What Is Valtoco? Uses, Dosage, and What You Need to Know in 2026

If you or your child has been prescribed Valtoco for epilepsy, you probably have questions. What exactly does it treat? How do you use the nasal spray? What dose is right? How often can you use it? This guide answers all your essential questions about Valtoco in plain language.

What Is Valtoco?

Valtoco is the brand name for diazepam nasal spray, manufactured by Neurelis, Inc. It is the only FDA-approved nasal spray formulation of diazepam available in the United States. Diazepam is a benzodiazepine that has been used for decades as an anticonvulsant and sedative.

Valtoco was first FDA-approved on January 10, 2020, for patients ages 6 and older. In April 2025, the FDA expanded approval to include children ages 2 to 5. Valtoco is classified as a Schedule IV (CIV) controlled substance.

What Is Valtoco Used For?

Valtoco is FDA-approved for one specific use: the acute (immediate) treatment of intermittent, stereotypic episodes of frequent seizure activity—also called

seizure clusters or

acute repetitive seizures—that are distinct from a patient's usual seizure pattern in people with epilepsy ages 2 and older.

Important: Valtoco does NOT replace daily anti-seizure medications. It is a rescue medication—used only when a seizure cluster occurs. Continue your regular daily epilepsy medications as prescribed.

What Is a Seizure Cluster?

A seizure cluster (also called acute repetitive seizures) is a group of 2 or more seizures within a 24-hour period that are different from your normal seizure pattern—more frequent, more severe, or of a different type than usual. These episodes may signal a need for immediate intervention with a rescue medication like Valtoco.

What Are the Valtoco Dose Kits Available?

Valtoco is available in four dose kits:

5 mg: 1 nasal spray into one nostril (5 mg diazepam in 0.1 mL)

10 mg: 1 nasal spray into one nostril (10 mg diazepam in 0.1 mL)

15 mg: 2 nasal spray devices, one spray into each nostril (7.5 mg in each device)

20 mg: 2 nasal spray devices, one spray into each nostril (10 mg in each device)

Your dose is determined by your weight and age. Your prescriber will select the appropriate kit for you. Do not use a dose other than what is prescribed.

How to Use Valtoco: Step by Step

Remove Valtoco from the blister pack just before use. Do not prime the device.

Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.

Insert the nozzle into one nostril until your fingers are against the bottom of the nose.

Press the plunger firmly with your thumb. The person does NOT need to inhale deeply.

For 15 mg or 20 mg doses: repeat in the other nostril with the second device.

Discard the used device. Do NOT reuse.

Stay with the person. Monitor breathing and level of consciousness. Note the time of administration.

How Often Can You Use Valtoco?

Valtoco has strict usage limits to prevent tolerance and dependence:

Maximum 2 doses per seizure cluster episode

Second dose may be given at least 4 hours after the first

No more than 1 episode treated every 5 days

No more than 5 episodes per month

Storage and Expiration

Store Valtoco at room temperature (68°F to 77°F). Short-term exposure to 59°F to 86°F is permitted (e.g., during transport). Do not freeze. Protect from light. Check the expiration date on your blister pack regularly—Neurelis offers a free expiration reminder service through the myNEURELIS program.

Finding Valtoco in Stock

Valtoco is not stocked at all retail pharmacies. If your pharmacy doesn't carry it, medfinder can call pharmacies near you on your behalf to locate which ones have your specific dose kit in stock. Results are texted directly to you.

For a deeper explanation of how Valtoco works in the brain, see: How Does Valtoco Work? Mechanism of Action Explained in Plain English.