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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.