Drugs administered in Status Epilepticus

A 21 year old is brought to your clinic in status epilepticus. What drug should be administered initially?

• A) Lorazepam
• B) Phenytoin
• C) Phenobarbital
• D) Pentobarbital
• E) Fosphenytoin

Answer and Discussion
The answer is A. Lorazepam should be administered intravenously and approximately 1 minute allowed to assess its effect. Diazepam or midazolam may be substituted if lorazepam is not available. If seizures continue at this point, additional doses of lorazepam should be infused and a second intravenous catheter placed in order to begin a concomitant phenytoin (or fosphenytoin) loading infusion. Even if seizures terminate after the initial lorazepam dose, therapy with phenytoin or fosphenytoin is generally indicated to prevent the recurrence of seizures.