From the Guidelines
Midazolam should be added to a syringe driver for a patient with epilepsy.
Medication Details
- The dose of midazolam can be adjusted based on the patient's response, with a typical loading dose of 0.15-0.20 mg/kg, followed by a continuous infusion of 1 mg/kg per min, increasing by increments of 1 mg/kg per min (maximum: 5 mg/kg per min) every 15 min until seizures stop 1.
Alternative Options
- Valproate is also a viable option, with studies showing it to be at least as effective as phenytoin for refractory status epilepticus, with potentially fewer adverse effects 1.
- Levetiracetam and fosphenytoin are also acceptable treatment options for refractory status epilepticus, with approximately half of patients experiencing cessation of seizures 1.
Important Considerations
- When using midazolam, there is an increased incidence of apnea when combined with other sedative agents, and respiratory support should be prepared regardless of the route of administration 1.
- Monitoring of oxygen saturation is also crucial when using midazolam 1.
From the Research
Medication Options for Epilepsy
- Brivaracetam is a suitable option for patients with epilepsy who require medication via a syringe driver, as it can be administered subcutaneously and has a low incidence of drug interactions 2.
- Midazolam can also be administered subcutaneously using a syringe driver, but it may cause sedation 2.
- Other antiepileptic drugs, such as lorazepam and diazepam, can be administered via alternative routes, including buccal, sublingual, or intranasal, but may not be suitable for syringe driver administration 3.
Considerations for Syringe Driver Use
- The delivery of medication via a syringe driver can be affected by changes in relative height between the patient and the syringe driver, which can result in interrupted delivery or boluses of medication 4.
- It is essential to minimize vertical movements of the syringe driver relative to the patient to ensure accurate and consistent medication delivery 4.
Available Formulations
- Various formulations of antiepileptic drugs are available, including oral extended-release formulations, which can provide advantages such as simplified dosing regimens and reduced peak-to-trough fluctuations in serum drug concentration 5.
- The choice of formulation and medication will depend on the individual patient's needs and circumstances, including the severity and type of epilepsy, as well as any comorbidities or interactions with other medications 6.