Antiepileptic Drugs Available for Rectal Administration

Drug Treatment Usefulness Dose (mg/kg/dose) Preparation Pharmaco-
kinetics
Comments
Carbamazepine Maintenance Same as oral Oral Suspension (dilute with equal volume of water)
Suppository gel (carba-
mzepine powder disolved in 20% alcohol and methyl hydroxy cellulose)*
Peak concentration 4-8 hrs; 80% absorbed Carthartic effect
Clonazepam Acute 0.02-0.10mg Suspension Peak concentration 0.1-2.0 hrs Onset may be too slow for acute use. Well tolerated.
Diazepam Acute 0.2-0.5 mg Parenteral solution Effect in 2-10 mins; peak concentraion 2-30 mins Well tolerated.
Nordia-
zepam accum-
ulates with repeated doses
Lorazepam Acute 0.05-0.10 mg Parenteral solution Peak concentration 0.5-2.0 hrs Well tolerated.
Paraldehyde Acute 0.3 ml Oral solution (dilute with equal volume of mineral oil) Effect in 20 mins; peak concentration 2.5 hrs Moderate cathartic effect; use glass syringe
Phenobarbital Acute 10-20 mg Parenteral solution Peak concentration 4-5hrs; 90% absorbed Onset may be too slow for acute use.
Secobarbital Acute 5 mg Parenteral solution Peak concentration 0.5-1.5 hrs  
Maintenance Same as oral Same as acute Same as acute  
Valproic acid Acute 5-25 mg Oral solution (dilute with equal volume of water) Peak concentration 1-3 hrs Cathartic effect
Maintenance Same as oral Valproic acid liquid from capsules mixed into Supocire C lipid base Peak concentration 2-4 hrs; 80% absorbed  

*Extemporaneously prepared using commercial products; all other preparations are commercial products given rectally.

Adapted from NM Graves, AL Kriel. Rectal administration of antiepileptic drugs in children. Pediatric Neurol 1987;3:321-326. These data are based largely on pediatric studies.

Authored By: 
NM Graves
AL Kriel
Authored Date: 
01/2004