Rescue Medications for Seizures

Fast-acting Medications That Stop a Seizure

Intravenous medications in emergency setting

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Rescue seizure medications are prescription medications used to stop a seizure while it is occurring. Emergency treatment of seizures may be necessary in a number of situations, including status epilepticus, cluster seizures, and seizures during alcohol withdrawal. These medications are rapid-acting and their effects often wear off within a few hours.

It’s often not possible to take a medication by mouth during a seizure, and the medications used for emergency management of seizures are available in forms that can be injected into a muscle (IM), administered intravenously (IV, in a vein), used as a nasal spray, or administered rectally. 

Rescue Seizure Medications 

A number of rescue seizure medications can be used to stop seizures. Several of these medications are benzodiazepines, which inhibit the activity of the nervous system, including the brain, by binding to and regulating the action of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.

In addition to stopping seizures, rescue seizure medications also cause tiredness, dizziness, and slowed thinking. They may also slow down breathing, potentially requiring medical respiratory support. The anti-seizure effects and the side effects of rescue seizure medications generally stop after a few hours.

Ativan (lorazepam)

Ativan is a benzodiazepine. The oral form of this medication is used for treatment of anxiety disorders. For treatment of status epilepticus, the intravenous (IV, in a vein) form of Ativan is recommended at a dose of 4 milligrams (mg) at a rate of 2 mg/min for patients 18 years and older.

If the seizures stop, no further administration of Ativan is recommended. If the seizures continue or recur after 10 to 15 minutes, an additional 4 mg dose is administered at the same rate as the first dose.

Diastat (diazepam)

This benzodiazepine is a rectal gel that is administered in a weight-based recommended dose of 0.2-0.5 mg/kilograms (kg) of body weight, depending on age.

Valtoco (diazepam)

This benzodiazepine is administered as a nasal spray. It is indicated for acute treatment of seizure clusters in patients with epilepsy 6 years of age and older. The initial recommended dose is a single intranasal spray of 5 mg or 10 mg into one nostril or 15 mg or 20 mg doses, which requires two nasal spray devices, one spray into each nostril.

If necessary, a second dose can be used at least 4 hours after the initial dose. No more than two doses should be used to treat a single episode and Valtoco should not be used more than every five days and it shouldn't be used to treat more than five episodes per month.

Valium (diazepam)

This oral benzodiazepine is used in managing anxiety disorders and muscle spasms. It is also used as a rescue seizure treatment in selected circumstances, when a person can safely take it by mouth.

Klonopin (clonazepam)

Klonopin is a benzodiazepine that is used in the treatment of anxiety disorders. It is also used to treat persistent, repetitive seizures that occur as part of Lennox-Gastaut syndrome and myoclonic epilepsy.

Nayzilam (midazolam)

This benzodiazepine nasal spray is indicated for acute treatment of seizure clusters in patients with epilepsy 12 years of age and older. The recommended dose is one 5 mg spray into one nostril. An additional 5 mg spray can be used into the opposite nostril after 10 minutes if necessary.

No more than two doses should be used for a single seizure cluster episode, and Nayzilan should not be used more than every three days and should not be used to treat more than five episodes per month

Midazolam is also available in a form that is injected IM.

Phenytoin

The oral form of this non-benzodiazepine medication is used as a maintenance therapy, and the IV formulation is used to stop ongoing seizures in the medical setting. Dosing is typically weight-based.

Phenobarbital

This barbiturate medication interacts with GABA to control seizures. An oral formulation is used as maintenance therapy, and the IV form is used for emergency seizure control in a medical setting.

Keppra (levetiracetam)

This anticonvulsant is approved for treatment of seizures in adults and children ages four and older. It is indicated for certain types of epilepsy that are typically difficult to treat, including myoclonic epilepsy. It is available as a tablet and an oral solution.

Rescue Medications vs. Maintenance Therapies

Rescue medications are different from maintenance therapies, which are anti epilepsy drugs (AEDs) that are taken on a regular ongoing basis to prevent seizures.

Most maintenance AEDs are taken orally (by mouth) and are not absorbed quickly enough to stop ongoing seizures. However, the injected formulations of some maintenance AEDs are sometimes used as rescue seizure medications. 

Indications

Rescue medications are often used in an emergency setting, such as in the hospital. In these situations, you can be monitored closely for side effects, such as slowed breathing, and you would have medical support as needed.

In some cases, such as when a person has frequent seizures despite the use of maintenance AEDs, the doctor might prescribe a rescue medication to take at home or at an assisted care facility. Usually, caregivers will be given detailed instructions about dosing and timing.

Rarely, a person who has seizures would be given instructions about how to self-administer a rescue medication during the pre ictal stage of a seizure to prevent the seizure from progressing to the ictal phase.

Specific settings when rescue seizure medications may be needed include:

  • Cluster seizures: These are intermittent, stereotypic episodes of repetitive seizure activity that occur within a short period of time. These events require medical attention, and the recommended treatment is a benzodiazepine. Currently, rectal diazepam gel is the only FDA approved rescue medication for seizure clusters.
  • Status epilepticus: This is a persistent prolonged seizure that does not improve on its own, and often persists despite treatment. Phenytoin and phenobarbital are approved for treatment of status epilepticus, and levetiracetam and benzodiazepines are often used as well.
  • Neonatal seizures: Neonatal seizures can manifest with minimal obvious symptoms, although they are usually associated with electroencephalogram (EEG) evidence of seizure activity. Common treatments include levetiracetam and phenobarbital, with weight-based dosing.
  • Alcohol withdrawal: Alcohol withdrawal seizures should be treated in a medical setting. Lorazepam with diazepam are recommended.
  • Paramedics: Sometimes paramedics must begin anti-seizure treatment on the way to the hospital, and IM midazolam is often used in this situation.

A Word From Verywell

Rescue medications can be a necessary part of managing seizures. In some situations, your doctor may recommend that you have a rescue medication with you in case a breakthrough seizure occurs—and would provide you with detailed instructions about when and how to use your rescue medication.

Rescue seizure medications are often used in the medical care setting when a seizure is occurring or to treat a prolonged seizure that won't stop on its own.

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