Can Valium (diazepam) and Ativan (lorazepam) be administered intravenously (IV) for seizure management?

From the Guidelines

Yes, both Valium (diazepam) and Ativan (lorazepam) can be administered intranasally (IN) for seizure management, though this is considered an off-label route. For intranasal diazepam, a typical dose is 0.2-0.5 mg/kg, while intranasal lorazepam is typically dosed at 0.1 mg/kg 1. The medication should be administered using an atomizer device to ensure proper distribution within the nasal cavity. Intranasal administration offers several advantages in seizure emergencies, including rapid absorption through the nasal mucosa with quick brain penetration, ease of administration without requiring IV access, and the ability to give medication to actively seizing patients when IV access is difficult.

However, be aware that commercial preparations are not specifically designed for intranasal use, so the volume administered may be larger than ideal for the nasal cavity. Intranasal benzodiazepines represent a valuable alternative when IV access is challenging or unavailable, particularly in pre-hospital settings or for caregivers of patients with recurrent seizures. According to the most recent guidelines, the use of benzodiazepines, such as diazepam and lorazepam, is recommended as a first-line treatment for seizures, with a focus on rapid control of the seizure to reduce morbidity and mortality 1.

Key considerations for the administration of intranasal benzodiazepines include:

• Using an atomizer device for proper distribution
• Being aware of the potential for larger volumes than ideal for the nasal cavity
• Monitoring for adverse reactions, particularly respiratory depression
• Having a plan in place for potential complications, such as the need for respiratory support or reversal with flumazenil 1.

Overall, the use of intranasal benzodiazepines, such as Valium and Ativan, can be a valuable option for seizure management, particularly in situations where IV access is challenging or unavailable, and should be guided by the most recent and highest-quality evidence available 1.

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. IM lorazepam is not preferred in the treatment of status epilepticus because therapeutic lorazepam levels may not be reached as quickly as with IV administration The safety and effectiveness of lorazepam for status epilepticus have not been established in pediatric patients

• Valium (Diazepam) is not mentioned in the provided drug labels, so its use for seizures cannot be determined from this information.
• Ativan (Lorazepam) can be given IV for seizures in adults, with a recommended dose of 4 mg given slowly (2 mg/min) for patients 18 years and older 2.
• Ativan (Lorazepam) can be given IM for seizures, but it is not the preferred route because therapeutic levels may not be reached as quickly as with IV administration 2.
• The safety and effectiveness of Ativan (Lorazepam) for status epilepticus have not been established in pediatric patients 2.

From the Research

Administration of Valium and Ativan for Seizures

• Valium (diazepam) and Ativan (lorazepam) are benzodiazepines that can be used to treat seizures, including status epilepticus 3, 4, 5.
• These medications can be administered intravenously (IV) for rapid onset of action 3, 6, 7.
• IV administration of lorazepam is often preferred over diazepam due to its longer duration of action and smaller volume of distribution of unbound drug 3, 7.
• However, diazepam can also be effective, especially when given as a continuous IV infusion 3.

Efficacy and Comparison of Valium and Ativan

• A meta-analysis comparing IV lorazepam and diazepam for adult status epilepticus found that lorazepam was more effective in stopping seizures 7.
• Another study found that benzodiazepines, including lorazepam and diazepam, were effective in treating status epilepticus, but the choice of medication depends on individual patient factors and the specific clinical situation 4.
• A review of benzodiazepines in the management of seizures and status epilepticus noted that lorazepam, diazepam, and midazolam are commonly used, but each has different pharmacokinetic and pharmacodynamic properties 5.

Dosage and Administration

• The dosage of benzodiazepines, including Valium and Ativan, can vary depending on the individual patient and the specific clinical situation 6.
• A study found that the mean dose of lorazepam administered IV was 2.6 mg, while the mean dose of diazepam administered rectally was 10.0 mg 6.
• It is essential to follow established guidelines and consult with a healthcare professional to determine the appropriate dosage and administration route for each patient 6.