Comprehensive medication guide to Valtoco including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$0–$100 copay with commercial insurance after prior authorization; commercially insured patients can pay as little as $20 with the Neurelis copay assistance card. Medicare and Medicaid coverage varies by plan.
Estimated Cash Pricing
$2,100–$2,572 retail for a 5-dose kit; approximately $1,760–$1,864 with GoodRx or SingleCare discount coupons. No generic is available.
Medfinder Findability Score
52/100
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Valtoco is the brand name for diazepam nasal spray, manufactured by Neurelis, Inc. It is the only FDA-approved intranasal formulation of diazepam available in the United States. First approved on January 10, 2020 for patients ages 6 and older, the FDA expanded the indication in April 2025 to include children as young as 2 years old.
Valtoco is indicated for the acute treatment of intermittent, stereotypic episodes of frequent seizure activity—also known as seizure clusters or acute repetitive seizures—that are distinct from a patient's usual seizure pattern in people with epilepsy ages 2 and older. It is not a daily preventive medication; it is used only when a seizure cluster occurs.
Valtoco is classified as a Schedule IV (CIV) controlled substance under the DEA due to its potential for abuse, misuse, and dependence. It carries a Boxed Warning for risks from concomitant use with opioids, abuse and addiction, and physical dependence and withdrawal reactions.
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Valtoco contains diazepam, a benzodiazepine that enhances the effects of GABA (gamma-aminobutyric acid)—the brain's primary inhibitory neurotransmitter. Diazepam binds to the benzodiazepine binding site on GABA-A receptors and acts as a positive allosteric modulator, making GABA more effective at calming overactive neurons.
Valtoco uses proprietary INTRAVAIL technology—a combination of n-dodecyl beta-D-maltoside (DDM) and Vitamin E—to enhance nasal absorption. DDM reversibly loosens the tight junctions between nasal epithelial cells, allowing diazepam to pass through the highly vascularized nasal mucosa rapidly and bypass first-pass metabolism. This results in 2- to 4-fold less pharmacokinetic variability compared to diazepam rectal gel.
In clinical studies, the median time to seizure cessation when Valtoco was administered within 5 minutes of seizure onset was 2 minutes. Peak plasma concentrations are reached approximately 1.5 hours after administration in adults. Diazepam has a long half-life (15–21 hours in pediatric patients), which is why Valtoco requires a 4-hour interval between doses and a 5-day interval between treated episodes.
5 mg — nasal spray (1 device)
Single spray into one nostril. Weight-based: 0.5 mg/kg for ages 2-5.
10 mg — nasal spray (1 device)
Single spray into one nostril. Weight-based: 0.3 mg/kg for ages 6-11.
15 mg — nasal spray (2 devices)
One spray into each nostril (two 7.5 mg devices). Weight-based for appropriate patients.
20 mg — nasal spray (2 devices)
One spray into each nostril (two 10 mg devices). Weight-based: 0.2 mg/kg for ages 12 and older.
As of 2026, Valtoco is not listed on the FDA Drug Shortage Database and is not in an active national shortage. However, most retail pharmacies do not stock Valtoco as a standard inventory item. It is a brand-name-only specialty medication made by a single manufacturer (Neurelis, Inc.) with no generic alternative, which means pharmacies only order it on demand.
Specialty pharmacies—including CVS Specialty, Walgreens Specialty, and PharmaCord Pharmacy (NABP 1836191, the preferred myNEURELIS pharmacy)—are the most reliable sources. Patients should contact the myNEURELIS program (1-866-696-3873) for pharmacy access support, prior authorization assistance, and savings program enrollment.
Patients looking for Valtoco can use medfinder to have pharmacies near them called on their behalf to check which ones have their specific Valtoco dose kit in stock. Results are texted directly to the patient, eliminating the need for hours of individual pharmacy calls.
Valtoco is a Schedule IV (CIV) controlled substance, requiring a valid prescription from a licensed prescriber with DEA Schedule IV prescribing authority. Because it is a specialty seizure rescue medication, it is most commonly prescribed by neurologists and epileptologists. Some insurers require that prescriptions come from or in consultation with a neurologist for prior authorization approval.
Prescriber types who commonly prescribe Valtoco include:
Neurologists and epileptologists
Pediatric neurologists (for patients ages 2 and older)
Primary care physicians (PCPs) with epilepsy management experience
Nurse practitioners (NPs) and physician assistants (PAs) with Schedule IV prescribing authority
Telehealth prescribing of Schedule IV controlled substances like Valtoco is subject to DEA and state regulations. For new patients, in-person neurological evaluation is typically recommended. Some established telehealth neurology platforms may prescribe Valtoco within an existing patient relationship.
Yes. Valtoco is a federally controlled substance classified as Schedule IV (CIV) by the DEA. The active ingredient, diazepam, is a benzodiazepine with recognized potential for abuse, misuse, and addiction. Schedule IV substances are considered to have a lower potential for abuse than Schedule III drugs, but misuse can still lead to physical and psychological dependence.
As a Schedule IV controlled substance, Valtoco requires a valid prescription and is subject to DEA recordkeeping and storage regulations at the pharmacy level. Prescriptions for Schedule IV substances typically cannot be refilled more than 5 times within 6 months in most states. Selling or giving away Valtoco to another person is illegal and can cause serious harm.
Valtoco carries a Boxed Warning for three critical risks: (1) concomitant use with opioids, which can cause respiratory depression, coma, and death; (2) abuse, misuse, and addiction; and (3) physical dependence and withdrawal reactions. Because Valtoco is intended for intermittent use only (not daily), the risk of dependence is lower than with daily benzodiazepine use—but exceeding the prescribed frequency significantly increases this risk.
The most common side effects reported in clinical studies (255 patients ages 2 and older) include:
Somnolence (drowsiness) — most common systemic effect
Headache
Nasal discomfort (5%)
Dysgeusia / altered taste (2%)
Epistaxis / nosebleeds (2%)
Rhinorrhea / runny nose (1%)
Respiratory depression (slowed or stopped breathing) — especially with opioids or alcohol
Extreme drowsiness / unresponsiveness
Severe allergic reaction (hives, throat swelling, difficulty breathing)
New or worsening suicidal thoughts or behaviors (call 988 or 911)
Signs of physical dependence or withdrawal (if used more frequently than prescribed)
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Nayzilam (midazolam nasal spray)
FDA-approved nasal spray for seizure clusters in patients ages 12 and older. Contains midazolam; faster onset but shorter duration than Valtoco. Allows 1 episode every 3 days vs. Valtoco's 5 days.
Diastat / diazepam rectal gel
Same active ingredient (diazepam) as Valtoco. FDA-approved for ages 2 and older. Available as a generic (more affordable). Rectal route is less convenient but widely stocked and effective.
Lorazepam (oral)
Widely available generic benzodiazepine. Not FDA-approved as a nasal spray for seizure clusters, but sometimes used as an oral rescue option in patients who can take medication by mouth during or after a seizure.
Clonazepam (oral)
Generic benzodiazepine used adjunctively for epilepsy. Not a dedicated seizure cluster rescue spray; used as part of some seizure action plans under neurologist guidance.
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Opioid analgesics (oxycodone, morphine, fentanyl, codeine, etc.)
majorBoxed Warning: concomitant use can cause profound sedation, respiratory depression, coma, and death.
Alcohol
majorIncreased CNS depression, risk of respiratory depression. Avoid alcohol while using Valtoco.
Other CNS depressants (benzodiazepines, sleep aids, antipsychotics, muscle relaxants)
majorAdditive CNS depression and sedation. Use with extreme caution; monitor for respiratory depression.
CYP2C19/CYP3A4 inhibitors (fluconazole, omeprazole, clarithromycin, ritonavir)
moderateSlows diazepam metabolism; increases diazepam blood levels and prolongs effects. Monitor for enhanced sedation.
CYP3A4 inducers (carbamazepine, rifampin, phenytoin, phenobarbital, St. John's Wort)
moderateAccelerates diazepam metabolism; may reduce Valtoco effectiveness as a rescue medication.
Valtoco (diazepam nasal spray) represents an important advancement in seizure rescue therapy for patients with epilepsy. Its non-invasive nasal spray delivery, proprietary INTRAVAIL absorption technology, and FDA approval for patients as young as 2 years old make it one of the most versatile and patient-friendly rescue medications available. Clinical data showing median seizure cessation within 2–3 minutes and single-dose success in 87% of treated episodes underscores its effectiveness.
The main practical challenges with Valtoco are availability and cost. As a brand-name-only specialty medication made by a single manufacturer, Valtoco is not stocked at most retail pharmacies and typically requires prior authorization from insurance. Patients and caregivers should plan ahead, establish a relationship with a specialty pharmacy, and enroll in the myNEURELIS support program to address both challenges proactively.
For patients who struggle to find Valtoco at local pharmacies, medfinder can call pharmacies on your behalf to locate your specific dose kit nearby. Always keep Valtoco on hand before it's needed—as a rescue medication, it must be available before a seizure cluster occurs.
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