Drugs used for Status epilepticus not listed below:

• Diazepam (see 4.1.2 Anxiolytics)

Benzodiazepines

MHRA Drug Safety Update (March 2020): Benzodiazepines and opioids: reminder of risk of potentially fatal respiratory depression.

• benzodiazepines (and benzodiazepine-like drugs) and opioid medicines (opioids) can both cause respiratory depression; when used together, additive effects on the central nervous system increase the risks of sedation, respiratory depression, coma, and death.

Buccolam

(Midazolam)

• Oromucosal solution 5mg/ml pre-filled oral syringe 2.5mg/0.5ml, 5mg/1ml, 7.5mg/1.5ml, 10mg/2ml (£22.88 = 10mg pre-filled oral syringe)

Dose

• >6 months to <1 year: 2.5mg
• 1 year to <5 years: 5mg
• 5 years to <10 years: 7.5mg
• 10 years to <18 years: 10mg
• 18 years and older: 10mg (unlicensed)

Notes.

1. Prescribe by brand (the brand of midazolam should be specified on the individual patient care plan).
2. Buccolam brand is recommended for new initiations.
3. Prescribers are reminded that the different brands of buccal midazolam contain different concentrations of the drug.
4. For patients currently established on Epistatus brand (10mg/ml, non-formulary), continued prescribing is accepted, however there should be no new initiations without careful clinical consideration.
5. The brand should not be changed without the full involvement of specialist and patient/carer.
6. For infants between 3-6 months of age treatment should be in a hospital setting where monitoring is possible and resuscitation equipment is available.
7. Although the pack size is 4 prefilled oral syringes, Buccolam may be prescribed and dispensed in singles. To prevent wastage, please prescribe only as many prefilled syringes as necessary.
8. Whilst Buccolam is not licensed for patients aged 18 years and older, NICE CG137 recommends buccal midazolam as first-line treatment for prolonged or repeated seizures in adults in the community. Rectal diazepam (licensed) may be used if preferred, or if midazolam is not available.
   

Lorazepam

• Tablets 1mg (£1.30 = 1mg daily)

Indications

• Acute behavioural disturbance in bipolar disorder, short-term use (unlicensed)