All About Valtoco

What is Valtoco used for?

Valtoco is a “rescue” (short-term) treatment that’s used as needed to treat seizure clusters in adults and in children ages 6 years and older.

Seizure clusters, also called acute repetitive seizures, occur when you experience two or more seizures within 24 hours. Seizure clusters differ from your typical seizure pattern and are unpredictable. Without treatment, seizure clusters can lead into status epilepticus, which is a medical emergency.

It’s not fully known how Valtoco works to treat seizure clusters. But it’s thought that the drug slows the signaling between brain cells and increases the levels of gamma amino butyric acid (GABA) in the brain. These actions may help stop symptoms of seizure clusters.

What is Valtoco’s dosage?

Your doctor will recommend the dosage of Valtoco that’s right for you. Below are commonly used dosages, but always use the dosage your doctor prescribes.

Form and strengths

Valtoco comes as a liquid solution that’s used as a nasal spray. It’s available in three strengths:

• 5 milligrams (mg) per 0.1 milliliters (mL) of solution
• 7.5 mg per 0.1 mL
• 10 mg per 0.1 mL

Recommended dosages

Valtoco’s dosage is based on your body weight in kilograms (kg). For reference, 1 kg equals about 2.2 pounds (lb).

For adults and children ages 12 years and older, the recommended Valtoco dose is 0.2 mg per kg of body weight (0.2 mg/kg). For children ages 6 to 11 years, the recommended Valtoco dose is 0.3 mg per kg (0.3 mg/kg).

To see weight-based dosing charts for adults and children, see this Valtoco dosage article.

If your seizures continue after your first Valtoco dose, your doctor may instruct you to use a second dose. The second dose should be given at least 4 hours after the initial dose. You should use a new Valtoco device for the second dose. You should not use more than two doses of Valtoco to treat a single seizure cluster episode.

Note: Valtoco can be used to treat up to one seizure cluster episode every 5 days. The drug should be used to treat no more than five seizure cluster episodes per month. If you experience more than five episodes per month, let your doctor know. They may want to adjust your seizure treatment plan.

When to use Valtoco

When your doctor prescribes Valtoco, they’ll tell you how to identify a seizure cluster and when to use Valtoco. The signs of increased seizure activity will vary based on your typical seizure pattern and symptoms.

If you have questions about when to give yourself a dose of Valtoco, including how to identify a seizure cluster, ask your doctor for more information.

How to use

Your doctor will explain how you should use Valtoco. They’ll also explain how much to use and how often. Be sure to follow your doctor’s instructions.

Valtoco is available as a liquid solution that’s used as a nasal spray. Each Valtoco device contains only one dose, so it’s very important that you do not prime the nasal spray device before using Valtoco.

To use a dose, insert the tip of the nasal spray device into one nostril and press the plunger. If your dose requires using two Valtoco devices, give the second spray into your other nostril using a new Valtoco device.

The manufacturer of Valtoco provides step-by-step instructions on how to use Valtoco. You can also view Valtoco’s prescribing information or ask your doctor or pharmacist for additional help.

Questions about using Valtoco

Below are some common questions about using Valtoco.

• Will I need to use Valtoco long term? Valtoco is used as needed to treat seizure clusters. Although you won’t use Valtoco on a regular basis, you may use it long term on an as-needed basis to treat seizure clusters when they occur.
• How long does Valtoco take to work? When used within 5 minutes after a seizure begins, Valtoco stops the seizure in an average of 2 minutes.

Overdose

Do not use more Valtoco than your doctor prescribes, as this can lead to harmful effects.

Symptoms of overdose

Symptoms caused by an overdose can include:

• drowsiness
• confusion
• slurred speech
• slowed reflexes
• problems with balance and coordination
• respiratory depression (slow, shallow breathing)

In rare cases, overdose of Valtoco may lead to coma or even death if the drug is used with alcohol or certain medications, including opioids.

Valtoco has a boxed warning regarding the risks if it’s used with opioids. To learn more, see the “What should be considered before using Valtoco?” section.

What to do in case you use too much Valtoco

Call your doctor if you think you’ve used too much Valtoco. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. But if you have severe symptoms, immediately call 911 or your local emergency number or go to the nearest emergency room.

What are Valtoco’s side effects?

Like most drugs, Valtoco may cause mild to serious side effects. The lists below contain some of the more common side effects Valtoco may cause, but they don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

• your age
• other health conditions you have
• other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Valtoco. They can also suggest ways to help reduce side effects. You can check out this Valtoco side effects article to learn more.

Mild side effects

Here’s a list of some of the mild side effects that Valtoco can cause. To learn about other mild side effects, talk with your doctor or pharmacist or read Valtoco’s prescribing information.

Mild side effects of Valtoco that have been reported include:

• drowsiness
• headache
• discomfort in your nose
• changes in the way things taste
• nosebleed
• diarrhea
• problems with balance and coordination
• skin rash

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Valtoco can occur, but they aren’t common. If you have serious side effects from Valtoco, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Valtoco that have been reported include:

• central nervous system (CNS) depression (slowed activity in your brain and nerves), which can slow your reaction times, make you extremely drowsy or dizzy, and affect your balance and coordination
• increased short-term risk of suicidal thoughts and behaviors
• boxed warnings: risk of serious side effects if used with opioids, risk of misuse and addiction, and risk of physical dependence and withdrawal symptoms (see “What should be considered before using Valtoco?” for details)

ALLERGIC REACTION

For some people, Valtoco can cause an allergic reaction. But it’s not clear whether this side effect occurred in the drug’s studies.

In general, symptoms of allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should keep using Valtoco.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Valtoco, they may have you switch to a different treatment.

What should be considered before using Valtoco?

Below is important information you should consider before using Valtoco.

Interactions

Taking a drug with certain medications, vaccines, foods, and other things can affect how the drug works. These effects are called interactions.

Valtoco can interact with several other medications. It can also interact with certain supplements and certain foods.

Before using Valtoco, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you take. Sharing this information can help you avoid potential interactions.

For more information, see this Valtoco interactions article.

Drug interactions

Below is a list of medications that can interact with Valtoco. This list does not contain all drugs that may interact with Valtoco. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

* Valtoco has a boxed warning regarding the risks if it’s used with opioids. To learn more, see the “Boxed warning” section.

Valtoco and alcohol

Your doctor will likely advise you not to consume alcohol while using Valtoco. Drinking alcohol after you’ve used a dose of Valtoco can lead to severe drowsiness and respiratory depression (slow, shallow breathing). In rare cases, it may cause coma or even death.

Because Valtoco is not a medication you’ll expect to use every day, your doctor may tell you it’s safe to consume alcohol on days you don’t use Valtoco. But be sure to talk with your doctor first. They may advise you to avoid alcohol entirely while you’re prescribed Valtoco.

In addition, alcohol can be a seizure trigger for some people. If consuming alcohol worsens your seizures or causes them to happen more frequently, your doctor will likely recommend that you avoid alcohol.

Other interactions

Valtoco can interact with other substances such as:

• Vitamins or supplements: Valtoco may interact with St. John’s wort, which is used to ease symptoms of depression and other conditions. Your doctor may recommend that you not take this supplement during your Valtoco treatment.
• Foods: Valtoco may interact with grapefruit and grapefruit juice. Your doctor may recommend that you not consume grapefruit products during your Valtoco treatment.

Pregnancy and breastfeeding

Valtoco may cause harmful effects if it’s used during pregnancy, especially during the late stages of pregnancy. Examples of these harmful effects include extreme sleepiness and benzodiazepine withdrawal symptoms in a newborn. (Valtoco is a benzodiazepine drug.) If you’re pregnant or planning to become pregnant, talk with your doctor before starting Valtoco treatment. They can discuss the risks and benefits with you.

If you and your doctor decide you’ll use Valtoco during pregnancy, consider joining the Antiepileptic Drug Pregnancy Registry. (Valtoco is a type of antiepileptic drug.) This registry helps determine the safety of using medications such as Valtoco during pregnancy. You can learn more or sign up for the registry by calling 888-233-2334 or by visiting the registry site.

Your doctor may recommend that you not breastfeed while using Valtoco. Valtoco passes into breast milk and may cause side effects such as drowsiness, low appetite, and slowed weight gain in a breastfed child. Talk with your doctor before breastfeeding while you’re using Valtoco. They can discuss your options with you.

Boxed warnings

Valtoco has several boxed warnings. A boxed warning is the most serious warning from the Food and Drug Administration (FDA) about drug effects that may be dangerous.

Boxed warnings for Valtoco include:

Risk of severe side effects if used with opioids: Using opioids with benzodiazepines, including Valtoco, can cause severe side effects such as severe drowsiness and respiratory depression. In rare cases, it can even lead to coma or death.

Due to these risks, doctors usually will not prescribe benzodiazepines and opioids together unless no other treatments work for your condition. If your doctor must prescribe Valtoco and an opioid together, they’ll prescribe the opioid at the lowest dose for the shortest time frame needed to treat your symptoms.

If you need to use an opioid with Valtoco, ask your doctor or pharmacist about naloxone (Narcan). It’s a nasal spray that can treat an opioid overdose. (The severe side effects listed above can also be symptoms of an opioid overdose.) After Narcan is used, it’s still necessary to call 911 right away. Narcan is not a substitute for emergency medical attention for a known or suspected opioid overdose.

Risk of misuse and addiction: Treatment with any benzodiazepine, including Valtoco, comes with a risk of misuse and addiction. “Misuse” refers to using a drug in a manner other than how it’s prescribed or intended to be used. “Addiction” refers to feeling unable to stop taking a drug, even though it may be causing harm. Misuse can increase your risk of addiction and overdose.

Due to this risk, it’s important to talk with your doctor before using Valtoco if you have a history of substance use disorder.

Risk of physical dependence and withdrawal symptoms: Using Valtoco more than recommended can raise your risk of physical dependence, a condition in which your body needs a drug in order to function as usual. And suddenly stopping a medication that your body is physically dependent on can cause withdrawal symptoms.

If you need to stop using Valtoco after frequent use, your doctor will likely lower your dosage gradually until it’s safe for you to stop.

Other warnings

Valtoco can sometimes cause harmful effects in people who have certain conditions. This is known as a drug-condition interaction. Other factors may also affect whether Valtoco is a good treatment option for you.

Talk with your doctor about your health history before you use Valtoco. Be sure to tell them if any of the following factors apply to you:

• breathing problem, such as asthma or chronic obstructive pulmonary disease (COPD)
• glaucoma, especially narrow-angle glaucoma
• substance use disorder, such as opioid use disorder or alcohol use disorder
• mental health conditions, including depression or suicidal thoughts or behaviors
• kidney problem, such as chronic kidney disease
• liver problem, such as cirrhosis
• previous allergic reaction to Valtoco
• pregnancy
• breastfeeding

What are some frequently asked questions about Valtoco?

Find answers to some commonly asked questions about Valtoco.

How does Valtoco compare with Nayzilam?

Valtoco and midazolam (Nayzilam) are similar medications, although they do have some differences.

Both Valtoco and Nayzilam are approved to treat seizure clusters. Valtoco and Nayzilam both come as a liquid solution that’s used as a nasal spray. But the drugs differ in their recommended dosages and the side effects they can cause.

Valtoco and Nayzilam both belong to a group of drugs called benzodiazepines.

To learn more about how Valtoco compares with Nayzilam, ask your doctor or pharmacist.

Is Valtoco a controlled substance?

Yes, Valtoco is a controlled substance. A controlled substance is a medication with special regulations in place to help prevent misuse and harm. Valtoco is classified as a controlled substance with accepted medical use but with risks of misuse, addiction, and dependence.

Valtoco has boxed warnings about the risks of misuse and addiction and of physical dependence and withdrawal symptoms. To learn more, see the “What should be considered before using Valtoco?” section. You can also ask your doctor or pharmacist for more information.

How does Valtoco compare vs. Diastat?

Valtoco and Diastat are similar medications. Valtoco and Diastat contain diazepam as the active ingredient (what makes a drug work). Both medications are used to treat seizure clusters.

But a key difference is how they’re given. Valtoco comes as a liquid solution that’s given as a nasal spray, while Diastat comes as a rectal gel.

Talk with your doctor or pharmacist if you’d like to learn more about how Valtoco compares with Diastat.

Valtoco cost

Whether you have health insurance or not, cost may be a factor when you’re considering Valtoco. What you’ll pay for Valtoco may depend on several things, such as your treatment plan and the pharmacy you use.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. A Valtoco Co-Pay Savings Program may also be available.

Learn more about saving on your prescriptions. You can also see this Valtoco cost article for more information.