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Benzodiazepine Selection in the Management of Status Epilepticus: A Review

Rogalski, Rachel MSN, RN, CEN; Rogalski, Andrew PharmD, BCPS

Section Editor(s): Weant, Kyle A. PharmD, BCPS; Column Editor

Advanced Emergency Nursing Journal: April/June 2015 - Volume 37 - Issue 2 - p 83–94
doi: 10.1097/TME.0000000000000064

The choice and route of administration of benzodiazepines for the treatment of acute status epilepticus (SE) in both prehospital and emergency department (ED) settings often vary by provider and institution. Prehospital and ED care often involves intramuscular, intravenous, or rectal administration of these medications. Diazepam, lorazepam, and midazolam are available as parenteral formulations in the United States. A literature review of clinical trials and SE treatment guidelines was conducted in an attempt to identify which benzodiazepine and route are the best treatment option for adult patients with SE. For initial treatment of SE in adults, intravenous lorazepam is the recommended drug of choice. However, evidence suggests that intramuscular midazolam has at least equal efficacy in prehospital settings and may be more appropriate for use in this environment. Despite the support of multiple clinical trials and treatment guidelines, inconsistencies in the treatment of acute SE continue to occur in both the prehospital and ED settings.

Emergency Department (Ms R. Rogalski), Pharmacy Department (Dr A. Rogalski) University Medical Center of Princeton at Plainsboro.

Corresponding Author: Rachel Rogalski, MSN, RN, CEN, 1 Plainsboro Rd, Plainsboro, NJ 08536 (

Disclosure: The author reports no conflicts of interest.

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