Valtoco (diazepam) is a brand-name drug prescribed for certain types of seizures in adults and some children with epilepsy. Valtoco comes as a nasal spray that’s typically given in one or both nostrils.
Specifically, Valtoco is approved by the Food and Drug Administration (FDA) to treat seizure clusters. A seizure cluster is an episode of increased seizure activity that’s different from a person’s usual seizure pattern. It’s prescribed for adults and children ages 6 years and older with epilepsy.
Valtoco belongs to a drug class called benzodiazepines. Valtoco isn’t available in a generic version.
Keep reading for specific information about the dosage of Valtoco, including its strengths and how to use the medication. For a comprehensive look at Valtoco, see this article.
Note: This article describes typical dosages for Valtoco provided by the drug’s manufacturer. With Valtoco, always follow the dosage prescribed by your doctor.
Below are details about Valtoco’s form, strengths, and dosage.
Valtoco form
Valtoco comes as a solution in a nasal spray device. Each device contains one dose of diazepam (Valtoco’s active drug) in 0.1 milliliters (mL) of solution. After giving a dose, safely dispose of the device. For details, see the “How to use Valtoco” section below.
Valtoco strengths
Valtoco comes in three strengths: 5 milligrams (mg), 7.5 mg, or 10 mg per 0.1 mL of solution.
Typical dosages
The following information describes dosages that are commonly prescribed or recommended in adults. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.
Dosage for seizures
Valtoco is prescribed to treat seizure clusters in adults with epilepsy. A seizure cluster is an episode of increased seizure activity due to epilepsy. Valtoco dosages are based on body weight in kilograms (kg).*
The typical dosage for seizures is 0.2 mg Valtoco per kg (0.2 mg/kg) of body weight. The table below shows the manufacturer’s recommended dosages for Valtoco by body weight:
| Body weight | Treatment dose | Nasal spray strength | Given as |
| 14–27 kg (about 31–60 lb) | 5 mg | one 5-mg device | one spray in one nostril |
| 28–50 kg (about 62–110 lb) | 10 mg | one 10-mg device | one spray in one nostril |
| 51–75 kg (about 112–165 lb) | 15 mg | two 7.5-mg devices | one spray in each nostril |
| 76 kg (about 167 lb) and greater | 20 mg | two 10-mg devices | one spray in each nostril |
Note: The maximum recommended dosage of Valtoco is two doses per seizure cluster. Valtoco may be used to treat one seizure cluster episode within a 5-day period and up to five episodes per month.
* One kg equals 2.2 pounds (lb).
Children’s dosage
Valtoco is prescribed to treat seizure clusters in children ages 6 years and older with epilepsy. Valtoco dosages for children are based on the child’s age and body weight.
For children ages 12 years and older, the dosage is the same as the adult dosage. For details, see “Dosage for seizures” just above.
For children ages 6–11 years, the dosage is typically 0.3 mg/kg of body weight. The table below shows the usual Valtoco dosages by body weight:
| Body weight | Treatment dose | Nasal spray strength | Given as |
| 10–18 kg (about 22–40 lb) | 5 mg | one 5-mg device | one spray in one nostril |
| 19–37 kg (about 42–82 lb) | 10 mg | one 10-mg device | one spray in one nostril |
| 38–55 kg (about 84–121 lb) | 15 mg | two 7.5-mg devices | one spray in each nostril |
| 56–74 kg (about 124–163 lb) | 20 mg | two 10-mg devices | one spray in each nostril |
If your child’s seizure cluster continues after one dose of Valtoco, their doctor may recommend a second dose. If their doctor recommends a second dose, you’ll give it to your child at least 4 hours after the first dose. When your child’s doctor prescribes the drug, they’ll tell you about the situations in which to give a second dose.
Note: The maximum recommended dosage of Valtoco is two doses per seizure cluster. Valtoco may be used to treat one seizure cluster episode within a 5-day period and up to five episodes per month.
Long-term treatment
Valtoco isn’t meant to be a long-term treatment. It’s a rescue treatment for seizure clusters. Rescue treatments are medications that work quickly to stop a seizure. You use them only as needed for seizure clusters.
If you have questions about what to expect with Valtoco, talk with your doctor.
The Valtoco dosage your doctor prescribes will depend on several factors. These include:
- the type and severity of the condition you’re taking Valtoco to treat
- your body weight, which can change over time
- your age
- other medications you may take
Other medical conditions you have can also affect your Valtoco dosage.
Dosage adjustments
If you’re taking opioid medications, your doctor may recommend a lower dosage of Valtoco for you.
Note: Valtoco has a boxed warning about the risk of taking Valtoco with opioids. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). For more information, see “Boxed warnings” at the top of the article.
Valtoco comes as a nasal spray device. Each device contains one dose of drug — a single spray — that’s given into one nostril.
To give a dose, open the device, insert the tip into the nostril, and press the plunger. Do not prime the device before use or try to spray it more than once. After you give the dose, safely dispose of the device. For more information on how Valtoco is given, you can refer to drug’s instructions for use and watch this video.
When your doctor prescribes the drug, they’ll tell you whether to give a second dose. If you give a second dose, you’ll open a new device. For details about dosages, see the “Valtoco dosage” section above.
Note: Keep in mind that you may not be able to spray your own dose of Valtoco. Be sure that your caregiver knows how to give you your dose.
ACCESSIBLE DRUG LABELS AND CONTAINERSSome pharmacies offer labels with large print, braille, or a code you scan with a smartphone to convert text to speech. If your local pharmacy doesn’t have these options, your doctor or pharmacist might be able to recommend a pharmacy that does.
Valtoco has a boxed warning about the risk of misuse (also called abuse) and addiction. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).
With misuse, a drug is taken or used in a way other than how it’s prescribed. Drug misuse increases the risk of addiction. With addiction, a drug is taken even though it’s causing harm. Valtoco misuse and addiction can lead to overdose, coma, or even death in some cases. (To learn about overdose, see the “Valtoco and overdose” section just below.)
The risk of misuse is higher for people who consume alcohol or take illegal drugs with Valtoco. For this reason, tell your doctor if you’ve previously had problems with alcohol or drug misuse. Before prescribing Valtoco, your doctor will determine whether it’s safe for you to take.
Symptoms of Valtoco misuse include:
- seizures
- respiratory depression
- sudden confusion or anxiety
- hallucinations (seeing or hearing things that aren’t real)
- paranoia
- thoughts about suicide or suicide attempts
Seek emergency medical care if you notice any of the symptoms listed above.
If you have thoughts of suicide during Valtoco treatment, call 911 or your local emergency number. In the United States, you can also call or text the Suicide and Crisis Lifeline at 988 or text HOME to the Crisis Textline at 741741. You can also refer to this article for ways to seek support.
If you use more Valtoco than your doctor prescribes, you may develop harmful effects.
It’s important that you do not use more Valtoco than your doctor advises.
Symptoms of overdose
Valtoco overdose symptoms can include:
- extreme drowsiness
- respiratory depression
- confusion
- changes in awareness of your surroundings
- increased talking
- slurred speech
- low muscle tone
- decreased reflexes
- decreased coordination
- behavior changes, such as irritability, agitation, and impulsivity
- violent behavior
- coma
If you take more than the recommended amount of Valtoco
Call your doctor right away if you believe you’ve taken too much Valtoco. Another option is to call America’s Poison Centers at 800-222-1222 or use its online tool. If you have severe symptoms, immediately call 911 or your local emergency number, or go to the nearest emergency room.
Valtoco contains the active drug diazepam. It belongs to a class of drugs called benzodiazepines. As with other drugs in this class, Valtoco has a risk of physical dependence and withdrawal. Valtoco has a boxed warning for these effects. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).
With physical dependence, your body needs the drug to function as usual. This can lead to withdrawal symptoms if you suddenly stop taking the drug. These symptoms may include:
- increased talking or activity
- changes in behavior
- changes in mood such as anxiety
- difficulty sleeping
- shaking or muscle twitching
- weakness
- unusual sensations on your skin such as prickling, burning, or crawling
- ringing in your ears
- difficulty with concentration and memory
- hallucinations (seeing or hearing things that aren’t real)
- psychosis (loss of touch with reality)
- seizures
- thoughts about suicide or suicide attempts
If you have thoughts of suicide during Valtoco treatment, call 911 or your local emergency number. In the United States, you can also call or text the Suicide and Crisis Lifeline at 988 or text HOME to the Crisis Textline at 741741. You can also refer to this article for ways to seek support.
Due to the risk of withdrawal, a dosage taper for Valtoco may be needed in some cases. A taper is a slow reduction in dosage over time. A taper may be necessary in cases of Valtoco misuse (also called abuse).* If your doctor recommends stopping Valtoco, they’ll give you specific instructions to follow. For more information, talk with your doctor.
* Valtoco has a boxed warning about the risk of misuse. To learn more, see the “Valtoco and misuse” section above.
The dosages in this article are typical dosages provided by the drug’s manufacturer. If your doctor recommends Valtoco for you, they’ll prescribe the dosage that’s right for you. Always follow the dosage that your doctor prescribes.
As with any drug, never change your dosage of Valtoco without your doctor’s recommendation. If you have questions about the dosage of Valtoco that’s best for you, talk with your doctor.
Besides learning about dosage, you may want other information about Valtoco. These additional articles might be helpful:
- More about Valtoco. For information about other aspects of Valtoco, refer to this article.
- Cost. If you’d like to learn about Valtoco and cost, see this article.
- Details about your condition. For details about your condition, see our epilepsy and seizure hub.
Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.