Valtoco is a nasal spray form of diazepam used to stop seizure clusters in people with epilepsy. It is FDA-approved for patients 6 years of age and older who experience intermittent episodes of frequent seizure activity that differ from their usual seizure pattern. It’s a rescue medication, meaning it’s not taken daily but kept on hand for emergencies.
What Seizure Clusters Are
Most people with epilepsy have a recognizable pattern to their seizures. Seizure clusters, also called acute repetitive seizures, break from that pattern. They involve multiple seizures occurring in a short window of time, often over hours or a single day, in a way that’s noticeably different from what’s typical for that person. These episodes can escalate and become dangerous if not treated quickly, which is why doctors prescribe rescue medications like Valtoco to have ready before they happen.
Valtoco is not a replacement for daily epilepsy medication. It’s designed to be used alongside a person’s regular treatment plan, specifically for those breakthrough episodes that daily medication doesn’t fully prevent.
How It Works
The active ingredient in Valtoco is diazepam, the same drug found in Valium. Diazepam enhances the activity of a calming brain chemical called GABA. During a seizure, nerve cells fire in rapid, uncontrolled bursts. By boosting GABA’s natural inhibitory effect, diazepam helps quiet that excessive electrical activity and stop the seizure.
What makes Valtoco different from older forms of diazepam is the delivery method. Before Valtoco, the main rescue option for seizure clusters was a rectal gel (Diastat). A nasal spray is far more practical, especially in public settings, school environments, or any situation where rectal administration would be difficult or embarrassing. The spray is absorbed through the lining of the nose and enters the bloodstream quickly without needing the person to swallow anything, which matters when someone is actively seizing.
How Quickly It Works
Speed is critical with seizure clusters, and Valtoco acts fast. Clinical data show that when the spray is given within 5 minutes of a seizure starting, seizures typically stop within about 2 minutes of administration. In those cases, total seizure duration from start to finish was roughly 4 minutes.
Even when treatment is delayed, Valtoco still performs well. For seizures treated between 5 and 15 minutes after onset, clusters stopped a median of 7 minutes after the spray was given. The takeaway: using it sooner produces faster results, but a delay of several minutes doesn’t mean it won’t work.
Advantages Over Rectal Diazepam
Beyond the obvious convenience of a nasal spray versus a rectal gel, Valtoco has a pharmacological advantage. The drug is absorbed more consistently through the nose than through the rectum. FDA review data found that blood levels of diazepam after Valtoco were 2 to 4 times less variable compared to Diastat. With rectal gel, a person’s body weight and BMI significantly affected how much drug actually got absorbed, sometimes leading to large differences in effectiveness between patients. Valtoco’s more predictable absorption means the prescribed dose is more likely to deliver the intended effect.
Who Can Use It
Valtoco is approved for anyone 6 years of age or older with epilepsy who experiences seizure clusters. The dose is based on both age and body weight. Children ages 6 to 11 receive a higher dose per kilogram of body weight (0.3 mg/kg) than adolescents and adults 12 and older (0.2 mg/kg), because younger children metabolize the drug differently.
The spray comes in four strengths: 5 mg, 10 mg, 15 mg, and 20 mg. A doctor selects the right strength based on where the patient falls in age and weight ranges. For the 5 mg and 10 mg doses, a single spray device delivers the full dose into one nostril. For the 15 mg and 20 mg doses, two devices are needed, one sprayed into each nostril to complete the full dose.
People with narrow-angle glaucoma should not use Valtoco. Anyone with a known allergy to diazepam should also avoid it.
How to Give It
Valtoco is designed to be given by a caregiver, family member, or trained bystander, not by the person having the seizure. If someone appears to be seizing, the first step is to gently help them to the floor and lay them on their side in a safe area where they can’t fall. The person can be on their side or back to receive the spray.
The device itself is simple. You hold it with your thumb on the plunger and two fingers on either side of the nozzle, insert the tip gently into one nostril until your fingers rest against the bottom of the nose, and press the plunger firmly. There’s no priming or testing required. Each device is a single use, prefilled unit that comes sealed in a blister pack.
For higher doses that require two devices, you give the first spray in one nostril, then immediately repeat the process with the second device in the other nostril. This completes the full dose.
Side Effects
Because Valtoco contains diazepam, it carries the same general side effects as other benzodiazepines. Drowsiness is the most expected effect and is partly the point, since calming brain activity is how it stops seizures. Other common effects include dizziness, fatigue, and nasal discomfort from the spray itself. Since it’s a rescue medication used infrequently rather than daily, the risk of dependence is lower than with regular benzodiazepine use, though the potential still exists with repeated dosing over time.
Diazepam can slow breathing, particularly when combined with opioids, alcohol, or other sedating medications. After giving Valtoco, caregivers should monitor the person’s breathing and level of consciousness until the episode has clearly resolved.