Paraldehyde and olive oil enema

This page describes how paraldehyde enema is given and some of its possible side effects. Every person reacts differently to medicines, so your child will not necessarily experience every side effect mentioned. 

If you have any questions or concerns, please speak with your doctor, nurse or pharmacist or call the Medicines Information Team.

Paraldehyde enema solution can catch fire. 

• Do not use near a naked flame or fire.
• Store the bottle in a cool, dry place away from direct sunlight or heat. 
• Store out of reach of children. 

Please read all this leaflet, to make sure you understand the risks of this medication and how to take it correctly.

Paraldehyde is used to treat seizures or status epilepticus. It works by calming the nervous system so that a seizure will stop. It has a sedative effect – people often sleep after it has been given. 

Paraldehyde is mixed with olive oil so it can be given rectally (via the bottom) as an enema. It is administered directly into the anus using a syringe and plastic tubing.

The paraldehyde olive oil solution comes pre-mixed, as a 50% paraldehyde and 50% olive oil solution. It will be labelled ‘Paraldehyde and olive oil 50% enema’ and for RECTAL use only.

The solution is a yellowy-orange colour and has a very strong unpleasant smell.

The use of paraldehyde as an enema is not currently licensed in the UK. Medicines are often used outside of their licence (off label) in children. Find out more about understanding medicines.

Your Neurology Team or seizure rescue plan will advise you on when paraldehyde enema should be given. If you are unsure, please speak with your local epilepsy team (who manage emergency care plans) or Neurology at Great Ormond Street Hospital for further advice.

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

Your treatment team will provide you with the equipment you will need. 

This includes: 

• Paraldehyde and olive oil 50% enema
• 10ml or 20ml plastic syringe (Luer or ENFit™)
• Plastic tubing (rectal quill or ENFit™ rectal straw)
• Lubricating gel
• Disposable plastic gloves
• Small measuring cup (if needed)
• You may also wish to wear a facemask and eye goggles. 

Types of syringes and tubing

• The type of syringe or tubing you are given may vary depending on local availability.
• ENFit™ syringes are only compatible with ENFit™ rectal straws. They should not be used with other equipment.

Make sure to keep sufficient stock of the paraldehyde enemas, syringes and tubing.

Prepare:

1. Wash your hands thoroughly with soap and warm water. Put on disposable gloves.
2. Lay your child on their side.
3. Remove enough clothing to expose their bottom. You can use a towel or blanket to maintain their privacy.
4. Keep the lower leg straight and bend the upper leg.

Prepare the medicine:

1. Open a new bottle of paraldehyde and olive oil 50% enema.
2. Draw up the prescribed dose: 

• For doses of 10 ml or less: 
• Insert a 10ml plastic syringe directly into the bottle.
• Draw up the dose.
• Remove the syringe from the bottle.
• For doses greater than 10 ml: 
• Pour the solution into a small measuring cup.
• Draw up the dose using a 20ml plastic syringe.

1. Draw approximately 0.5 ml of air into the syringe. 
2. Hold the syringe upright so that the air bubble moves to the plunger end of the syringe.
3. Attach the plastic tube to the syringe.

Give the medicine

1. Gently insert the tube into your child's rectum. Do not insert it more than 2cm. Use a small amount of lubricating gel to the end of the tube if needed.
2. Slowly push the medicine through the syringe. 
3. If medicine leaks out immediately, you may need to insert the tube slightly further.
4. Keep the air bubble at the plunger end. The air should be pushed out of the syringe last, to help deliver the full dose.
5. Keep the plunger pressed down and slowly remove the tube.

After giving the medicine

1. Hold your child's buttocks together for a few minutes. This helps prevent the medicine from leaking out and allows time for absorption.
2. Keep your child in the recovery position.
3. Watch for signs that the seizure is stopping and follow your child's rescue care plan.
4. Remove gloves and wash your hands thoroughly with soap and warm water.
5. Make sure the room is well ventilated.

Dispose of any used or opened paraldehyde bottles at your local pharmacy. If your doctor decides to stop treatment with paraldehyde, return any unused medicine to your pharmacist. Do not flush it down the toilet or throw it away.

Dispose of used equipment in a clinical waste box or appropriate sharps box. You can get a sharps box on prescription. Ask your local pharmacy or GP where to return used boxes in your local area. 

If you do not have an appropriate box, use a reinforced plastic bottle or box until you are able to safely dispose of the equipment. 

Keep the equipment easy to find

• Store all the equipment together. 
• Some people use a plastic box, so it is easy to grab in an emergency.
• Keep it somewhere easy to access in an emergency.

How to store paraldehyde

• Paraldehyde is highly flammable – store the solution bottle in a cool, dry place away from direct sunlight or heat.
• Keep medicines in a safe place where children cannot reach them.

Do not use the paraldehyde solution if:

• It is a brown colour.
• It smells of vinegar.
• It is past the expiry date. 
• The bottle has been opened. Once opened the bottle must be disposed of – it cannot be reused.  

• Paraldehyde can melt plastic – the enema solution must always be given within 15 minutes of drawing up a syringe. 
• Wear gloves when giving the enema. You can also wear a mask and goggles.
• If you get the solution onto uncovered skin, wash the area with cold, running water for at least 10 minutes. 
• If you get the solution in your eyes, wash with running water for 5 to 10 minutes. 
• If you spill the solution, clean it up with disposable kitchen towels and plenty of water. Dispose of in a clinical waste bin or box. 
• Make sure the room is well ventilated. 

All medications can cause side effects. You may not experience these side effects, but it is important to be aware of them. 

Side effects include: 

• Itchiness or a rash around the bottom after the enema has been given. You can apply a moisturising cream or anti-itch cream to help. If this does not help or you are concerned that your child is having an allergic reaction, contact your GP or local hospital.
• Breath smelling of paraldehyde for some hours after it has been given. This is because of the way paraldehyde is broken down in the body – it is nothing to worry about.
• Feeling sleepy after taking paraldehyde. This can last for a few hours.
  If your child is still sleepy more than a few hours later, contact your GP or local hospital. 
• Feeling feel dizzy or light-headed on standing, or fainting. Encourage your child to stand up slowly, and to sit or lie down if they feel dizzy or light-headed. If this happens frequently, contact your local hospital, or GP, as your child's blood pressure might be low. 

If you are concerned about any of these side effects, please discuss them with your child’s GP, local hospital team or pharmacist. Out of hours, contact 111 for advice.  

Before your child starts taking paraldehyde you should let your child’s doctor know if they have any of the following conditions: 

• Hypersensitivity to paraldehyde or olive oil*
• Lung disease
• Colitis (an inflammatory gut disorder)
• Liver disease

*If you are concerned your child may be allergic, please discuss this with your child’s GP, local hospital team or pharmacist. Out of hours, contact 111 for advice.

Some medicines can interact with paraldehyde. Always check with child’s doctor or pharmacist before giving your child any other medicines, including herbal or complementary medicines.

Your child’s GP will need to write you a repeat prescription for paraldehyde. 

Your local pharmacist may need to order the medicine in, so make sure to request another prescription before you run out or it expires. It can take around two weeks to get a new prescription, so make sure to allow enough time, and have enough medication at home in case you need to use it in the meantime.  

If you have any questions or queries about the information in this leaflet, please speak with your local epilepsy nurse, or named GOSH epilepsy nurse through the MYGOSH app. 

You can also contact the GOSH Pharmacy Medicine Information team through the Medications page on the MyGOSH app or by telephone.

Telephone: 020 7829 8608

The team are available Monday to Friday, 9am to 5pm (excluding Bank Holidays).

Please note this is not an emergency number.