The use of rectally administered antiepileptic drugs (AEDs) is reviewed by experts from the College of Pharmacy and Division of Pediatric Neurology, University of Minnesota, Minneapolis, Minn. Paraldehyde, diazepam, secobarbital, and valproic acid (VPA) in solution are used when a rapid effect is desired for termination of prolonged or serial seizures. VPA, lorazepam, carbamazepine, and phenytoin in suspension or suppository can be used in maintenance therapy. The authors recommended the following rectal doses: paraldehyde 0.3ml/kg diluted with an equal volume of mineral oil in glass, not plastic, syringe and rubber tube; diazepam 0.5mg/kg as parenteral solution or commercially available rectal preparation in Europe; valproic acid 6-15 mg/kg as oral solution diluted with equal volume of water; clorazepam 0.05-0.1 mg/kg as parenteral solution; clonazepam 0.02-0.1 mg/kg as suspension; secobarbital 5 mg/kg as parenteral solution or suppository; and carbamazepine 5 mg/kg as oral suspension diluted with equal volume of water as maintenance therapy only. Experience with rectal phenobarbital and phenytoin is limited. [1]
COMMENT. This practical and informative article emphasizes the usefulness of the rectal route of administration of antiepileptic drugs in children. The method is particularly applicable for use in the home by parents of children with acute recurrences of refractory epilepsies and as prophylaxis for febrile seizures at times of fever. Diazepam is the agent most commonly employed, and a commercial rectal preparation similar to those available in Europe would be welcome in the US.