Seizure disorders:

Indications for: VALTOCO

Acute treatment of intermittent, stereotypic episodes of seizure activity (eg, seizure clusters, acute repetitive seizures) that are distinct from usual seizure pattern.

Adults and Children:

For intranasal use only. Individualize. Calculate dose based on body weight (in kg) and round up to next available dosage strength. Treat no more than 1 episode every 5 days and no more than 5 episodes per month. <6yrs: not established. 6–11yrs: 0.3mg/kg. ≥12yrs: 0.2mg/kg. See full labeling for dosing chart. If needed, may give 2nd dose at least 4 hours after 1st dose. Max 2 doses/episode. Elderly: reduce dose.

VALTOCO Contraindications:

Acute narrow-angle glaucoma.

Boxed Warning:

Risks from concomitant use with opioids. Abuse, misuse, and addiction. Dependence and withdrawal reactions.

VALTOCO Warnings/Precautions:

Risks from concomitant use with opioids; see Interactions. Caregiver must be fully able to identify cluster seizures, be able to decide when to treat, correctly administer dose, monitor patient, and assess response. CNS depression. Monitor for emergence or worsening of depression, suicidal thoughts or behavior, and/or unusual changes. Untreated open-angle glaucoma. Compromised respiratory function. Assess patient's risk for abuse, misuse, addiction prior to and during therapy. Avoid abrupt cessation. Drug or alcohol abusers. Renal impairment. Elderly. Premature neonates/infants: gasping syndrome (due to benzyl alcohol content). Neonatal sedation and withdrawal syndrome; monitor neonates exposed during pregnancy or labor. Pregnancy (esp. late stage). Nursing mothers: monitor infants.

VALTOCO Classification:


VALTOCO Interactions:

Increased sedation, respiratory depression, coma, and death with concomitant opioids; reserve use in those for whom alternative treatment options are inadequate; if needed, limit dosages/durations to minimum and monitor. CNS depression potentiated with alcohol, other CNS depressants (eg, valproate). Caution with other psychotropics. May be potentiated by inhibitors of CYP2C19 (eg, cimetidine, quinidine, tranylcypromine) or CYP3A4 (eg, ketoconazole, troleandomycin, clotrimazole). May be antagonized by inducers of CYP2C19 (eg, rifampin) or CYP3A4 (eg, carbamazepine, phenytoin, dexamethasone, phenobarbital). Diazepam may interfere with the metabolism of drugs which are substrates for CYP2C19 (eg, omeprazole, propranolol, imipramine) or CYP3A4 (eg, cyclosporine, paclitaxel, theophylline, warfarin).

Adverse Reactions:

Somnolence, headache, nasal discomfort; dependence, withdrawal reactions.


Hepatic (CYP2C19, CYP3A4).

Drug Elimination:

Half-life: ~49.2 hours.

Generic Drug Availability:


How Supplied:

Nasal spray 5mg—2; 7.5mg—4; 10mg—2, 4