TREATING CLUSTER SEIZURES
WITH THE RECTAL AND ORAL VALIUM PROTOCOL

 

What is Valium?

Is there a difference between Valium and diazepam?

When is Valium used?

What kind of seizures require Valium treatment?

How can I receive a copy of the rectal and oral Valium protocol?

What if my dog always clusters?

How is Valium administered?

How is the proper dosage determined?

What about Valium Suppositories?

Why add oral tablets to the rectal Valium?

What side effects are possible?

Is it possible to overdose my dog on Valium?

Can all dogs take Valium?

How do I administer the Valium?

Is Valium used for daily seizure control?

 

What is Valium(diazepam)?

Valium is a drug of the Benzodiazepine sedative class.  Valium (diazepam) acts on the limbic, thalmic and hypothalmic regions of the central nervous system to potentiate the effects of inhibitory neurotransmitters, raising the seizure threshold in the motor cortex.

Is there a difference between Valium and diazepam?

No both terms refer to the same drug.  Diazepam is the generic name and Valium is the brand name of diazepam by Roche.  Frequently the injectible is the generic form and is labeled diazepam.  The tablet may be brand name Valium or generic called diazepam.

When is Valium used?

Although used frequently in human medicine to treat anxiety and stress, in emergency veterinary care it is used to treat grand mal seizure activity.  Although there are other drugs available, many veterinarians and neurologists feel that Valium (diazepam) is the drug of choice for the emergency treatment of seizures.

What kind of seizures require Valium treatment?

Specific recommendations for each dog should be made by the attending veterinarian, but generally, those dogs who have one single seizure are not given valium treatment.  Those who have a history of clustering (have more than one seizure in 24 hours) or those who lapse into status (either a continuous seizure lasting at least 5 minutes, or two or more separate seizures with no clear recovery in between each seizure) would be candidates for the rectal and oral Valium protocol.  When using rectal Valium to stop cluster seizures, it is extremely important that the rectal Valium be administered during or just after the initial seizure.  It is almost impossible to stop cluster seizures with valium after 2 or 3 seizures have occurred.

How can I receive a copy of the rectal and oral Valium protocol?

For a copy of the protocol and all supporting information please click on the link below.  You will receive eight (8) separate e-mails including published studies, neurologists' recommendations and research citations that will be important to your vet.

Click Here to request the Valium Protocol
NOTE:  If you have NOT received eight (8) separate emails
containing the Valium Protocol within three days of sending your request,
please write again - emails do get lost in "cyberspace" from time to time!!!
Also, internet providers are blocking e-mails that come to you in groups (like our 8 e-mails)
Please check your spam/junk mail folder for the valium protocol if you do not get it in your in box.

What if my dog always clusters?

Cluster seizures require immediate attention!

The use rectal and oral Valium has proven to be effective for stopping cluster seizures and being able to keep your dog at home, rather than having to rush them to the ER and perhaps leave them there.  The following is a discussion on the use of rectal and oral Valium (diazepam) in stopping cluster seizures.  A protocol that has been used very effectively by many owners of epileptic dogs who have cluster seizures, is the rectal and oral Valium protocol.

The main approach that this protocol is based on is described in Dr. Podell's article:  Podell, M. "The Use of Diazepan Per Rectum At Home for the Acute Management of Cluster Seizures in Dogs. J Vet Int Med (1995) 9:68-76.  Oral Valium is used after the rectal Valium to maintain a longer anti seizure level in the bloodstream.

The key to the success of the Valium protocol is to;

1.  Use the proper dose of rectal Valium immediately after the first Grand Mal. 

2.  Administer an extra dose of the anti-convulsant medication once they have recovered enough to safely swallow.

3.  Maintain the anti-seizure level in the bloodstream by administering oral Valium 20 minutes after dosing with rectal Valium and then continue dosing the oral Valium every 1 to 2 hours for the next 12 to 36 hours or for the time frame the cluster seizures have occurred in the past (i.e. If the cluster seizures occur in a time frame of 6 or 9 hours then that is the length of time you should dose the oral Valium). By maintaining the anti seizure effect of oral Valium in the bloodstream, many owners have had success with eliminating or at least significantly reducing any further seizures.

How is Valium administered?

Veterinarians and/or animal emergency clinics will usually inject liquid Valium in the vein, but intravenous injections are not practical for most owners.  Liquid Valium is absorbed poorly when injected into the muscle or under the skin, therefore rectal administration is recommended for at home use.  Liquid Valium administered rectally is rapidly absorbed from the rectum.  Anti-seizure effects are achieved within 5 to 15 minutes.  These effects are relatively short-lived (approximately 30 to 60 minutes.)  If the seizure has not stopped after 10 minutes the dose can be repeated.  If the seizures do not stop after the third dose, urgent evaluation by a veterinarian or animal emergency clinic is necessary.

How is the proper dose determined?

Dosage guidelines for rectal Valium can be found in Dr. Thomas' published article, which can be viewed on our website and in the published studies by Dr. Podell, which is included in the copy of the rectal and oral Valium protocol.  The attending veterinarian is the best person to make specific recommendations.

What about  Valium suppositories?

 Some pharmacists can compound diazepam suppositories for rectal administration, however, no clinical studies have been done on the use of suppositories and the  absorption rate is unknown.

Why add oral Valium tablets to the rectal Valium?

Rectal Valium's advantage is that the anti-seizure effect starts within 5 to 15 minutes and lasts 30 to 60 minutes.   The anti-seizure effect of Valium given by mouth will begin after 30 to 40 minutes and lasts 1 to 2 hours.  Oral valium tablets are used in conjunction with liquid Valium in the rectal and oral Valium Protocol, to maintain the anti-seizure level for a longer period of time.  

What are the potential side effects of Valium?

Valium may cause drowsiness, incoordination or disorientation.  However these signs are also common in dogs immediately after a seizure.  These side effects are temporary.

Is it possible to overdose my dog on Valium?

Valium is one of the safer anti-seizure drugs that is used, because it is metabolized very quickly.  This means that even if too much is administered the side effects will not last long because the drug is eliminated so quickly from the body.  However, as with all drugs an overdose is possible if you do not follow your veterinarian's recommendations.

Can all dogs take Valium?

The majority of dogs have no problem with Valium, however, some will become hyper while taking Valium.  This response to Valium is temporary and the hyper activity will subside as the Valium is eliminated from the dog's body.  Even if your dog becomes hyper rather than sedated the anti-seizure effect of valium may still be effective.  

How do I give rectal Valium?

Either your vet or the pharmacy should have given or sold you a syringe large enough to hold the amount determined to be correct for one dose for you dog, with the accompanying needle to draw the valium into the syringe.  You will also need a teat cannula, a 'Tom Cat Catheter' or a regular catheter which will fit the syringe you have been given after the needle has been removed.  If you are given a regular catheter, the tubing length needs to be cut down to approximately six inches.  Measure from the top, cut from the bottom.  After cutting, mark the tubing three inches from the end with a permanent ink type marker.  The three inches of tubing is the part that goes into the rectum.

If you have the liquid Valium in a brown bottle intended for injection, proceed as follows:

1.  With the needle attached to the syringe, pull the plunger back, filling the syringe with air equal to the cc's of liquid valium you will be giving.

2.  Insert the needle into the opening in the bottle, making sure the needle tip is just past the rubber guard on the bottle.

3.  Push the plunger on the syringe, putting the air from the syringe into the bottle.  This helps to create a vacuum in the bottle.

4.  Turn the bottle and the needle upside down.  Now the bottle is on top, and the needle below, then the syringe, with the plunger toward the floor.  Pull the plunger back out to the correct cc dosage marking and the valium should now fill the syringe.

5.  When the correct amount of valium is in the syringe, remove the syringe from the needle and attach the catheter.

6.  Spread KY Jelly or Vaseline on the rectum for lubrication.  Attach the syringe to the other end of the catheter.  Insert three inches of the catheter into the rectum and push the plunger, slowly and steadily.

Hint:  Ask your pharmacist for a vial filled with water or placebo liquid.  It is important to practice as much as you can before you actually have to use it during or after a seizure.  The liquid diazepam is oily feeling.  With the practice vial, you can practice filling the syringe and then just push the plunger down with the needle inserted into the practice vial, putting the practice liquid back into the vial so you can practice some more.  The hardest part of administering the rectal valium is, without doubt, filling the syringe!

How should I store the Valium?

Store the small brown bottle at room temperature, away from direct light.  Valium should not be pre-filled and stored in plastic syringes.  If having valium pre-loaded is more convenient, pre-filled (2 ml.) syringes of valium, made using disposable glass, are available.  However, plastic binds to valium and will render the valium ineffective if stored in a plastic syringe.  Following is from Dr. William Thomas, DVM, MS on storing valium:

"Theoretically, diazepam (valium) solution will bind to certain plastics. That's why it is not recommended to store diazepam liquid in a plastic syringe. We dispense liquid diazepam in a glass vial and have the client draw it up into a syringe immediately before administration."


WB Thomas DVM, MS
Dipl.ACVIM (Neurology)
University of Tennessee
Knoxville, TN
wthomas@utk.edu

Is Valium used for daily seizure control?

NO!  Because of the short anti-seizure effect of Valium it is not recommended for use on a daily basis.  Remember oral Valium is only effective for 1 to 2 hours and rectal valium is only effective for 30 to 60 minutes.