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.
