From the FDA Drug Label
For the primary purpose of sedation and relief of anxiety, the usual recommended initial dose of lorazepam for intravenous injection is 2 mg total, or 0.02 mg/lb (0. 044 mg/kg), whichever is smaller. Parenteral medication, administered intramuscularly in doses of 2 to 5 mg, is utilized for prompt control of the acutely agitated schizophrenic patient with moderately severe to very severe symptoms
Agitation Treatment:
- For a patient with a seizure, lorazepam (IV) at a dose of 2 mg total, or 0.02 mg/lb (0. 044 mg/kg), whichever is smaller, may be used for sedation and relief of anxiety 1.
- Alternatively, haloperidol (IV) may not be the first choice due to the risk of lowering the seizure threshold, but haloperidol (IM) in doses of 2 to 5 mg can be used for prompt control of agitation 2.
- However, it is crucial to note that the treatment of agitation in a patient with a seizure requires careful consideration of the underlying cause of the seizure and the potential risks and benefits of each medication.
From the Research
The treatment for agitation in a patient with a seizure involves benzodiazepines as first-line therapy, with midazolam being a preferred option due to its rapid sedation effects, as shown in a recent study 3. This approach prioritizes the patient's safety and well-being, reducing the risk of harm to themselves or others. The use of benzodiazepines, such as midazolam, is supported by the most recent and highest quality study available, which compared the efficacy and safety of intramuscular midazolam, diphenhydramine, and haloperidol in acute agitation management 3. Key points to consider in the management of agitation in a seizure patient include:
- Ensuring patient safety by removing harmful objects and maintaining airway patency
- Using benzodiazepines, such as midazolam, as first-line therapy due to their rapid sedation effects and relatively low risk of adverse events
- Monitoring vital signs, especially respiratory status, as benzodiazepines can cause respiratory depression
- Considering non-pharmacological approaches, such as speaking calmly and minimizing stimulation, to help manage agitation
- Addressing underlying causes of seizures as part of long-term management, as indicated by studies such as 4, 5, 6, and 7. It is essential to prioritize the most recent and highest quality evidence, such as the study published in 2025 3, when making treatment decisions to ensure the best possible outcomes for patients.