Medications Used in the Abortive Treatment of Ongoing Seizure Activity in the Emergency Department



INITIAL THERAPY

 - Diazepam - May repeat in 10 min; monitor respiratory status.

 - Lorazepam - Preferred IV benzodiazepine; may repeat in 10 min; monitor respiratory status.

 - Midazolam - Preferred IM benzodiazepine; may repeat in 10 min; monitor respiratory status.

SECOND-TIER TREATMENTS

 - Phenytoin - May cause hypotension and dysrhythmia; May give additional 5—10 mg/kg 10 minutes after the loading dose

 - Fosphenytoin - May give an additional 5 PE/kg 10 min after loading dose

 - Valproic acid - May give additional dose of 20 mg/kg 10 min after loading dose

 - Levetiracetam - Efficacy and safety data come from small studies.

THIRD-TIER TREATMENTS

 - Pentobarbital - Titrate to EEG; intubation and hemodynamic support required

 - Phenobarbital - Intubation required; may give additional 5-10 mg/kg 10 min after loading dose

 - Midazolam - Titrate to EEG; monitor respiratory status

 - Propofol Infusion - Intubation required; use with caution in doses >4.8 mg/kg/hr



#Abortive #Seizure #Medications #Neurology #Pharmacology #Dosing #Table