People who experience seizure activity (epilepsy) often take anti-seizure medicine to control the condition. However, sometimes additional medicine may be needed to control bouts of increased seizure activity (cluster seizures or breakthrough seizures). The Diastat AcuDial rectal administration system contains the medicine diazepam, rectal gel, to manage these breakthrough seizures. The product is available in a 10 mg rectal syringe designed to deliver a minimum dose of 5 mg, or a 20 mg rectal syringe designed to deliver a minimum dose of 12.5 mg. Both syringes allow for the dose to be increased by 2.5 mg up to a maximum of either 10 mg or 20 mg, respectively. (There is a 2.5 mg syringe for pediatrics.)
Before the product is dispensed, the pharmacist must dial, set, and lock in the prescribed dose (Figure 1). Once set and locked, the dialed dose will appear in the dose display window, and the locking ring, designated with a green “ready” band, will be in place. This helps prevent the wrong dose from being administered. 
Since the introduction of the device, errors have occurred because the device was not properly dialed to the intended dose and locked by the pharmacy. Thus, too much medicine was given. An event was reported by a woman who gave her adult daughter 20 mg of the medication instead of 15 mg because the syringe was not locked by the pharmacist to deliver just the 15 mg dose.
In another event, a pharmacy dispensed an unlocked 10 mg Diastat Acudial rectal syringe to parents of a small child. The parents were new to the device and not educated that the dose needed to be locked. They administered the entire contents of the syringe to their son, who then developed respiratory depression requiring transport to the emergency room. Thankfully, the child recovered.
Here’s what you can do:
✔ Ask to speak with the pharmacist.
✔ Open up the package and ask the pharmacist to make sure it is locked in place at the prescribed dose.
✔ Look at the display window to verify the dose and confirm that the green ready band is visible.
✔ Because 2 DIASTAT AcuDial delivery systems are packaged in a Twin Pack (with each prescription) be sure to double-check both syringes.
✔ If you are unsure how to give the medicine, ask the pharmacist to explain the procedure.
✔ Review any handouts or educational materials provided by the pharmacist.
