R. Edward Hogan, MD: Clinician Takeaways for Using Diazepam Nasal Spray


The director of the adult epilepsy center at Washington University in St. Louis discussed the takeaways for clinicians regarding the use of intranasal diazepam as a treatment for runs of seizures in patients with refractory epilepsy.

“It’s important for clinicians to understand that some patients just don’t respond to the basic, standard antiepileptic drugs. They have runs of seizures. If you sit with patients and you talk with them, a lot of times that’s a little in-road you can make—find a time where they’re more likely to have seizures and give this little extra boost of medicine.”

Data presented at the 2019 American Academy of Neurology Annual Meeting in Philadelphia, Pennsylvania, suggested that over the long-term, intranasal diazepam (Valtoco, Neurelis) is both safe and well-tolerated, with fewer than 20% of patients administered a range of doses up to 20 mg experiencing a treatment-related adverse event.

While this formulation of diazepam is much more convenient to patients compared to its rectal counterpart, R. Edward Hogan, MD, director, adult epilepsy center, and professor of neurology, Washington University in St. Louis, told NeurologyLive that it offers advantages to clinicians as well. When patients experience cluster seizures—series of seizures which start and stop, experienced as a group—this intranasal form allows for a “boost,” according to Hogan, which can help address these runs.

Hogan offered insight into the takeaways for the physician community who may see intranasal diazepam as a possible rescue option for their patients with refractory epilepsy, as well as which situations the treatment offers the most advantages.


Sperling M, Hogan RE, Biton V, et al. A 12-month, open-label, repeat-dose safety study of Valtoco ™ (NRL-1, diazepam nasal spray) in patients with epilepsy: Interim report. Presented at: American Academy of Neurology Annual Meeting; May 4-9, 2019; Philadelphia, PA. Poster P1.5-028.

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