Table 2.

Treatment strategy from Yale New Haven Hospital [38–40]

Stage of SE	Drug	Route	Dose	Mechanism/class	Additional notes
Early (< 10 min)	Lorazepam	IV	4 mg over 2 min	Benzodiazepine	Repeat ×1 if necessary after 5 min; Preferred drug if IV is available
Early (< 10 min)	Diazepam	rectal	20 mg (IV solution)	Benzodiazepine	If no IV access
Early (< 10 min)	Midazolam	IN/IM	10 mg (IV solution)	Benzodiazepine	If no IV access
Established (10–30 min)	Valproate	IV	40 mg/kg over 10 min	Anti-epileptic drug (AED), Modulator of GABA and cerebral metabolism [38]	Additional 20 mg/kg if needed
Established (10–30 min)	Fosphenytoin	IV	20 mg PE/kg, up to 150 mg PE/min	AED, Voltage-gated cation channel modulator [39]	Additional 5 mg PE/kg if needed
Established (10–30 min)	Fosphenytoin	IM	20 mg PE/kg	AED, Voltage-gated cation channel modulator [39]	Only if IV access is not achievable; Additional 5 mg PE/kg if needed
Established (10–30 min)	Levetiracetam	IV	2500–4000 mg over 5–10 min	AED, Pre-synaptic calcium channel blocker [39]	Additional 1500–3000 mg if needed
Established (10–30 min)	Lacosamide	IV	400 mg over several minutes	AED, Slow inactivator of sodium channels [40]	Additional 200 mg over 10 min if needed
Established (10–30 min)	Midazolam	IV	0.2–0.4 mg/kg every 5 min until resolution (max 2 mg/kg), 0.1–2.9 mg/kg/h maintenance	benzodiazepine	Only if intubated; use in conjunction with AED
Established (10–30 min)	Propofol	IV	1–2 mg/kg every 2–3 min until resolution (max 10 mg/kg), 1.02–15 mg/kg/h maintenance	Induction anesthetic	Only if intubated; use in conjunction with AED
Refractory (> 30 min)	Pentobarbital	IV	Load 5 mg/kg at 50 mg/min, 1–5 mg/kg/h maintenance	barbiturate	Only if intubated
Refractory (>30 min)	Thiopental	IV	Load 1–2 mg/kg, 1–5 mg/kg/h maintenance	Barbiturate	Only if intubated