Benzodiazepines for prolonged seizures

Buccal and intranasal lorazepam clinical pharmacokinetics: can it adequately compete with intravenous lorazepam in pediatric care patients?

“…This clinical pharmacokinetic study assumes high importance for the reason that intravenous lorazepam is now a drug of choice for the management of seizures in pediatric patients as compared to either diazepam or midazolam since it provides the benefit of prolonged efficacy with a lesser potential for side effects [1,4]. Given the anecdotal pharmacokinetic data reported in the literature for various routes [5][6][7][8][9], it was therefore important that the pharmacokinetics of lorazepam following buccal and intransal routes of dosing of lorazepam be re-examined, as achieved by Anderson et al in their single crossover study [3].…”

“…With regard to the management of prolonged epileptic seizures in pediatric care, the use of benzodiazepines has emerged as the best practice [1]. The recent introduction of buccal delivery of midazolam is expected to revolutionize treatment options for seizures in children since midazolam not only achieves the target concentrations needed for efficacy but also provides an aesthetic option for drug introduction [2].…”

Comparative Study of Buccal Midazolam and I.V Diazepam for Acute Treatment of Seizure in Pediatrics Age Group

“…The longer the duration of seizure, the more likely the development of pharmacoresistance [1] and animal studies suggest a greater likelihood of neuronal damage [2] . Therefore the seizure or intermittent seizures without full recovery of consciousness lasting more than 5 minutes is used as a guide for intervention [3] . The major problem in the management of a child with active seizure is the wastage of time prior to drug administration that occur in reaching a hospital and gaining an intravenous (I/V) access.…”

Correction

“…7 Nevertheless, about 30% of the patients using benzodiazepines are chronic users, predominantly for insomnia. 2,8 In the Netherlands, after consultation with patient and professional organizations, a change was made in the reimbursement status of benzodiazepines that was announced mid 2008 1,2009. From that date on, benzodiazepines were excluded from the Dutch reimbursement list (full reimbursement regardless of diagnosis or other restrictions) when used as anxiolytic, hypnotic, or sedative.…”

“…[1][2][3] Long-term use of benzodiazepines is associated with an increased risk of abuse, misuse, and adverse events. [4][5][6] Expert bodies, such as the Netherlands College of General Practitioners, have long advised that use of benzodiazepines should be limited to short courses for acutely distressed patients and generally be avoided in elderly people.…”