Table 1.
Benzodiazepine products, routes, FDA indications, and cost [18,19,20,21,22,23,24,25,26,27,28,29,30].
| Agent | Routes of Administration |
FDA Indications | Other Considerations |
Cost (AWP) |
|---|---|---|---|---|
| Lorazepam | (IV, IM, IN, SL, Oral solution) | IV approved for status epilepticus Other routes used off-label for acute active seizure |
IV solution contains propylene glycol IM onset of action is variable [14] SL not available in the US |
Ativan®—IV/IM: USD 2.28/2 mg vial Lorazepam—IV/IM: USD 0.60–4/2 mg vial Ativan Intensol®—Oral solution: USD 1.60/2 mg |
| Diazepam | (IV, IM, PR, IN) | IV approved for status epilepticus IV and rectal approved for acute seizure activity IN approved for acute repetitive seizures IM autoinjector approved for the US military use; however, not commercially available |
IV solution contains propylene glycol IM onset of action variable [14] |
Diazepam—IV/IM: USD 11–16/5 mg Diastat®—PR: USD 421/10 mg Valtoco®—IN: USD 336/5 mg |
| Midazolam | (IV, IM, buccal, IN) | IN approved for acute repetitive seizures Other routes used off-label for status epilepticus or other seizure types |
Buccal not commercially available in the US | Midazolam—IV/IM: USD 3.43/5 mg Nayzilam®—IN: USD 330/5 mg |
| Clobazam | (Oral: tablet, film, susp.) | Approved for Lennox-Gastaut as an adjunctive therapy Other indications used off-label for catamenial epilepsy, refractory seizures, and recurrent seizures |
All oral forms are available in the US | Sympazan®—oral film: USD 17.22/5 mg Onfi®—oral suspension: USD 12.67/2.5 mg |
AWP—Average wholesale price in the United States. IM, intramuscular; IN, intranasal; IV, intravenous; PR, rectal; Susp, suspension. Ativan® manufactured by MEDA Manufacturing GmbH Cologne, Germany for Valeant Pharmaceuticals North America LLC, Bridgewater, NJ, USA. Ativan Intensol® marketed by Paddock Laboratories Inc., Minneapolis, MN, USA. Lorazepam manufactured by Baxter Healthcare Corporation, Deerfield, IL, USA. Diazepam manufactured by Pfizer Inc., New York, NY, USA and distributed by Hospira Inc., Lake Forest, IL, USA. Diastat® manufactured by DPT Laboratories Ltd, San Antonio, TX, USA for Valeant Pharmaceuticals North America LLC, Bridgewater, NJ, USA. Valtoco® manufactured by Catalent Pharma Solutions, Morrisville, NC, USA. Midazolam manufactured by Pfizer Inc., New York, NY, USA and distributed by Hospira Inc., Lake Forest, IL, USA. Nayzilam® manufactured for Proximagen, LLC, Plymouth, MN, USA. Sympazan® manufactured by Aquestive Therapeutics Warren, NJ, USA. Onfi® manufactured by Rosemont Pharmaceuticals, Ltd. Leeds, West Yorkshire, U.K for Lundbeck, Deerfield, IL, USA.