Paraldehyde and olive oil enema

Paraldehyde is a medicine given to treat seizures or status epilepticus. It works by damping down (suppressing) the nervous system so that a seizure will stop. It has a sedative effect so children usually sleep after it has been given.

It is mixed with olive oil so it can be given rectally (into the bottom) as an enema. The enema solution is amber-coloured and has a very strong unpleasant smell.

Paraldehyde for use as an enema is not licensed in the UK, so has to be made as a 'special' or imported from abroad by a licensed pharmaceutical importer. Medicines are often used off label in children for a number of reasons, for example limited data available for a specific use in children. This is not necessarily hazardous, but should be explained and agreed before use. Your doctor will explain this further to you.

The enema solution can catch fire if used near a naked flame or stored at too high a temperature. Do not give the enema to your child by candlelight, near an open flame or while smoking a cigarette. Store the enema solution in a cool dry place away from direct sunlight or heat.

How is a paraldehyde and olive oil enema given?

The paraldehyde and olive oil enema is given only to treat a seizure that is occurring. It should not be given to prevent seizures.

  1. put on a pair of gloves

  2. lay your child on their left side

  3. draw up the required dose from the bottle using the syringe

  4. attach the tube to the end of the syringe

  5. insert the tube a few centimetres into your child’s rectum

  6. gently push the plunger on the syringe until the entire dose is given

  7. remove the tube and hold your child’s buttocks together for a few minutes

Due to the nature of paraldehyde, special handling measures should be followed:

  • Paraldehyde can melt plastic so extra caution is needed. However, if the enema solution is drawn up and given within 10 minutes, a plastic syringe should not be affected.

  • Gloves should always be worn when giving the enema. A mask and goggles may also be worn.

  • If you get any of the solution on uncovered skin, you should wash the area with cold running water for at least 10 minutes.

  • If any of the solution gets into your eyes, wash with running water for five to 10 minutes.

  • If you spill any of the solution, clean it up using disposable kitchen towels and plenty of water.

Who should not use paraldehyde and olive oil enemas?

People with the following conditions should discuss using the enema with their doctor:

  • hypersensitivity to paraldehyde or olive oil

  • lung disease

  • colitis (an inflammatory gut disorder)

  • liver disease

What are the side effects?

The main side effect of the paraldehyde and olive oil enema is irritation around the bottom after the enema has been given. This can be soothed with an aloe vera cream or similar balm. Paraldehyde can also cause a skin rash.

Paraldehyde and olive oil enemas and other medicines

Some medicines can react with paraldehyde, altering how well it works. Always check with your doctor or pharmacist before giving your child any other medicines, including medicines on prescription from your family doctor (GP), medicines bought from a pharmacy (chemist) or herbal or complementary medicines. The following is known to react with paraldehyde:

  • disulfiram

Important information

  • Keep medicines in a safe place where children cannot reach them.

  • Paraldehyde and olive oil enema solution should be kept in a cool, dry place out of direct sunlight or heat. If the solution is stored at 25°C or higher, it could burst into flames.

  • The enema solution should be amber-coloured. If the solution darkens, do not use and return to your pharmacist for disposal.

  • If your doctor decides to stop treatment with paraldehyde and olive oil enemas or they pass their expiry date, return any unused solution to the pharmacist. Do not flush it down the toilet or throw it away.

Compiled by: 
The Pharmacy department in collaboration with the Child and Family Information Group This information sheet should be read in conjunction with any patient information sheet provided by the manufacturer.
Last review date: 
May 2013
Ref: 
2013F1068

Disclaimer

Please read this information sheet from GOSH alongside the patient information leaflet (PIL) provided by the manufacturer. If you do not have a copy of the manufacturer’s patient information leaflet please talk to your pharmacist. A few products do not have a marketing authorisation (licence) as a medicine and therefore there is no PIL.

For children in particular, there may be conflicts of information between the manufacturer’s patient information leaflet (PIL) and guidance provided by GOSH and other healthcare providers. For example, some manufacturers may recommend, in the patient information leaflet, that a medicine is not given to children aged under 12 years. In most cases, this is because the manufacturer will recruit adults to clinical trials in the first instance and therefore the initial marketing authorisation (licence) only covers adults and older children.  

For new medicines, the manufacturer then has to recruit children and newborns into trials (unless the medicine is not going to be used in children and newborns) and subsequently amend the PIL with the approved information. Older medicines may have been used effectively for many years in children without problems but the manufacturer has not been required to collect data and amend the licence. This does not mean that it is unsafe for children and young people to be prescribed such a medicine ‘off-licence/off-label’. However, if you are concerned about any conflicts of information, please discuss with your doctor, nurse or pharmacist.