Status epilepticus
Continuous seizure lasting 5 minutes or longer, or recurrent seizures without recovery of consciousness between them. Life-threatening; first-line treatment is benzodiazepines.
ICD-10 G412 drugs
Also known as: Convulsive status epilepticus
Drugs used for this condition
- ADiazepamFirst line · Anxiolytics. Benzodiazepine derivativesIntravenous (0.15–0.2 mg/kg, max 10 mg) or rectal diazepam is one of the first-line agents for status epilepticus in adults and children per AAN 2016. Lorazepam and midazolam are comparable in efficacy. Used immediately after a prolonged seizure (>5 minutes). If seizures persist 5 minutes after the first dose, repeat or move to second-line agents (fosphenytoin, valproate, levetiracetam).
- APhenobarbitalSecond line · Antiepileptics. BarbituratesPhenobarbital is used in status epilepticus in resource-limited settings when modern second-line drugs (fosphenytoin, valproate, levetiracetam) are unavailable. AAN 2016 and WHO Essential Medicines List support this. Dose 15–20 mg/kg IV slowly. For refractory status, high-dose phenobarbital (barbiturate coma) is a third-line option in critical care.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit