Hesperian Health Guides

Medicines for Severe Pre-eclampsia and Seizures

Pregnancy and Birth: Medicines

Magnesium sulfate

Magnesium sulfate is the best medicine to treat seizures (convulsions) in pregnant women with eclampsia. If you cannot get magnesium sulfate, give diazepam instead.


Only use magnesium sulfate if a woman’s blood pressure is over 160/110 (pre-eclampsia), or if she has a seizure.

Count the breaths before and after giving. Do not give if her breathing is less than 12 breaths per minute. Do not give a second dose if her breathing slows to less than 12 breaths per minute, or if the woman cannot urinate within 4 hours after the first dose.

Magnesium sulfate comes in different concentrations (the number of mg in each ml of liquid), so check the label carefully and be sure to mix in the correct amount of sterile water before using.

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Inject 10 grams of 50% solution in the buttocks. Because such a large injection can be painful, split the injection so 5 grams go into each buttock muscle.

If after 4 hours you have not yet reached medical help, you can give one more injection of 5 grams into one buttock only.


Diazepam can be used to relax muscles and calm pain. It can also be used to stop a single seizure. For people with ongoing seizures (epilepsy), use a different medicine, one that can be taken every day.

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  • Too much diazepam can slow down or stop breathing. Do not give more than the recommended dose and do not give more than 2 doses.
  • Diazepam is a habit-forming (addictive) drug. Avoid long-term or frequent use.
  • Do not give during pregnancy or breastfeeding unless the woman has a seizure (for example, due to eclampsia).
  • Do not inject diazepam unless you have experience or training to do so. It is very difficult to give safely by injection. Instead, during a seizure, you can put it into the rectum.

How to use

For a seizure during pregnancy

Use the liquid solution for injection or grind up the tablets and mix with a little water. Take the needle off a syringe, then draw up the medication. Or use diazepam gel made for use in the anus.

Lay the woman on her side and use the needle-less syringe to put the medicine deep into her rectum. Then hold her buttocks together for 5 minutes to keep the medicine in.
Give 20 mg diazepam in the rectum.

If seizure continues 10 minutes after the first dose, you can give another 10 mg, but do not give more than that amount.

This page was updated:05 Jan 2024