Table 6

Diazepam rectal

Diazepam rectal
What is it?Benzodiazepine
Mechanism of actionGABAA modulator
Starting dose2.5 mg (approximately equivalent to 1.25 mg midazolam)
10 mg for seizure
Time to onset of effect30 min17
FormulationRectal tube
IndicationAgitated delirium
Common adverse effectsdrowsiness; fatigue; muscle weakness; nausea; respiratory depression (particularly with high dose and intravenous use—facilities for its treatment are essential); sleep disorders; vertigo; vision disorders; withdrawal syndrome16
ContraindicationsComa; current alcohol abuse; current drug abuse; respiratory depression16
CautionHepatic impairment
Renal failure
LicenceLicensed for anxiety and seizures; ‘off label‘for delirium
BenefitsAlternative route of administration
RisksGreater evidence base with buccal midazolam than rectal diazepam
Cost2.5 mg—£5.65 for 5
5 mg—£6.49 for 5
10 mg—£6.49 for 5
  • GABAA - gamma aminobutyric acid receptor type A