Medicines used for emergency seizures.

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Rescue anticonvulsants are prescription medications used to stop a seizure when it occurs. Management of emergency seizures may be necessary in a number of situations, including status epilepticus , cluster seizures, and seizures during alcohol withdrawal. These drugs are fast-acting and often go away within a few hours.

Often times, it is not possible to take the drug orally during an attack, and drugs used for emergency treatment of seizures are available in forms that can be injected into a muscle (intramuscularly), injected intravenously (intravenously). intravenously, into a vein), used as a nasal spray or rectally.

Rescue anticonvulsants

Various life-saving anticonvulsants can be used to control seizures. Some of these drugs are benzodiazepines, which inhibit the activity of the nervous system, including the brain, by binding and regulating the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

In addition to stopping seizures, anticonvulsants also cause fatigue, dizziness, and slow thinking. They can also slow down breathing, which may require medical respiratory assistance. Antiseizure effects and anticonvulsant side effects usually resolve after a few hours.

Ativan (lorazepam)

Ativan is a benzodiazepine. The oral form of this medication is used to treat anxiety disorders. For the treatment of status epilepticus, patients over 18 years of age are recommended to inject the Ativan form intravenously (intravenously, into a vein) at a dose of 4 milligrams (mg) at a rate of 2 mg. / min.

If the seizures cease, further administration of Ativan is not recommended. If the attacks continue or reappear after 10 to 15 minutes, an additional 4 mg dose is given at the same rate as the first dose.

Diastat (diazepam)

This benzodiazepine is a rectal gel that is administered at a recommended dose of 0.2-0.5 mg / kg of body weight, depending on age.

Valtoko (diazepam)

This benzodiazepine is given as a nasal spray. It is indicated for the treatment of acute seizure disorders in patients with epilepsy from 6 years of age. The dose depends on weight and age. The recommended dose is a single 5 mg or 10 mg intranasal spray per nostril, or 15 or 20 mg doses, requiring two nasal spray devices, one spray in each nostril.

If necessary, you can use a second dose at least 4 hours after the first. No more than two doses should be used to treat an episode, Valtoko should not be used more often than every five days, and should not be used to treat more than five episodes per month.

Valium (diazepam)

This oral Benzodiazepine is used to treat anxiety disorders and muscle cramps . It is also used as an emergency treatment for seizures in certain circumstances where a person can safely take it by mouth.

Klonopin (clonazepam)

Klonopin is a benzodiazepine that is used to treat anxiety disorders . It is also used to treat persistent recurrent seizures that occur as part of Lennox-Gastaut syndrome and myoclonic epilepsy .

Naizilam (midazolam)

This benzodiazepine nasal spray is indicated for the treatment of acute seizure disorders in patients with epilepsy who are 12 years of age or older. The recommended dose is a 5 mg spray into one nostril. If necessary, after 10 minutes, you can put another 5 mg of the spray into the opposite nostril.

No more than two doses should be used for a single cluster attack episode, and Naisilan should not be used more often than every three days, and should not be used to treat more than five episodes per month.

Midazolam is also available as an intramuscular injection.

Phenytoin

The oral form of this non-benzodiazepine drug is used as maintenance therapy and the intravenous form is used to stop ongoing seizures in healthcare settings. Dosage is generally based on weight.

Phenobarbital

This barbiturate drug interacts with GABA to control seizures. Oral medication is used as supportive therapy and the intravenous form is used for emergency seizure control in healthcare settings.

Keppra (levetiracetam)

This anti-seizure medication is approved for the treatment of seizures in adults and children four years of age and older. It is indicated for some types of epilepsy that are often difficult to treat, including myoclonic epilepsy. It is available as a tablet and an oral solution.

Rescue drugs versus supportive therapy

Emergency medications are different from supportive care, which are antiepileptic medications (AEDs) that are taken regularly to prevent seizures.

Most maintenance AEDs are taken by mouth (by mouth) and are not absorbed quickly enough to stop ongoing seizures. However, injectable forms of some maintenance AEDs are sometimes used as life-saving anticonvulsants.

Indications

Life-saving drugs are often used in an emergency, such as in a hospital. In these situations, you can be closely monitored for side effects, such as slow breathing, and you will receive medical support as needed.

In some cases, such as when a person has frequent seizures despite using maintenance AEDs, the healthcare provider may prescribe an emergency medication to be taken at home or in a care facility. Caregivers usually receive detailed instructions on dosage and timing of administration.

In rare cases, the person with seizures will be instructed on how to self-administer life-saving medications during the preictal phase of the seizure to prevent it from progressing to the ictal phase .

Specific settings in which life-saving anticonvulsants may be required include:

  • Cluster seizures: These are stereotypical periodic episodes of repetitive seizure activity that occur over a short period of time. These events require medical attention and treatment with benzodiazepines is recommended. Valtoco nasal, nizilam, and diazepam rectal gel are FDA-approved seizure rescue medications.
  • Status epilepticus : This is a long-lasting, persistent seizure that does not go away on its own and often persists despite treatment. Phenytoin and phenobarbital are approved for the treatment of status epilepticus, and levetiracetam and benzodiazepines are also commonly used.
  • Neonatal seizures: Neonatal seizures can present with minimal overt symptoms, although these are usually associated with an electroencephalogram (EEG) indicating seizure activity. Common treatments include levetiracetam and phenobarbital in weight-based doses.
  • Alcohol withdrawal . Alcohol withdrawal attacks should be treated in a healthcare setting. Lorazepam with diazepam is recommended.
  • Paramedics : Sometimes paramedics have to start anticonvulsant treatment on the way to hospital, and in this situation intramuscular midazolam is often used.

Get the word of drug information

Rescue medications can be a necessary part of seizure management. In some situations, your healthcare provider may recommend that you carry a life-saving medicine with you in the event of a sudden attack, and will give you detailed instructions on when and how to use the life-saving medicine.

Rescue anticonvulsants are often used in healthcare settings when a seizure occurs or to treat a long-term seizure that does not go away on its own.

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