BENZODIAZEPINES
diazepam (Diastat, Diazepam Intensol, Valium)
lorazepam (Ativan, Lorzepam Intensol)
clorazepate (Tranxene)
clonazepam (Klonopin)

Indication: Diazepam (intravenous and rectal) and lorazepam (intravenous) are useful in managing status epilepticus (a seizure which continues for more than ten minutes) and/or seizure flurries (several seizures in a row). However, their effect lasts only a short time and they are not recommended for long-term anticonvulsant therapy. Clorazepate can be used for complex partial as well as other seizure types. It is usually used along with another, so-called "primary" anticonvulsant drug such as carbamazapene or phenytoin. Clonazepam is clinically most effective in the primary generalized epilepsies, and in particular, against myoclonic and clonic seizures as well as nonepileptic myoclonus. It is not as effective for partial and secondarily generalized seizures as some of the primary anticonvulsants but may be useful as adjunct therapy.

Possible side effects: The most frequent side effects of the benzodiazepines are dose-related and are characterized by sedation, difficulty with concentration, dizziness, and difficulty with walking. Hyperactivity and sometimes drooling can be a problem in children or the developmentally disabled. Depression and personality changes can occur with chronic therapy. Rarely, leukopenia, thrombocytopenic purpura and rash have been reported.

Drug interactions: There is increased central nervous system depression with symtoms such as confusion, tiredness, or thinking difficulties when benzodiazepines are given with other central nervous system depressants. Diazepam allows phenobarbital to be eliminated from the body more quickly and phenobarbital lowers clonazepam levels. Valproic acid can enhance diazepam's effect on the central nervous system. Cimetidine can increase diazepam levels and probenecid can increase lorazepam levels. Other drugs can affect and be affected by these drugs.

Dosage: A prepared rectal diazepam called Diastat using 10mg, 15 mg, and 20mg can be used at home to treat seizure flurries or to treat a prolonged seizure so as to prevent status epilepticus. This is particularly useful because caregivers can institute treatment at home and perhaps prevent an emergency room visit. There also are two liquid formulations, Diazepam Intensol and Lorazepam Intensol. These are rapidly absorbed through the mucous membrane linings of the mouth and should be useful for emergent situations. Oral diazepam also can be given in 5 and 10mg tablet forms for less emergent situations. Oral lorazepam also can be used for seizure flurries at a range of 1 to 2mg for patients under 50 Kg (about 160 pounds) and 2 to 4mg for patients over 50 Kg. This can be repeated once if necessary.