Diazepam rectal
| Diazepam rectal | |
| What is it? | Benzodiazepine |
| Mechanism of action | GABAA modulator |
| Starting dose | 2.5 mg (approximately equivalent to 1.25 mg midazolam) 10 mg for seizure |
| Time to onset of effect | 30 min17 |
| Formulation | Rectal tube |
| Indication | Agitated delirium Anxiety Seizures |
| Common adverse effects | drowsiness; 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 |
| Contraindications | Coma; current alcohol abuse; current drug abuse; respiratory depression16 |
| Caution | Hepatic impairment Renal failure |
| Licence | Licensed for anxiety and seizures; ‘off label‘for delirium |
| Benefits | Alternative route of administration |
| Risks | Greater evidence base with buccal midazolam than rectal diazepam |
| Cost | 2.5 mg—£5.65 for 5 5 mg—£6.49 for 5 10 mg—£6.49 for 5 |
GABAA - gamma aminobutyric acid receptor type A