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Anti-seizure medicines for management of acute tonic clonic seizures when no intravenous access is available

[Updated 2015]

Recommendation(s)

When intravenous access is not available for the control of acute tonic clonic seizures in adults, non- parenteral routes of benzodiazepine administrations should be used. Options include rectal diazepam, buccal or intranasal midazolam, rectal or intranasal lorazepam. The preference may be guided by availability, expertise and social preference. Some benzodiazepines (lorazepam or midazolam) may be given by intramuscular route, which requires additional expertise. Intramuscular administration of diazepam is not recommended because of erratic absorption.
Strength of recommendation: STRONG
Quality of evidence: LOW

When intravenous access is not available for the control of acute tonic clonic seizures in children, non-parenteral routes of benzodiazepine administration should be used. Options include rectal diazepam, oral or intranasal midazolam and rectal or intranasal lorazepam. Some benzodiazepines (lorazepam and midazolam) may be given intramuscularly, which involves additional expertise and expense. The preference may be guided by availability, expertise and social preference.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW

In children presenting with acute tonic clonic seizures or status epilepticus where intravenous administration is available, either intravenous diazepam or intravenous lorazepam should be used to terminate the seizure.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW