1st line:
- Lorazepam 0.1mg/kg IV MAX 4mg/dose (max rate 2mg/min). May be given IM but IV preferred. Repeat q10-15 min to max 8mg/12hr.
- OR
- Diazepam 0.2-0.5mg/kg PR single dose q4-12h PRN
2nd line:
- Fosphenytoin 20mg PE/kg IV loading dose (at 100-150 mg PE/minute) then second dose 5-10mg PE/kg if necessary. Time to peak with IV ~ 15 min. May be given IM. Time to peak with IM is 30 min to 3 hours.
- OR
- Phenytoin 20mg/kg IV loading dose max rate 50mg/min then second dose 5-10mg/kg if necessary. Onset of action 0.5-1 hour. Do NOT give IM due to tissue necrosis effects--use fosphenytoin IM instead.
3rd line (move on to 3rd line if patient still seizing after loading dose of 2nd line drug):
- Phenobarbital 20mg/kg IV (max rate 50 mg/min). Maximum dose: 1000 mg. Then second dose as soon as 10 min later: 5-10mg/kg if necessary. Maximum total dose: 40 mg/kg. May be given IM but IV is proper route for status epilepticus.
Content on this page has not been checked for accuracy. The author's credentials have not been confirmed. Always use multiple peer-reviewed scholarly sources and good clinical judgement in your decision making.
The Compendium platform was created by David Kwinter, MD, CCFP(EM).
Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.
Dr. Kwinter is a Cayman Family Doctor. He runs a Family Medicine Clinic at Cayman Medical in George Town, Grand Cayman, Cayman Islands.