Mental health

Anti-epileptic medications for management of acute convulsive seizures when no intravenous access is available

[Updated 2015]

Recommendation(s)

When intravenous access is not available for the control of acute seizures in adults, non- parenteral routes of benzodiazepine administrations should be used. Options include rectal diazepam, buccal or intranasal midazolam, rectal or intranasal lorazepam. The preference may be guided by availability, expertise and social preference. Some benzodiazepines (lorazepam or midazolam) may be given by intramuscular route, which requires additional expertise. Intramuscular administration of diazepam is not recommended because of erratic absorption.
Strength of recommendation: STRONG
Quality of evidence: LOW

Choice of anticonvulsant medicines in children with active seizures when no IV access is available* [New 2015]

Recommendation(s)

When intravenous access is not available for the control of acute seizures in children, non-parenteral routes of benzodiazepine administrations should be used. Options include rectal diazepam, buccal or intranasal midazolam, rectal or intranasal lorazepam. Some benzodiazepines (lorazepam or midazolam) may be given intramuscular, which require additional expertise and expense. The preference may be guided by availability, expertise and social preference.
Strength of recommendation: STRONG
Quality of evidence: LOW

*Recommendation is part of the 2015 Paediatric Emergency Triage, Assessment and Treatment Guidelines