Medications Used in the Abortive Treatment of Ongoing Seizure Activity in the Emergency Department INITIAL THERAPY - Diazepam - May repeat in 10 min; monitor respiratory status. - Lorazepam - Preferred IV benzodiazepine; may repeat in 10 min; monitor respiratory status. - Midazolam - Preferred IM benzodiazepine; may repeat in 10 min; monitor respiratory status. SECOND-TIER TREATMENTS - Phenytoin - May cause hypotension and dysrhythmia; May give additional 5—10 mg/kg 10 minutes after the loading dose - Fosphenytoin - May give an additional 5 PE/kg 10 min after loading dose - Valproic acid - May give additional dose of 20 mg/kg 10 min after loading dose - Levetiracetam - Efficacy and safety data come from small studies. THIRD-TIER TREATMENTS - Pentobarbital - Titrate to EEG; intubation and hemodynamic support required - Phenobarbital - Intubation required; may give additional 5-10 mg/kg 10 min after loading dose - Midazolam - Titrate to EEG; monitor respiratory status - Propofol Infusion - Intubation required; use with caution in doses >4.8 mg/kg/hr #Abortive #Seizure #Medications #Neurology #Pharmacology #Dosing #Table
