A 24-year-old man presents with generalized tonic-clonic seizures for the last 20 minutes. Intravenous access has been secured. Which drug is the preferred first-line agent to terminate this episode?

• A Intramuscular phenobarbital
• B Intravenous phenytoin
• C Intravenous sodium valproate
• D Intravenous lorazepam ✓

Explanation

An intravenous benzodiazepine is the established first-line therapy for ongoing status epilepticus. Lorazepam is preferred over diazepam because its lipid redistribution is slower, giving a longer duration of antiseizure action and fewer seizure recurrences while awaiting a second-line agent such as phenytoin or valproate. Phenytoin and valproate are second-line drugs given after the benzodiazepine.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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