Is diazepam or lorazepam the most effective benzodiazepine for use in paramedic management of convulsive seizures in adults?

Diazepam, a drug from the benzodiazepine family, has been used for the acute management of status epilepticus outside of hospital since its introduction in 1963 (Roche, 2007). Although known to be an effective treatment for the termination and subsequent prophylaxis of seizures (Dreifuss et al, 1998), there have been a number of developments in benzodiazepine production since its emergence, leading to the discovery of alternative agents.The Human Medicines Regulations (2012) provides registered paramedics with legal exemption in relation to the administration of diazepam, but does not allow for the autonomous use of any other benzodiazepine medications. Therefore, unless patient specific or patient group directions exist, diazepam remains the only benzodiazepine generally available to ambulance clinicians despite the presence of alternatives that may be more effective. This article compares and contrasts the available literature regarding the qualities of diazepam with those of lorazepam in the setting of managing convulsive status epilepticus.The authors found that lorazepam is often reported to be more effective in terminating seizures than diazepam. Lorazepam may offer a more effective, safer and cheaper treatment option for the management of seizures in the pre-hospital environment.

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