certain seizure emergencies in people with epilepsy. Diazepam is a benzodiazepine, a class of medications that act on the brain to produce calming, sedative, and anti-seizure (anticonvulsant) effects, and it is well known in other forms (such as the brand Valium) for treating anxiety, among other uses. Diastat is a specific formulation of diazepam: it is a gel that is given rectally (into the rectum), using a pre-filled applicator (a special syringe designed for this purpose). This rectal gel form is designed for a particular purpose, to treat seizure clusters (episodes of increased seizure activity) quickly, outside of a hospital, often by a caregiver. Understanding what Diastat is, a rectal gel form of the benzodiazepine diazepam, used for seizure emergencies, is the starting point for understanding how and why it is used.
This article explains what Diastat is, what it is used for, how it treats seizure emergencies, and important safety information. The central message is that Diastat (diazepam rectal gel) is a medication used to stop or reduce clusters of seizures (acute repetitive seizures) in people with epilepsy, that it is designed to be given rectally, often by a trained caregiver outside of a hospital, to quickly deliver the medication during a seizure emergency, and that it must be used exactly as directed, following the doctor’s instructions and the person’s seizure action plan. Understanding Diastat is important particularly for people with epilepsy who are prescribed it, and for their caregivers, who need to know how and when to use it. This article provides general information; anyone prescribed Diastat, or caring for someone who is, should follow the specific guidance and training provided by their healthcare professional. Diastat is a valuable medication for managing seizure emergencies when used correctly.
What Diastat is used for and how it works
Diastat is used to treat seizure clusters, also called acute repetitive seizures or seizure clusters, in people with epilepsy. Seizure clusters are episodes of increased seizure activity, bouts of seizures that are different from a person’s usual, everyday seizure pattern, in which seizures occur more frequently or in a group over a period. These episodes are a particular concern because they represent a departure from the person’s normal pattern and, if not treated, can potentially progress or lead to a prolonged seizure emergency. Diastat is prescribed for specific patients (typically those with epilepsy who are prone to such seizure clusters) as a rescue or emergency medication, to be used when a cluster occurs, to stop or reduce the seizure activity. It is used for these acute episodes, not as a regular daily anti-epileptic medication; a person usually has their ongoing epilepsy managed with other regular medications, and Diastat is kept for use in these specific emergency situations.
Diastat works because diazepam, as a benzodiazepine, has anticonvulsant (anti-seizure) effects: it enhances the calming brain chemical GABA, which reduces the excessive brain activity that causes seizures, helping to stop or reduce seizure activity. The rectal gel form is important for how Diastat is used in emergencies. During a seizure, a person often cannot swallow or take medication by mouth, so an alternative route is needed to deliver the medication quickly. The rectal route allows the diazepam to be absorbed rapidly into the body, providing a fast effect, and it can be administered even when the person is having a seizure and cannot cooperate. This makes Diastat suitable for use outside of a hospital, at home or in the community, so that a caregiver can give it promptly when a seizure cluster occurs, without waiting to get to a hospital. Diastat comes as a pre-filled applicator (syringe) with a measured dose, designed to make it possible for a trained caregiver (such as a family member) to administer it. The caregiver is trained by a healthcare professional on when a seizure emergency warrants using Diastat, how to give it correctly, what to do afterward, and when to seek further emergency help. So Diastat works by delivering the anticonvulsant diazepam rectally, allowing fast treatment of a seizure cluster outside of a hospital, typically by a trained caregiver, as part of the person’s seizure management plan.
| Aspect | Detail |
|---|---|
| What it is | Diazepam rectal gel (a benzodiazepine) |
| Used for | Seizure clusters / acute repetitive seizures in epilepsy |
| How given | Rectally, via a pre-filled applicator (syringe) |
| Who gives it | Often a trained caregiver, outside of a hospital |
| Why rectal | Fast absorption when the person can’t take it by mouth |
| Part of | A seizure action plan, per the doctor’s instructions |
Safety information and important considerations
Diastat must be used exactly as directed, following the specific instructions and training provided by the healthcare professional and the person’s seizure action plan. Because Diastat is a serious medication given in an emergency situation, it is important that the caregiver is properly trained on when to use it (which seizure situations warrant it, according to the person’s plan), how to give it correctly (the correct technique with the applicator, and the correct dose, which is set by the doctor), what to monitor afterward, and, crucially, when to call for emergency medical help. In general, if a seizure does not stop, if seizures continue or worsen, if the person has difficulty breathing, or in other situations specified in the plan, emergency help should be sought; the caregiver’s training and the seizure plan will specify exactly when to call emergency services. It is vital to make sure you understand these instructions if you care for someone prescribed Diastat.
Like all benzodiazepines, Diastat can cause side effects, the most common being drowsiness and sedation (which is expected, given its calming, anti-seizure action), as well as possible dizziness, unsteadiness, headache, and, sometimes, other effects; because it causes sedation, the person will usually be drowsy after receiving it and should be monitored. More serious effects are possible, and importantly, as a central nervous system depressant, diazepam can, particularly at higher doses or in vulnerable people, cause slowed breathing (respiratory depression), so the person’s breathing should be monitored after Diastat is given, and emergency help sought if breathing is affected. Diastat should be used with particular caution, or its use carefully considered, in certain situations, and it should not be combined with alcohol or other central nervous system depressants (which can dangerously increase sedation and the risk to breathing). As a benzodiazepine, diazepam also carries the class’s general considerations regarding dependence with regular use, though Diastat is used for occasional emergency treatment rather than regular daily use, which limits this concern; nonetheless, it should only be used as prescribed for its intended purpose. Diastat should be stored properly and its expiry checked. It is prescribed for a specific person and should not be used for anyone else. The key messages are that Diastat (diazepam rectal gel) is a medication for treating seizure clusters in epilepsy, given rectally, often by a trained caregiver outside of a hospital, to quickly treat a seizure emergency, that it must be used exactly as directed following the doctor’s instructions and seizure plan, that it can cause side effects (notably drowsiness) and requires the person to be monitored (including their breathing), and that caregivers must know when to seek emergency help. If you are prescribed Diastat or care for someone who is, make sure you understand how and when to use it, and always follow the guidance and training of your healthcare professional.
Summary
Diastat is a brand name for diazepam rectal gel, a medication used to treat certain seizure emergencies. Diazepam is a benzodiazepine, and Diastat is a special gel form of it that is given rectally (into the rectum) using a pre-filled applicator (syringe). It is used to stop or reduce clusters of seizures (also called acute repetitive seizures or seizure clusters), episodes of increased seizure activity that are different from a person’s usual seizure pattern, in people with epilepsy. Diastat is designed to be given by a caregiver (such as a family member) outside of a hospital, at home or in the community, to quickly deliver the medication and help stop a seizure emergency, because the rectal route allows fast absorption when a person cannot take medication by mouth during a seizure. It is prescribed for specific patients as part of a seizure action plan, with the caregiver trained by a healthcare professional on when and how to use it. Like all benzodiazepines, Diastat can cause side effects (such as drowsiness) and carries the class’s considerations, and it must be used exactly as directed, following the doctor’s instructions and seizure plan. If you care for someone prescribed Diastat, make sure you understand how and when to use it, and always follow medical guidance.
As Dr. Ponlawat Pitsuwan, addiction medicine specialist at Phuket Island Rehab, puts it, “Diastat is diazepam, a benzodiazepine, but in a very specific and clever form: a rectal gel that a trained family member can give at home to break a cluster of seizures before it turns into something more dangerous. The rectal route matters, because when someone is seizing they cannot swallow a pill, and this gets the medicine in fast. For families of people with epilepsy who are prone to seizure clusters, having Diastat and knowing exactly when and how to use it, and when to call for an ambulance, can be genuinely reassuring and even life-saving. It should always be used strictly according to the neurologist’s seizure plan, and the person watched afterward, especially their breathing, since it does cause sedation. Used as directed, it is a valuable rescue medication.”
Frequently asked questions
What is Diastat used for?
Diastat (diazepam rectal gel) is used to treat seizure clusters, also called acute repetitive seizures, in people with epilepsy. Seizure clusters are episodes of increased seizure activity, bouts of seizures that are different from a person’s usual, everyday seizure pattern, in which seizures occur more frequently or in a group over a period. Diastat is prescribed for specific patients (typically people with epilepsy who are prone to such seizure clusters) as a rescue or emergency medication, to be used when a cluster occurs, to stop or reduce the seizure activity. It is used for these acute episodes, not as a regular daily anti-epileptic medication; the person’s ongoing epilepsy is usually managed with other regular medications, and Diastat is kept for use in these specific emergency situations. Because seizure clusters can potentially progress if untreated, having a fast-acting rescue medication like Diastat available allows prompt treatment, often by a trained caregiver at home or in the community, without waiting to get to a hospital. So Diastat is used specifically for the emergency treatment of seizure clusters in epilepsy, as part of a person’s seizure management plan. It is prescribed for particular individuals for this purpose, and used according to their doctor’s instructions and seizure action plan. If you are prescribed Diastat or care for someone who is, your healthcare professional will explain exactly when to use it for seizure clusters.
How is Diastat given?
Diastat is given rectally (into the rectum), using a pre-filled applicator, a special syringe designed for the purpose, that contains a measured dose of the diazepam gel. This rectal route is used because, during a seizure, a person often cannot swallow or take medication by mouth, so an alternative route is needed, and the rectal route allows the medication to be absorbed rapidly for a fast effect, and can be given even when the person is seizing and cannot cooperate. Diastat is designed so that a trained caregiver (such as a family member) can administer it outside of a hospital, at home or in the community, when a seizure cluster occurs. The caregiver is trained by a healthcare professional on the correct technique for using the applicator, the correct dose (which is set by the doctor for the specific person), and the proper steps to follow. It is important that Diastat is given correctly, following the specific instructions and training provided, and using the correct dose. After giving Diastat, the person should be monitored (including their breathing and level of alertness, as it causes sedation), and the caregiver should know when to seek emergency medical help, according to the seizure action plan. So Diastat is given rectally via a pre-filled applicator, typically by a trained caregiver, as an emergency treatment for seizure clusters. Anyone who may need to give Diastat should be properly trained by a healthcare professional and follow the specific instructions carefully. Proper administration is important for it to work safely and effectively.
Why is Diastat given rectally?
Diastat is given rectally for practical reasons related to treating seizures in an emergency. The main reason is that, during a seizure, a person often cannot swallow or safely take medication by mouth, because they may be unconscious, convulsing, or unable to cooperate, so giving an oral medication is not possible or safe at that moment. The rectal route provides an effective alternative: it allows the medication (diazepam) to be absorbed rapidly into the body through the rich blood supply in the rectum, giving a fast effect, which is important for quickly treating a seizure emergency. The rectal gel can also be administered by a caregiver even while the person is having a seizure and cannot help, using the pre-filled applicator. This makes it possible to treat a seizure cluster promptly, at home or in the community, without needing the person to swallow anything or waiting to reach a hospital. So the rectal route is chosen because it allows fast, effective delivery of the medication in a situation where oral administration is not feasible, enabling prompt emergency treatment of seizures. This is a key part of what makes Diastat useful as a rescue medication for seizure clusters. There are also other newer forms of rescue medications for seizures given by other non-oral routes (such as nasal sprays), but Diastat specifically uses the rectal route with its gel formulation. The rectal administration, while perhaps seeming unusual, is a practical and effective way to deliver emergency seizure medication when a person cannot take it by mouth.
What are the side effects of Diastat?
Like all benzodiazepines, Diastat (diazepam) can cause side effects. The most common is drowsiness and sedation, which is expected given its calming, anti-seizure action, so the person will usually be sleepy after receiving it and should be monitored. Other possible side effects include dizziness, unsteadiness or poor coordination, headache, and, sometimes, other effects. Because diazepam is a central nervous system depressant, a particularly important potential effect, especially at higher doses or in vulnerable people, is slowed breathing (respiratory depression), so the person’s breathing should be monitored after Diastat is given, and emergency help sought if breathing is affected or if there are other concerning signs. Rarely, more serious reactions can occur. The risk of serious effects is increased if Diastat is combined with alcohol or other central nervous system depressants, which should be avoided, as they can dangerously increase sedation and the risk to breathing. Because Diastat is used for occasional emergency treatment rather than regular daily use, some longer-term concerns associated with regular benzodiazepine use are less relevant, but it should still only be used as prescribed. If side effects or any concerning symptoms occur, particularly problems with breathing, alertness, or a seizure that does not stop, emergency help should be sought as directed. Caregivers should be aware of the possible side effects, monitor the person after giving Diastat, and know when to seek help. Any questions about Diastat’s side effects should be directed to the prescribing doctor or healthcare professional, who can provide guidance specific to the individual.
Is Diastat a controlled or addictive medication?
Diastat contains diazepam, which is a benzodiazepine, and benzodiazepines are controlled medications that carry a potential for dependence and misuse with regular use. However, the context of Diastat’s use is important. Diastat is used as an occasional rescue or emergency medication for seizure clusters, given rectally when needed, rather than as a regular, daily medication. Because it is used intermittently for emergencies, rather than taken regularly, the concern about developing dependence (which is mainly associated with regular, ongoing benzodiazepine use) is much less relevant to how Diastat is typically used. That said, because it is a benzodiazepine, Diastat is a controlled medication, it should be prescribed and used only as directed, for the specific person and purpose for which it is prescribed, and it should not be used by anyone other than the person it is prescribed for or for any purpose other than its intended emergency use. It should be stored securely. Misusing Diastat, or using diazepam or other benzodiazepines inappropriately or regularly outside of medical direction, would carry the risks associated with benzodiazepines, including dependence. But when Diastat is used correctly, as an occasional emergency treatment for seizures as prescribed, it is used appropriately and the risk of dependence is not a major concern. So Diastat is a controlled medication (as a benzodiazepine) with the class’s general considerations, but its intermittent, emergency use for seizures, as prescribed, means dependence is not the primary concern in its intended use. As always, it should be used exactly as directed by the healthcare professional.
When should you call for emergency help when using Diastat?
When using Diastat, you should call for emergency help in the situations specified in the person’s seizure action plan and by their healthcare professional, and it is essential that any caregiver who may give Diastat understands these instructions clearly. In general, emergency medical help (calling your local emergency number) should be sought in situations such as: if a seizure does not stop or lasts longer than expected; if seizures continue or worsen after Diastat is given, or if a further cluster occurs; if the person has difficulty breathing, very slow or shallow breathing, or turns blue; if the person does not recover as expected, remains unresponsive, or is excessively sedated; if there are any other concerning signs; or in any situation the person’s specific seizure plan identifies as requiring emergency help. Because Diastat can cause sedation and, in some cases, slowed breathing, monitoring the person’s breathing and alertness after giving it is important, and breathing problems warrant emergency help. The exact circumstances that require calling for help will be specified in the individual’s seizure action plan, which is tailored to their situation by their doctor, so it is vital to know and follow that plan. If you are ever unsure whether a situation is an emergency, it is safer to seek help. So caregivers using Diastat should be trained on, and clearly understand, when to call for emergency help, and should follow the person’s seizure plan; when in doubt, or if there are signs such as a seizure not stopping or breathing problems, call your local emergency number. Knowing when to seek emergency help is a crucial part of using Diastat safely.
Sources
National Library of Medicine (MedlinePlus). Diazepam Rectal. https://medlineplus.gov/druginfo/meds/a682047.html
U.S. Food and Drug Administration (FDA). Diastat (Diazepam Rectal Gel) Prescribing Information. https://www.fda.gov/drugs
Epilepsy Foundation. Rescue Treatments for Seizure Clusters. https://www.epilepsy.com/
National Institute of Neurological Disorders and Stroke (NINDS). Epilepsy and Seizures. https://www.ninds.nih.gov/
National Library of Medicine (MedlinePlus). Epilepsy. https://medlineplus.gov/epilepsy.html
National Health Service (NHS). Diazepam and Epilepsy. https://www.nhs.uk/
What is Diastat — key entities and related terms
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