Initial drug therapy for status epilepticus in palliative care

Status epilepticus is a medical emergency. Parenteral (particularly intravenous) drug administration is preferred because of its fast onset of action compared to other routes. However, sublingual, buccal and intranasal routes may be more practical in the community setting.

If intravenous access cannot be obtained quickly, for initial management of status epilepticus in patients with palliative care needs, use:

1midazolam 5 to 10 mg intramuscularly, as a single dose; use the lower end of the dose range in patients who weigh less than 40 kg, or who are older or frail. See Subsequent drug therapy for status epilepticus in palliative care Silbergleit, 2012 midazolam

1midazolam 5 to 10 mg subcutaneously, as a single dose; use the lower end of the dose range in patients who weigh less than 40 kg, or who are older or frail. See Subsequent drug therapy for status epilepticus in palliative care Silbergleit, 2012 midazolam

2midazolam 5 to 10 mg buccally or intranasally, as a single dose; see Subsequent drug therapy for status epilepticus in palliative care ¹ midazolam

3clonazepam 0.5 to 1 mg sublingually, as a single dose; see Subsequent drug therapy for status epilepticus in palliative care ². clonazepam

If intravenous access is available quickly, use:

midazolam 5 mg intravenously, as a single dose; see Subsequent drug therapy for status epilepticus in palliative care. midazolam

¹ Midazolam solution for injection (hydrochloride salt) can be given buccally or intranasally and may be provided under expert advice to family members and carers who have been trained in its use. Fact sheets that explain the method are available (eg from the Royal Children’s Hospital Melbourne).Return

² Five to ten drops of clonazepam 2.5 mg/mL oral liquid is equivalent to clonazepam 0.5 to 1 mg. Do not count drops directly into the mouth; count into a spoon first.Return