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Plasma-diazepam in infants after rectal administration in solution and by suppository
Insights
Rectal diazepam solution rapidly achieved anticonvulsant levels in infants, unlike suppositories. This rapid-acting diazepam solution may be beneficial for treating febrile convulsions at home.
Area of Science:
- Pediatrics
- Clinical Pharmacology
- Neurology
Background:
- Febrile convulsions are common in infants and young children.
- Prompt treatment is crucial to manage seizures effectively.
- Rectal diazepam is a potential option for acute management.
Purpose of the Study:
- To compare the pharmacokinetic profiles of rectal diazepam solution versus suppository in infants.
- To determine the onset of anticonvulsant plasma levels for each formulation.
- To evaluate the potential utility of rectal diazepam for home treatment of febrile convulsions.
Main Methods:
- A randomized study involving 20 infants aged 1-2 years with a history of febrile convulsions.
- Administration of a single rectal dose of diazepam, either as a solution (0.7 mg/kg) or suppository (5 mg).
- Repeated plasma-diazepam level measurements during the first hour post-administration using gas chromatography.
Main Results:
- Diazepam solution administered rectally achieved anticonvulsant plasma levels within 4 ± 1 minutes.
- Similar plasma levels were achieved with diazepam suppositories only after 20-30 minutes.
- Diazepam solution demonstrated significantly faster absorption compared to suppositories.
Conclusions:
- Rectal diazepam in solution offers rapid absorption and may be effective for acute febrile convulsions.
- Diazepam suppositories showed delayed absorption, limiting their utility in acute seizure management.
- Rectal diazepam solution shows promise for home use in recurrent febrile convulsions, pending further safety and efficacy data.
Abstract:
Twenty infants aged 1-2 years who had previously had one attack of febrile convulsions were randomly given a single dose of diazepam rectally, either as a solution (0.7 mg/kg) or by suppository (5 mg). Plasma-diazepam levels were determined repeatedly during the first hour using gas chromatography. Rectal administration of diazepam in solution resulted in anticonvulsant plasma values within 4 +/- 1 min. Similar plasma levels were obtained only after 20-30 min in the group treated with suppositories. Diazepam in solution given rectally may therefore be useful in the acute treatment of febrile convulsions, while treatment by suppository would seem to be of little value in this respect. Moreover, diazepam in solution given rectally seems suitable for use at home in case of recurrent febrile convulsions. This treatment, however, cannot be recommended until the anticonvulsant effect and side-effects have been elucidated further.