Hesperian Health Guides
Rescue medicines for status epilepticus
HealthWiki > Epilepsy and Seizures > Chapter 4: Medicines for epilepsy and seizures > Rescue medicines for status epilepticus
Medicines used to stop these seizures are called “rescue medicines.” Some are only for status epilepticus, while others can treat different seizure types.
| Diazepam (Calmpose, Diastat, Paxum, Peptica, Valium) | ||
| Diazepam is a benzodiazepine medicine It is a rescue medicine for status epilepticus. | ||
In what forms does this medicine come? Tablet (5 mg, 10 mg) Injection (10 mg in 2 ml)Rectal gel (2 mg in 1 ml, 4 mg in 1 ml) |
Important Diazepam does not work fast enough when injected into muscle (IM). | |
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How to use For status epilepticus: For children younger than 1 month, give 1 25 to 2 5 mg in the rectum Or slowly inject 0 3 mg per kg into a vein. If seizures do not stop 5 minutes after the first dose, give the same dose again Do not give more than 2 doses total. For children 1 month to 1 year, give 5 mg in the rectum Or slowly inject 0 3 mg per kg into a vein If seizures do not stop 5 minutes after the first dose, give the same dose again Do not give more than 2 doses total. For children 2 to 11 years, give 5 to 10 mg in the rectum Or slowly inject 0 3 mg per kg into a vein If seizures do not stop 5 minutes after the first dose, give the same dose again Do not give more than 2 doses total. For children 12 years and older and adults, give 10 to 20 mg in the rectum Or slowly inject 10 mg into a vein. If seizures do not stop 5 minutes after the first dose, give the same dose again Do not give more than 2 doses total. |
Side effects Feeling tired and/or sleepy, muscle weakness, shallow and short breathing if dose is given very fast. | |
 WARNING Giving too much diazepam can slow or stop breathing. | ||
Giving diazepam for status epilepticus
Diazepam comes as tablets, a liquid, and a gel. All of these forms can be given in the rectum as rescue medicine for status epilepticus.
- To use diazepam tablets, crush them into fine powder and mix with clean, cool water. The powder will not dissolve completely. Then draw the mixture into a syringe without a needle.
- To use diazepam liquid, draw the liquid into a syringe and then remove the needle.
- To use diazepam gel, adjust the dose on the pre-loaded syringe by rotating the protective cap at the bottom of the syringe barrel. Push the circular lock ring upward. The dose will be locked in when you hear the click. Pull the protective cap off the syringe before using.
How to give diazepam in the rectum
- Put the person having seizures on their side in a place where they cannot fall. Rest their forehead on a pillow or something soft. Remove enough of their clothing to expose their buttocks. For infants and toddlers: Position on their stomach.
- Put petroleum jelly (Vaseline) on the tip of a syringe that has had the needle removed.
- Bend the person’s upper leg forward and separate buttocks so the anus (opening of the rectum) is exposed. For infants and toddlers: Separate the cheeks of their buttocks with one hand and insert the syringe with the other.
- Gently insert the tip of the syringe into the rectum until the rim is snug against the opening of the anus.
- Slowly count “1, 2, 3” while pushing the plunger until it stops. Then hold the syringe in place for at least 5 minutes to keep the medicine from leaking out.
- Write down the time the medicine was given so that you will know when to give a second dose, if needed.
| Levetiracetam (Keppra) |  | |
| Levetiracetam treats tonic-clonic, focal, and absence seizures It can also be used as a rescue medicine for status epilepticus. | ||
| In what forms does this medicine come? Injection (500 mg in 5 ml) |
Important How this drug affects a developing pregnancy and newborn babies is not clear Use with caution during pregnancy and breastfeeding | |
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How to use For status epilepticus: For children 1 month and older, slowly inject 40 mg per kg of body weight into a vein over 10 minutes If seizures do not stop after the first dose, slowly inject an additional 20 mg per kg into a vein over 10 minutes Do not give more than a total of 4500 mg. For adults, slowly inject a single dose of 60 mg per kg of body weight into a vein over 15 minutes Do not give more than 4500 mg in that single dose. |
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Side effects Feeling tired, headache, dizziness, stomach upset or diarrhea, skin rash, feeling sad and worried, aggressive behavior. | ||
WARNING Use with caution if you have heart or kidney problems such as acute kidney injury, chronic kidney disease, frequent urinary tract infections, or kidney stones | ||
| Lorazepam (Ativan, Novolorazem) | | |
| Lorazepam is a benzodiazepine medicine. | ||
| In what forms does this medicine come? Injection (2 mg in 1 ml, 4 mg in 1 ml) |
Important Use with caution during pregnancy and breastfeeding. | |
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How to use For status epilepticus: For children 1 month to 11 years, 'slowly inject 0 1 mg per kg of body weight into a vein If seizures do not stop 10 minutes after the first dose, give the same dose again Do not give more than 4 mg in each dose Do not give more than 2 doses total. For children 12 to 17 years and adults, slowly inject 4 mg into a vein If seizures do not stop 10 minutes after the first dose, give the same dose again. Do not give more than 2 doses total. |
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Side effects Dizziness, feeling tired, diarrhea and stomach upset, difficulty with thinking and attention, soreness, redness or pain at injection site. | ||
WARNING Do not drink alcohol while taking this medicine. | ||
| Midazolam (Dormicum, Hypnovel, Midacum, Versed) | | |
| Midazolam is a benzodiazepine medicine, the only one that can be injected into muscle (IM) | ||
| In what forms does this medicine come?Liquid for injection, for administration between gum and cheek, or as nasal spray (1 mg in 1 ml, 5 mg in 1 ml) |
Important To give midazolam between the gum and cheek, lay the person on their side Fill a syringe with the dose of liquid midazolam and take the needle off the syringe Put the tip of the syringe in the space between the gum and cheek on one side of the person’s mouth Give the medicine by slowly pushing the syringe plunger. To give midazolam as nasal spray, lay the person in their side or back Fill a syringe with the dose of liquid midazolam and add an additional 0 1 ml to the dose to account for liquid that will remain in the delivery device Take the needle off the syringe and attach the device for giving medicine in the nose Push the syringe plunger to spray the medicine into the person’s nostril You can spray some of the dose into each nostril or all into the same nostril.. | |
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How to use For status epilepticus: For children 1 month and older, inject 0 2 mg per kg of body weight into muscle 1 time Or give 0 2 mg per kg between the gum and cheek Or give 0 2 mg per kg as nasal spray If seizures do not stop 10 minutes after the first dose, give the same dose again. Do not give more than 10 mg in a dose Do not give more than 2 doses total . For adults, inject 10 mg into muscle 1 time Or give 10 mg between the gum and cheek Or give 10 mg as nasal spray If seizures do not stop 10 minutes after the first dose, give the same dose again. Do not give more than 2 doses total. |
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Side effects Dizziness, feeling tired, diarrhea and stomach upset, difficulty with thinking and attention, pain at site of injection (if injected), irritation of nostrils (if given in nose). | ||
WARNING Injecting this medicine very quickly can make a person choke Giving too much medicine can slow or stop breathing. | ||
| Phenobarbital |  |
Phenytoin | |
| Phenobarbital and phenytoin are common daily medicines for treating tonic-clonic or focal seizures They can also be used for status epilepticus but are not the first choice of rescue medicines because of their side effects. | |||
| In what forms does this medicine come? Injection (200 mg in 1 ml) |
In what forms does this medicine come? Injection (50 mg in 1 ml) | ||
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How to use For status epilepticus: For children 1 month and older, give 20 mg per kg of body weight by IV infusion over 20 minutes Do not give more than 1 g (1000 mg) in a dose If seizures do not stop after this dose, give an additional 10 mg per kg by IV infusion over 20 minutes. For adults, give 15 mg per kg of body weight by IV infusion over 15 minutes Do not give more than 1 g (1000 mg) in a dose Do not give more than 1 dose |
How to use For status epilepticus: For children and adults, give 20 mg per kg of body weight by IV infusion For people up to 50 kg, give infusion over 20 minutes For people 50 to 75 kg, give infusion over 30 minutes For people 75 to 100 kg, give infusion over 40 minutes Do not give more than 2 g (2000 mg) in a dose. |
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Important Monitor breathing and blood pressure after treating with phenobarbital. |
Important Closely watch the person’s heart rate and blood pressure after giving phenytoin, as it can cause these to drop dangerously. Use with caution in people using rifampin (rifampicin, taken for tuberculosis) or mefloquine (taken for malaria) as these medicines may make phenytoin less effective. | ||
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Side effects Tiredness, slowed breathing, lowered blood pressure. |
Side effects Feeling tired, dizziness, stomach upset and diarrhea, heart problems. | ||
WARNING If possible, do not give to pregnant or breastfeeding people, or people trying to get pregnant Can be used if no safer medicine is available.
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WARNING If possible, do not give to pregnant or breastfeeding people, or people trying to get pregnant Can be used if no safer medicine is available.
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