4.8.2 Drugs used in status epilepticus

Drugs used for Status epilepticus not listed below:

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 prefilled oral syringe 2.5mg, 5mg, 7.5mg, 10mg (£22.88 = 10mg prefilled 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 CG137recommends 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 (£4.41 = 1mg daily)

Indications

 

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  • First line
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  • Specialist
  • Hospital