Mental health

Management of acute convulsive seizures in adults and children (when no intravenous access is available)

Question 1: In adults and children with acute convulsive seizures in first level care or in the community (when no IV access is available), which antiepileptic drugs when compared to comparator produce benefits/harm in the specified outcomes?

Management of epilepsy

  • Population: adults and children with acute convulsive seizures when no IV access is available
  • Interventions: antiepileptic drugs by non IV route
    • diazepam [rectal, intramuscular]
    • midazolam [intranasal, intramuscular, buccal]
    • lorazepam [rectal, intranasal]
    • paraldehyde [intramuscular]
    • phenobarbital [intramuscular]
  • Comparison:
    • intravenous benzodiazepines (diazepam IV, lorazepam IV)
    • one intervention versus other
  • Outcomes:
    • stopping seizure
    • adverse effects.


When IV access is not available, rectal diazepam should be administered for control of acute convulsive seizures.
Strength of recommendation: STRONG

IM administration of diazepam is not recommended because of erratic absorption.
Strength of recommendation: STRONG

IM phenobarbital may be considered as an option where rectal use of diazepam is not possible due to medical or social reasons.
Strength of recommendation: STANDARD

Evidence profile