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Although intravenous (IV) lorazepam is considered first-line therapy for status epilepticus, this therapy is impractical for patients who do not have IV access. Diazepam can be administered either intravenously or rectally but is less effective and associated with a higher risk for respiratory depression. Midazolam — although not formally recommended for treatment of seizures — can be given via IV, intramuscular (IM), intranasal (IN), or buccal routes.
These authors conducted a meta-analysis of randomized, controlled trials published from 1950 to 2009 that compared non-IV midazolam to diazepam by any route for initial treatment of status epilepticus in emergency department (ED) patients. Six studies involving 774 patients (age range, newborn…