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Diastat (Generic Diazepam Rectal)

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Diastat (diazepam rectal gel) is a medication primarily used for the emergency treatment of seizures, particularly in individuals who have epilepsy and experience prolonged or repeated seizures. Like any medication, Diastat carries certain risks, including:

  • Sedation: Diazepam, the active ingredient in Diastat, is a benzodiazepine that can cause drowsiness and sedation. This effect can impair cognitive and motor function, making activities such as driving dangerous.
  • Respiratory Depression: Diazepam can suppress breathing, especially in high doses or when combined with other central nervous system depressants like alcohol or opioids. This risk is particularly significant in individuals with respiratory conditions.
  • Dependence and Withdrawal: Long-term use of benzodiazepines like diazepam can lead to physical dependence, tolerance, and withdrawal symptoms upon discontinuation. Abrupt cessation can result in rebound seizures or other withdrawal effects.
  • Drug Interactions: Diazepam can interact with other medications, increasing the risk of side effects or reducing the effectiveness of either drug. It’s essential to inform healthcare providers about all medications, supplements, and herbal products being taken.
  • CNS Depression: Diazepam can depress the central nervous system, leading to confusion, dizziness, and impaired coordination. This effect is heightened in the elderly and those with compromised liver function.
  • Psychological Effects: Benzodiazepines like diazepam can cause paradoxical reactions, including increased agitation, aggression, or hallucinations, particularly in children or individuals with certain psychiatric conditions.
  • Allergic Reactions: While rare, some individuals may experience allergic reactions to diazepam, including rash, itching, swelling, or difficulty breathing. Seek medical attention immediately if these symptoms occur.
  • Intravenous Administration Risks: If administered intravenously instead of rectally as intended, diazepam can cause severe respiratory depression, cardiovascular collapse, and even death. Proper training and education are essential for caregivers and healthcare professionals.

It’s crucial for individuals prescribed Diastat to understand these risks and benefits, as well as to follow their healthcare provider’s instructions carefully. They should also be aware of signs of adverse effects and seek medical attention if necessary.

Why is this medication prescribed?

Diastat (diazepam rectal gel) is prescribed primarily for the emergency treatment of acute repetitive seizures (cluster seizures) or prolonged seizures that do not stop on their own (status epilepticus) in individuals with epilepsy, particularly those who are unable to swallow medication or have difficulty administering other forms of antiepileptic drugs during a seizure.

Diastat is a rectal gel formulation of diazepam, a benzodiazepine medication that works by calming excessive electrical activity in the brain, thereby stopping or reducing the duration of seizures. It is typically used when other seizure medications administered orally or intravenously are not feasible or effective during an acute seizure episode.

How should this medicine be used?

Dosage and administration instructions for Diastat may vary based on factors such as age, weight, seizure type, and individual response. However, general guidelines for using Diastat include:

  • Read the Instructions: Caregivers or individuals should thoroughly read and understand the instructions provided with the medication, including proper administration technique and dosage calculation.
  • Preparation: Before administering Diastat, ensure the rectal applicator is at room temperature. Warm the syringe by holding it in your hand for a few minutes if necessary. Avoid warming it in hot water or a microwave.
  • Administration: Place the individual in a comfortable position, preferably on their side. Remove the protective cap from the rectal applicator and gently insert the tip of the syringe into the rectum. Slowly push the plunger to administer the prescribed dose.
  • Monitoring: After administration, observe the individual closely for any adverse reactions or changes in their condition. Contact emergency medical services if the seizure persists or if there are signs of respiratory distress or other serious side effects.
  • Follow-Up: After using Diastat, follow up with a healthcare provider as soon as possible to discuss the seizure episode, evaluate the effectiveness of treatment, and determine any necessary adjustments to the treatment plan.

It’s essential for caregivers or individuals to receive proper training from a healthcare professional on the correct use of Diastat, including practice sessions with a dummy applicator if available. Additionally, they should have access to written instructions and emergency contact information for healthcare providers in case of any questions or concerns during an emergency seizure situation.

Other uses for this medicine

As for other uses, Diastat may be prescribed off-label in certain situations, such as:

  • Acute Anxiety: Diazepam, the active ingredient in Diastat, is a benzodiazepine medication with anxiolytic (anti-anxiety) properties. In some cases, healthcare providers may prescribe diazepam rectal gel off-label for the acute management of severe anxiety or panic attacks.
  • Muscle Spasms: Diazepam has muscle relaxant properties and may be used off-label to alleviate acute muscle spasms or spasticity, such as those associated with certain neurological conditions or musculoskeletal injuries.

What special precautions should I follow?

Special Precautions:

  • Respiratory Depression: Diastat can cause respiratory depression, especially when used in high doses or in combination with other central nervous system depressants such as alcohol, opioids, or certain medications. It should be used with caution in individuals with respiratory conditions or compromised respiratory function.
  • Dependence and Withdrawal: Like other benzodiazepines, diazepam can lead to physical dependence and withdrawal symptoms, particularly with long-term or high-dose use. Tapering off the medication gradually under medical supervision is essential to minimize the risk of withdrawal effects.
  • Sedation and Impaired Motor Function: Diastat can cause drowsiness, sedation, and impaired cognitive and motor function, which may affect the individual’s ability to perform tasks requiring mental alertness or coordination, such as driving or operating machinery. Caution should be exercised, and activities requiring full alertness should be avoided until the effects of the medication are fully understood.
  • Psychiatric Effects: Benzodiazepines like diazepam can exacerbate symptoms of depression, increase the risk of suicidal thoughts or behavior, or cause paradoxical reactions such as agitation, aggression, or hallucinations, particularly in individuals with pre-existing psychiatric conditions. Close monitoring by healthcare providers is necessary, especially when initiating or adjusting the dose of Diastat.
  • Special Populations: Diastat should be used with caution in certain populations, including the elderly, individuals with liver impairment, and those with a history of substance abuse or addiction. Lower doses or extended dosing intervals may be necessary in these cases to minimize the risk of adverse effects.
  • Pregnancy and Lactation: The use of Diastat during pregnancy or breastfeeding should be carefully considered, weighing the potential benefits against the risks to the fetus or infant. Diazepam can cross the placenta and may cause neonatal withdrawal syndrome or other adverse effects in newborns. Consultation with a healthcare provider is essential for pregnant or breastfeeding individuals.
  • Drug Interactions: Diastat can interact with other medications, including other benzodiazepines, antidepressants, anticonvulsants, and central nervous system depressants, leading to increased sedation or other adverse effects. It’s crucial to inform healthcare providers about all medications, supplements, and herbal products being taken to avoid potential interactions.

Individuals prescribed Diastat should follow their healthcare provider’s instructions carefully, including dosage recommendations, precautions, and any special monitoring requirements. Any questions or concerns about the use of Diastat should be discussed with a healthcare professional.

What special dietary instructions should I follow?

Regarding dietary instructions, there are no specific dietary restrictions associated with Diastat. However, alcohol consumption should be avoided or limited while taking diazepam, as alcohol can potentiate the sedative effects of the medication and increase the risk of respiratory depression.

What should I do if I forget a dose?

If you forget to administer a dose of Diastat during a seizure episode, follow these steps:

  • Assess the Situation: If the seizure has already stopped or if the individual is no longer experiencing prolonged or repetitive seizures, observe them closely for any signs of recurrence.
  • Contact Healthcare Provider: If in doubt or if the seizure continues despite missing the dose, contact a healthcare provider or seek medical attention promptly for further guidance.
  • Preventive Measures: To help prevent missed doses in the future, consider setting reminders or alarms, keeping Diastat readily accessible in case of emergencies, and ensuring caregivers are adequately trained in its administration.

What side effects can this medication cause?

Diastat (diazepam rectal gel) can cause several side effects, although not everyone will experience them. Common side effects of Diastat may include:

  • Drowsiness: Diazepam, the active ingredient in Diastat, can cause drowsiness or sleepiness, which may impair your ability to concentrate or perform tasks requiring mental alertness.
  • Fatigue: Feeling tired or fatigued is a common side effect of Diastat use.
  • Dizziness: Some individuals may experience dizziness or lightheadedness after using Diastat.
  • Muscle Weakness: Diazepam can cause muscle weakness, especially at higher doses.
  • Coordination Problems: Diastat may affect coordination and balance, leading to clumsiness or difficulty walking.
  • Confusion: Some individuals may experience confusion or cognitive impairment while using Diastat.
  • Headache: Headaches are a possible side effect of Diastat use.
  • Nausea and Vomiting: Some people may experience nausea or vomiting after using Diastat.
  • Constipation or Diarrhea: Changes in bowel habits, including constipation or diarrhea, may occur with Diastat use.
  • Respiratory Depression: In rare cases, Diastat can cause respiratory depression, particularly when used in high doses or in combination with other central nervous system depressants like alcohol or opioids. This side effect can be serious and requires prompt medical attention.
  • Allergic Reactions: While uncommon, some individuals may experience allergic reactions to Diastat, which can include rash, itching, swelling, or difficulty breathing. Seek medical attention immediately if you experience any signs of an allergic reaction.
  • Paradoxical Reactions: Paradoxical reactions, such as increased agitation, aggression, or hallucinations, may occur with benzodiazepine use, although they are rare.

It’s important to report any side effects to your healthcare provider, especially if they are severe, persistent, or concerning. Your healthcare provider can provide guidance on managing side effects and may adjust your treatment regimen if necessary. Additionally, if you experience any serious side effects, such as difficulty breathing or severe drowsiness, seek immediate medical attention.

What should I know about storage and disposal of this medication?

Storage and disposal guidelines for Diastat (diazepam rectal gel) are important to ensure its effectiveness and safety:


  • Room Temperature: Store Diastat at room temperature between 20-25°C (68-77°F). Avoid storing it in excessively hot or cold temperatures.
  • Protect from Light: Keep Diastat in its original packaging to protect it from light.
  • Keep Out of Reach of Children: Store Diastat in a secure location out of the reach of children and pets.
  • Do Not Freeze: Do not freeze Diastat, as freezing may affect its effectiveness.


  • Follow Local Regulations: Dispose of unused or expired Diastat according to local regulations or guidelines for medication disposal.
  • Do Not Flush: Do not flush Diastat down the toilet or pour it down the drain unless specifically instructed to do so by local authorities or a healthcare professional.
  • Consult Healthcare Provider: If you have questions about how to dispose of Diastat properly, consult your healthcare provider or pharmacist for guidance.

In case of emergency/overdose

  • Seek Medical Attention: In case of an overdose or if someone accidentally ingests Diastat, seek immediate medical attention or contact a poison control center (1-800-222-1222 in the United States).
  • Symptom Management: While awaiting medical assistance, monitor the individual’s vital signs and symptoms. If necessary, administer first aid measures such as maintaining an open airway and providing supportive care as directed by emergency responders.

What other information should I know?

  • Patient Education: Ensure that caregivers or individuals receiving Diastat are educated about its proper use, including administration technique, dosage, and potential side effects.
  • Emergency Preparedness: Keep Diastat readily accessible in case of seizures and ensure that caregivers are trained in its administration. Consider developing an emergency seizure action plan in consultation with healthcare providers.
  • Medication Review: Periodically review Diastat use with healthcare providers to assess its effectiveness, safety, and ongoing need. Adjustments to the treatment plan may be necessary based on changes in seizure frequency or other factors.
  • Communication: Maintain open communication with healthcare providers regarding any concerns or changes in the individual’s condition, including the need for adjustments to Diastat dosage or other aspects of the treatment regimen.

By following these guidelines, you can help ensure the safe and effective use of Diastat for the emergency treatment of seizures.

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