A 45-year-old man is brought to the emergency department in a witnessed generalised tonic-clonic seizure that has lasted more than 10 minutes. Airway, breathing and circulation are secured and intravenous access is obtained. Which drug should be administered first?
- A Intravenous fosphenytoin loading dose
- B Intravenous lorazepam ✓
- C Intravenous valproate
- D Intravenous levetiracetam
Correct answer: B. Intravenous lorazepam
Explanation
Initial therapy of established status epilepticus is an intravenous benzodiazepine, conventionally lorazepam 0.1 mg/kg. It terminates seizures by enhancing GABA-A mediated chloride conductance. Fosphenytoin, valproate and levetiracetam are second-line agents given after the benzodiazepine to prevent recurrence. Intravenous diazepam is equally effective acutely but its antiseizure effect fades within 15 to 20 minutes because of rapid redistribution out of the brain, whereas lorazepam's active duration is much longer.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
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