Antiseizure medicines for management of established status epilepticus
2023 updated
In adults with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, either intravenous fosphenytoin, intravenous phenytoin, intravenous levetiracetam, intravenous phenobarbital or intravenous valproic acid (sodium valproate) should be considered with appropriate monitoring. The choice of these medicines depends on local resources, including availability and facilities for monitoring.
Strength of recommendation: CONDITIONAL
Certainty of evidence: LOW
In children with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, intravenous fosphenytoin, intravenous phenytoin, intravenous levetiracetam, intravenous phenobarbital or intravenous valproic acid (sodium valproate) should be considered with appropriate monitoring. The choice of these medicines depends on local resources, including availability and facilities for monitoring.
Strength of recommendation: CONDITIONAL
Certainty of evidence: MODERATE
2015 Updated
Recommendation(s)
In adults with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, either intravenous valproic acid, intravenous phenobarbital or intravenous phenytoin can be used with appropriate monitoring.
Intravenous valproic acid is preferred over intravenous phenobarbital or intravenous phenytoin because of its superior risk-benefit profile. The choice of these medications depends on local resource settings, including availability and facilities for monitoring.
Where intravenous infusion may not be feasible, intramuscular phenobarbital remains an option, with appropriate monitoring. Phenytoin and valproic acid should not be given intramuscularly.
Strength of recommendation: CONDITIONAL
Quality of evidence: VERY LOW
Choice of second line anticonvulsant medicines in children with established status epilepticus resistant to first line benzodiazepines* [New 2015]
Recommendation(s)
In children with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, either intravenous valproate, intravenous phenobarbital or intravenous phenytoin can be used with appropriate monitoring. The choice of these drugs depends on local resource settings, including availability and facilities for monitoring. If available, intravenous valproate is preferred over intravenous phenobarbital or intravenous phenytoin because of its superior benefit-risk profile.
Intramuscular phenobarbital remains an option in settings where intravenous infusion or monitoring may not be feasible. Phenytoin and valproate should not be given intramuscularly.
Strength of recommendation: CONDITIONAL
Quality of evidence: LOW
*Recommendation is part of the 2015 Paediatric Emergency Triage, Assessment and Treatment Guidelines