From the Guidelines
Benzodiazepines are the first-line medications used to break an active seizure, with lorazepam (Ativan) being the preferred option at a typical dose of 2-4 mg given intravenously. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of prompt treatment to reduce morbidity and mortality 1. Other effective benzodiazepines include diazepam (Valium) at 5-10 mg IV and midazolam at 5-10 mg IM or intranasally if IV access isn't available. These medications work by enhancing the effect of the inhibitory neurotransmitter GABA in the brain, which helps suppress the abnormal electrical activity causing the seizure.
Some key points to consider when treating seizures include:
- Ensuring the person is in a safe position to prevent injury
- Timing the seizure to determine if it lasts longer than 5 minutes or if multiple seizures occur without recovery between them
- Seeking immediate medical attention if the seizure is prolonged or if there are multiple seizures without recovery
- Considering second-line treatments, such as fosphenytoin, valproate, or levetiracetam, if the seizure does not respond to benzodiazepines (status epilepticus) 1.
It's worth noting that the choice of second-line agent may depend on various factors, including the patient's medical history and current medications. However, according to the latest clinical policy, fosphenytoin, levetiracetam, or valproate may be used with similar efficacy 1. Ultimately, the goal of treatment is to stop the seizure as quickly as possible to minimize the risk of complications and improve outcomes.
From the FDA Drug Label
For the treatment of status epilepticus, the usual recommended dose of lorazepam injection is 4 mg given slowly (2 mg/min) for patients 18 years and older. In adults, a loading dose of 10 to 15 mg/kg should be administered slowly intravenously, at a rate not exceeding 50 mg per minute Other measures, including concomitant administration of an intravenous benzodiazepine such as diazepam, or an intravenous short-acting barbiturate, will usually be necessary for rapid control of seizures because of the required slow rate of administration of phenytoin
- Medications used to break a seizure include:
- Lorazepam (IV): 4 mg given slowly (2 mg/min) for patients 18 years and older
- Phenytoin (IV): a loading dose of 10 to 15 mg/kg administered slowly intravenously, at a rate not exceeding 50 mg per minute
- These medications may be used alone or in combination with other treatments, such as intravenous benzodiazepines or short-acting barbiturates, to rapidly control seizures 2 3
From the Research
Medications Used to Break a Seizure
- Benzodiazepines are the first-line treatment for seizures and status epilepticus due to their efficacy, tolerability, and rapid onset of action 4, 5, 6, 7, 8
- Specific benzodiazepines used to break a seizure include:
- Lorazepam, which is as effective as diazepam in the treatment of acute tonic-clonic convulsions and has fewer adverse events 7
- Midazolam, which is effective in stopping seizures and can be administered via various routes, including intravenous, intramuscular, buccal, and intranasal 4, 6, 7, 8
- Diazepam, which is commonly used to treat seizures, but may have more adverse events than lorazepam 7
- Clonazepam, which is also used to treat seizures, but may have a longer duration of action than other benzodiazepines 4
Administration Routes
- Benzodiazepines can be administered via various routes, including:
Treatment of Status Epilepticus
- Status epilepticus requires rapid identification of its cause and urgent pharmacological treatment 8
- The treatment of status epilepticus can be divided into four stages: early, established, refractory, and super-refractory 8
- Intravenous lorazepam and intramuscular midazolam are effective treatments for early status epilepticus 8
- In established status epilepticus, intravenous antiepileptic drugs such as valproate and levetiracetam can be used 8