Regular benzodiazepine regimens to prevent seizure recurrence in the last days of life

For acute seizure management, see Managing acute seizures in palliative care.

Once an acute seizure is controlled, consider starting regular benzodiazepine therapy by continuous subcutaneous infusion; a suitable starting dose is:

1clonazepam 2 mg/24 hours by continuous subcutaneous infusion1. Monitor response and adjust dose as needed. Seek specialist advice if more than 6 mg is required in 24 hours clonazepam

OR

1midazolam 20 mg/24 hours by continuous subcutaneous infusion. Monitor response and adjust dose as needed. Seek specialist advice if more than 60 mg is required in 24 hours. midazolam

If a continuous subcutaneous infusion of benzodiazepine is not possible, use:

1clonazepam 1 mg subcutaneously, 12-hourly. Monitor response and adjust dosage as needed. Seek specialist advice if more than 6 mg is required in 24 hours clonazepam

OR

1clonazepam 1 mg sublingually, 12-hourly2. Monitor response and adjust dosage as needed. Seek specialist advice if more than 6 mg is required in 24 hours. clonazepam

1 Clonazepam may be adsorbed onto PVC infusion tubing; non-PVC tubing is recommended, or adjust the dose to effect.Return
2 Ten drops of clonazepam 2.5 mg/mL oral liquid is equivalent to clonazepam 1 mg. Do not count drops directly into the mouth; count drops into a spoon first.Return