Table 3.
Drugs used for management of Convulsive Status Epilepticus (CSE) in Children.
| Drug | Dose/administration | Side effects |
|---|---|---|
| Lorazepam | IV: 0.1 mg/kg/dose (max: 4 mg/dose) slowly over 2-5 minutes; may repeat once in 5-15 minutes if needed. | Hypotension Respiratory depression |
| Diazepam | IV/IO: 0.15-0.2 mg/kg/dose (max: 10 mg/dose) slowly over 2-5 minutes; may repeat once in 5-15 minutes if needed. PR: 0.5 mg/kg/dose (max: 20 mg/dose) | Hypotension Respiratory depression |
| Midazolam | Buccal: 0.5 mg/kg/dose (max: 10 mg/ dose) IM: 0.2 mg/kg/dose (max: 10 mg/dose) IV Infusion: loading dose: 0.15 mg/kg (max: 8 mg/dose) over 2-3 min, followed by continuous IV infusion of 2 mcg/kg/min, titrate to effect by 2 mcg/kg/min every 10-15 min up to maximum rate of 24 mcg/kg/min. | Hypotension Respiratory depression |
| Phenytoin | IV/IO: 20 mg/kg/dose (max: 1000 mg/dose) Dilute in normal saline. Infuse over 20 minutes. Administered into a large vein, using an in-line 0.22 micron filter. Flush IV catheter with normal saline to avoid local venous irritation and extravasation. | Hypotension Bradycardia Arrhythmias *Use with caution in cardiac patient |
| Phenobarbitone | IV: 20 mg/kg/dose (max: 1000 mg/dose) Infusion over 20 minutes; may repeat in 10-15 minutes if needed up to max. total dose of 40 mg/kg | Hypotension Respiratory depression |
| Levetiracetam | IV: 20-60 mg/kg (max: 2500 mg/dose) Infusion over 15-20 minutes | Aggression |
| Sodium valproate | IV: 20-40 mg/kg (max: 3000 mg/dose) infusion over 20 minutes; an additional 20 mg/kg after 10-15 min can be used if needed, followed by a continuous IV infusion of 5 mg/kg/hour. Once patient is seizure free for 6-12 hours, reduce infusion rate by 1 mg/kg/hour every 2 hours | Hyperammonemia Pancreatitis Thrombocytopenia Hepatotoxicity |
| Thiopental | IV: 3-5 mg/kg (max: 500 mg/dose) over 10 minutes, repeat dose if needed after 10-15 min (up to max. total dose of 10 mg/kg); followed by continuous IV infusion of 3-5 mg/kg/hour, titrate to effect. | Hypotension Respiratory depression Arrhythmias |
| Pentobarbital | IV: 5 mg/kg over 10 minutes, may repeat the dose if needed; followed by continuous IV infusion of 0.5-5 mg/kg/hour, titrate to effect. | Hypotension Respiratory depression Arrhythmias Paralytic ileus |
CSE - Convulsive Status Epilepticus, IV - intravenous, IO - Intraosseous, IM - intramuscular, PR - Per rectal