Phenobarbital CSCIor daily SC | Well-proven anticonvulsant for all types of seizures. Experience suggests it is effective in doses of 200mg/24h. Phenobarbital is incompatible with most other drugs in a syringe driver, therefore a second syringe driver may be necessary. Stat doses of 100mg SC or IM can sting |
Midazolam CSCI | Midazolam is more useful as a sedative than as an anticonvulsant. Anticonvulsant efficacy of ‘standard’ doses is unknown, but probably requires 20–30mg/24h minimum. Unlicensed use If low risk of seizures, and midazolam indicated for, e.g. terminal agitation, then additional anticonvulsant probably unnecessary. If higher risk of seizures, use phenobarbital in addition |
Clonazepam CSCI | Main advantage is that clonazepam is compatible with many other drugs used in CSCI. Much less experience supporting its use in this way; doses recommended: 2–4mg/24h (4–8mg/24h if sedation acceptable or desired) |
Carbamazepine orvalproate suppositories | Occasionally suitable for patients well-controlled on one of these drugs who develop a temporary inability to take oral medication (e.g. vomiting and who would find rectal administration acceptable) |
Phenobarbital CSCIor daily SC | Well-proven anticonvulsant for all types of seizures. Experience suggests it is effective in doses of 200mg/24h. Phenobarbital is incompatible with most other drugs in a syringe driver, therefore a second syringe driver may be necessary. Stat doses of 100mg SC or IM can sting |
Midazolam CSCI | Midazolam is more useful as a sedative than as an anticonvulsant. Anticonvulsant efficacy of ‘standard’ doses is unknown, but probably requires 20–30mg/24h minimum. Unlicensed use If low risk of seizures, and midazolam indicated for, e.g. terminal agitation, then additional anticonvulsant probably unnecessary. If higher risk of seizures, use phenobarbital in addition |
Clonazepam CSCI | Main advantage is that clonazepam is compatible with many other drugs used in CSCI. Much less experience supporting its use in this way; doses recommended: 2–4mg/24h (4–8mg/24h if sedation acceptable or desired) |
Carbamazepine orvalproate suppositories | Occasionally suitable for patients well-controlled on one of these drugs who develop a temporary inability to take oral medication (e.g. vomiting and who would find rectal administration acceptable) |
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