Lesson 12 of 13
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Summary & References

Summary of Anti-Epileptic Drugs (AED) for Status Epilepticus

DrugRoute of Administration and Corresponding DoseAdverse EffectsPearls
Phenytoin or FosphenytoinIntravenous:Phenytoin: 20 mg/kg,maximum infusion rate: 50 mg/minFosphenytoin: 20 mg/kg PE IV, maximum infusion rate: 150 mg/min, may add 5-10 mg/kg for persistent seizures
Maintenance Dose:5-7 PE/kg/day in 2-3 divided doses
Hypotension, bradycardia, Steven-Johnsons syndrome, Pancytopenia, DeliriumAvoid combination with Valproate
Not the first agent for second-line therapy for SE with its numerous contraindications and adverse effects 
Levitiracetam (Keppra)Intravenous: 20-60 mg/kg, maximum infusion rate of 4.5g over 10 minutes
Maintenance Dose:1 – 1.5g q12hr
Syndrome of Inappropriate AdH (SIADH), Mood Disturbance
Preferred AED as second-line therapy for SE
Avoid combination with Fosphenytoin

Renally cleared
Valproic Acid
Intravenous: 40 mg/kg, maximum infusion rate up to 3000mg over 5-10 minutes, may add 20 mg/kg over 5 minutes
Maintenance Dose:30-60 mg/kg daily, divided TID

Hyperammonemia, Encepalopathy, Steven-Johnson syndrome, SIADH, Pancreatitis, Hepatotoxicity, Thrombocytopenia

Used for patients with agitated delirium or known psychiatric disorders
Interferes with pharmacokinetics of Phenytoin and Phenytoin equivalents and Phenobarbital
Contraindicated to pregnant patients
Lancomide (Vimpat)
Intravenous: 400mg IV over 5 minutes
Maintenance Dose:200 mg IV q12hr
Atrioventricular block, HypotensionMinimal drug interactions
PhenobarbitalIntravenous: 15-20 mg/kg IV, maximum infusion rate of 50-70 mg/minSomnolence, Respiratory Suppression
Increased risk for prolonged sedation due to long half-life
Preferred anti-epileptic for alcohol withdrawal seizures
Useful for patients off a barbiturate coma

Summary of Anaesthetic Drugs for Refractory Status Epilepticus (RSE)

DrugRoute of Administration and Corresponding DoseAdverse EffectsPearls
Intravenous: 0.2 mg/kg over 2-5 minutes, repeat 0.2 to 0.4 mg/kg bolus every  5 minutes until seizure stops, maximum loading dose of 2 mg/kg
Maintenance Dose: 0.05 to 2.9 mg/kg/h
CNS Depression, Hypotension, Extended half-life with prolonged useProlonged administration is associated with decrease in drug response
Tachyphylaxis with prolonged infusions
PropofolIntravenous: 1 to 2 mg/kg IV over 3 – 5 minutes, repeat boluses every 3 – 5 minutes until seizure stops, maximum loading dose of 10 mg/kg
Maintenance Dose:30 to 200 μg/kg/min
Occasional bradycardia, Hypertriglyceridemia, and life-threatening Propofol Infusion Syndrome (PRIS) that may ultimately lead to death
Best induction drug given its potent anti-epileptic activity
Pharmacologic effect is maintained only for 10 minutes if discontinued therefore may cause abrupt seizure if drug therapy is stopped
PentobarbitalIntravenous: 5 – 15 mg/kg, may repeat 5 mg/kg doses until seizure lyses
Maintenance Dose:0.5 – 5 mg/kg/h
Myocardial Depression, Hypotension, Ileus, Persistent Coma due to long half-life (up to 60 hours), Allergic reactions such as angioedema and Steven-Johnson syndrome
Prolonged mechanical ventilation
Must be used in caution in patients with hepatic or renal impairments
Increase risk for nosocomial infections for high-dose barbiturates
KetamineIntravenous: 1 – 2 mg/kg, may repeat to maximum dose of 10 mg/kg
Maintenance Dose:5 to 125 μg/kg/min
Dissociative psychosis, Hypertension, Airway complications
Synergistic effect with benzodiazepine
Combine with Midazolam to reduce risk of Dissociative Psychosis


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