Alternatives to Valtoco If You Can't Fill Your Prescription

If you've been prescribed Valtoco (diazepam nasal spray) for seizure clusters but can't get it filled at a nearby pharmacy, you may be wondering what your options are. While finding Valtoco in stock should always be your first step, there are FDA-approved and commonly used alternative seizure rescue medications your doctor may consider. This guide explains the main alternatives to Valtoco and how they compare.

Important: Never change your rescue medication without consulting your neurologist or epileptologist. Seizure rescue medications are prescribed for specific reasons, and switching requires medical guidance.

Why Might You Need a Valtoco Alternative?

There are several reasons a patient might need to explore alternatives to Valtoco:

Valtoco is not stocked at local pharmacies and you need a rescue medication immediately

Insurance denial or prior authorization delay for Valtoco

Cost concerns—Valtoco retails for approximately $2,100–$2,572 for a 5-dose kit without savings programs

Patient tolerance issues (nasal irritation or other side effects with Valtoco)

Alternative 1: Nayzilam (Midazolam Nasal Spray)

Nayzilam is the most similar alternative to Valtoco. Like Valtoco, it is an FDA-approved nasal spray benzodiazepine for the treatment of seizure clusters. The key differences:

Active ingredient: Midazolam (Nayzilam) vs. diazepam (Valtoco)

Age range: Nayzilam is approved for ages 12 and older; Valtoco for ages 2 and older

Dosing frequency: Nayzilam allows 1 episode every 3 days; Valtoco allows 1 episode every 5 days

Onset: Midazolam (Nayzilam) tends to have a slightly faster onset; diazepam (Valtoco) has a longer duration

Second dose: Nayzilam allows a second dose after 10 minutes; Valtoco requires waiting at least 4 hours

Neither drug has been proven superior in head-to-head trials. The choice typically depends on patient age, weight-based dosing needs, and prescriber preference.

Alternative 2: Diastat (Diazepam Rectal Gel)

Diastat is the same active ingredient as Valtoco—diazepam—but administered rectally rather than nasally. It has been used as a seizure rescue medication for decades and is available as a generic (diazepam rectal gel), making it significantly more affordable. Key points:

Approved for ages 2 and older—the same age range as Valtoco

Generic version available, making it much more affordable

Widely stocked at most retail pharmacies—easier to fill

Rectal route is less convenient and can feel embarrassing, especially for teens and adults—a major reason Valtoco was developed

Alternative 3: Oral Lorazepam

Lorazepam (Ativan) is a benzodiazepine available in generic tablets or liquid. While not FDA-approved specifically as an outpatient nasal spray rescue for seizure clusters, some neurologists prescribe oral lorazepam as a bridge or rescue option for patients who can take medication by mouth. It is widely available, inexpensive as a generic, and stocked at nearly every pharmacy.

Alternative 4: Oral Clonazepam

Clonazepam (Klonopin) is another benzodiazepine used adjunctively for epilepsy. It is not designed as a dedicated seizure rescue spray, but some patients use it as part of their seizure action plan. Like lorazepam, it is available as a generic and easily filled at most pharmacies.

How to Talk to Your Doctor About Switching

If you're considering switching from Valtoco to an alternative, bring these talking points to your next appointment:

Why you're having trouble getting Valtoco (stock, cost, insurance)

Your patient's age and weight (important for dosing, especially in pediatric patients)

Your preference for nasal spray vs. rectal vs. oral delivery

How often your seizure clusters occur and whether frequency limits matter

Try medfinder Before Switching

Before settling for an alternative, consider using medfinder to check which pharmacies near you have Valtoco in stock. medfinder calls pharmacies on your behalf and texts you results. Many patients find that Valtoco is available within a reasonable distance once they know where to look.

See also: How to Find Valtoco in Stock Near You (Tools + Tips).