Drug Therapy for Generalized Convulsive Status Epilepticus
| Drug | Dose | Comments |
|---|---|---|
| First line | ||
| Lorazepam | 0.1 mg/kg, give 4–8 mg IV | Dose can be repeated once after 20 min. Ampoules contain lorazepam 4 mg in 1 mL. Dilute 1:1 with water for injection. Longer duration of action and less likely to cause sudden hypotension or respiratory arrest than diazepam. |
| or | ||
| Midazolam | 10 mg in 1 or 2 mL (depends on manufacturer) bucally | In accord with NICE adult status guidelines but only licensed for those aged <18 years). |
| or | ||
| Diazepam | 10–20 mg IV at a rate of <2.5/min. | Risk of sudden apnoea with faster injection. Dose should not be repeated more than twice, or to a total dose >40 mg because of the risk of respiratory depression and hypotension. |
| Second line | ||
| Phenobarbital | Loading dose: 10 mg/kg to a maximum of 1000 mg, given at 100 mg/min. Maintenance dose 1–4 mg/kg/day given IV, IM or PO | Contraindicated in acute intermittent porphyria. Hypotension. Respiratory impairment due to sedation. |
| or | ||
| Phenytoin | Loading dose: 20 mg/kg IV (max dose 2g). Infusion rate should not exceed 50 mg/min. Maintenance dose of 100 mg 6–8-hourly IV, adjusted according to plasma level. Do not give more than one loading dose and do not load a patient who is taking oral phenytoin. | Monitor blood pressure and ECG (as risk of arrhythmia). Give through separate large-bore IV cannula, as alkaline and will precipitate other drugs. Valproate and levetiracetam are alternative second-line drugs |
| Third line | ||
| Midazolam | 0.1–0.2 mg/kg/h by IV infusion | |
| or | ||
| Propofol | 2 mg/kg IV bolus, then repeat bolus if necessary. Maintenance dose 5–10 mg/kg/h by IV infusion | |
| or | ||
| Thiopentone | 100–250 mg IV bolus, then 50 mg bolus every 3 min until burst suppression on EEG Maintenance dose 2–5 mg/kg/h by IV infusion |