Treatment of Prolonged Seizures and Prevention of Status Epilepticus
With Buccal Lorazepam or Midazolam
Prolonged tonic-clonic seizures (convulsions) or clusters of shorter seizures left untreated can sometimes lead to status epilepticus. Status epilepticus is a prolonged seizure that continues for 30 minutes or longer. Prompt treatment within 3-5 minutes can stop a seizure from becoming prolonged or status epilepticus. Visits to an emergency room might be avoided if seizures are treated early.
Buccal lorazepam or midazolam offers a safe, effective and easy way to prevent a seizure from progressing.
Both lorazepam and midazolam are absorbed well in the cheek or under the tongue and are easy to use by caretakers.
Side effects of lorazepam and midazolam are not common but can include sleepiness for 1-2 hours, agitation or restlessness, shallow breathing.
Overdose can cause breathing to stop, so never give more than the recommended dose.
The dose below of lorazepam or midazolam, available as 2mg/ml oral syrup, has been prescribed by your doctor:
If a convulsive seizure continues 5 minutes after this medicine is given, call 911.
If a long seizure or clusters of seizures happen again the same day, lorazepam or midazolam can be repeated if needed one hour after the first dose was given.
Check expiration date on medicine bottle. Lorazepam expires 90 days after the bottle is opened and needs to be refrigerated. Midazolam can be stored at room temperature. There is no specific expiration date for midazolam syrup when opened. It is usually recommended that you replace the bottle at least once a year.
Directions for giving lorazepam or midazolam are as follows:
Open the medicine bottle and insert a new sterile 1mL or 3mL syringe to draw up the correct amount of medicine. No needles are needed.
If the child or young person is in a chair and has no head support, support the head by standing behind him and holding his chin. Be careful not to press on the throat.
If the child or young person is lying on the floor or is in a chair with a head support in place, hold the chin to keep the head steady and turn the head to one side.
Open the mouth gently by holding the chin, apply downward pressure on the lower lip and wipe away any excess saliva. Do not try to part the teeth.
Place the syringe between the lower gum and the cheek on one side of the mouth. Slowly give half the amount of medicine into the mouth. Remove the syringe. Close the lips together and rub the cheek on the outside. Repeat this on the other side of the mouth to give the rest of the medicine.
Do not give the medicine too quickly, as this may cause the child to choke or swallow it. If a small amount is swallowed, it is not a problem.
Place the child on his side. Watch for ongoing seizure activity and watch for signs of breathing problems, for example, no air movement at the mouth or nose, gasping, blueness in the face. Call 911 if breathing stops and give “rescue” breaths if needed.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 09/06/2013
Copyright © 09/06/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7212
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