Which of the following is the recommended first-line initial therapy for generalized convulsive status epilepticus lasting more than 5 minutes?

• A Intravenous diazepam 10 mg repeated every 5 minutes indefinitely
• B Intravenous phenytoin 20 mg/kg as monotherapy
• C Intramuscular midazolam 0.05 mg/kg followed by phenobarbitone
• D Intravenous lorazepam 0.1 mg/kg (maximum 4 mg) ✓

Explanation

Established practice divides status epilepticus into an early phase treated with a benzodiazepine and a second phase treated with a longer acting antiseizure drug. Intravenous lorazepam at 0.1 mg/kg, maximum single dose 4 mg, is the standard first-line agent because of its longer duration of action than diazepam. Phenytoin or levetiracetam follows if seizures persist, but benzodiazepine remains the initial step.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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