Medication Summary
No specific antidote is indicated. Management is symptomatic and supportive. Benzodiazepines may be used if seizures occur. Gastric decontamination is typically not recommended unless another toxic substance is co-ingested.
Benzodiazepines
Class Summary
Prevent seizure recurrence and terminate clinical and electrical seizure activity.
Lorazepam (Ativan)
Useful to treat seizures and induce sedation. Sedative hypnotic with short onset of effects and relatively long half-life.
By increasing the action of GABA, a major inhibitory neurotransmitter in the brain, may depress all levels of CNS, including limbic and reticular formation. Monitor carefully for respiratory depression.
Diazepam (Valium)
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA. Third-line agent for agitation or seizures because of shorter duration of anticonvulsive effects and accumulation of active metabolites that may prolong sedation. Individualize dosage cautiously to avoid adverse effects. Monitor carefully for respiratory depression.
Midazolam (Versed)
Used as alternative in termination of refractory status epilepticus. Because water soluble, takes approximately 3 times longer than diazepam to peak EEG effects. Thus, clinician must wait 2-3 min to fully evaluate sedative effects before initiating procedure or repeating dose. Has twice the affinity for benzodiazepine receptors than diazepam. May be administered IM if unable to obtain vascular access.
Monitor carefully for respiratory depression.
