Acute seizure first aid & status epilepticus initial stabilization

5 to 10 mg IV (slow injection) or IM initially; may repeat at 10 to 15-minute intervals up to max 30 mg - single dose

0.2-0.4 mg/kg IV; second dose may be given after 10 minutes if required (max 10 mg/dose)

Egyptian National Drug Formulary - Nervous System Disorders 2025

Diazepam is a benzodiazepine that enhances GABA-A mediated inhibition in the brain to terminate an ongoing seizure; the rectal route allows rapid administration outside hospital while emergency transport is arranged for a seizure that will not stop.

10 mg oromucosal (buccal) as a single dose - single dose

Age restriction: minimum 3 months

(Buccal, by age band: 3-6 months 2.5 mg (hospital only), over 6 months to 1 year 2.5 mg, 1 to under 5 years 5 mg, 5 to under 10 years 7.5 mg, 10 years and over 10 mg.)

Alternatives by route. Buccal or intranasal midazolam is the out-of-hospital standard and Egypt stocks 6 products against 2 for diazepam.

Buccolam 10 mg oromucosal solution SmPC section 4.2 (eMC product 7460)

Rapid non-intravenous benzodiazepine alternative for acute seizure control

Adults 16 years and over: 250-500 mg twice daily, increased by 250-500 mg twice daily at 2-week intervals to a usual 1000-1500 mg twice daily - Long-term; when stopping, withdraw gradually using the same step sizes as at initiation

10-30 mg/kg/dose [child max 1500 mg]

(The 10-30 mg/kg/dose above is the 4-to-under-16 band. Younger children start lower - read the band you need. 4 to under 16 years: 10 mg/kg twice daily, increased by 10 mg/kg twice daily every 2 weeks to 30 mg/kg twice daily. 6 months to under 4 years: 10 mg/kg twice daily up to 25 mg/kg twice daily. 1 to under 6 months: 7 mg/kg twice daily up to 21 mg/kg twice daily. Syrup 100 mg/mL. Reduce in renal impairment per the formulary table.)

Alternatives. Levetiracetam needs no cardiac monitoring and has far fewer interactions than phenytoin; the ESETT trial found no difference in seizure termination.

Egyptian National Drug Formulary - Nervous System 2025 (levetiracetam monograph)

67 live products - the largest genuinely therapeutic orphan after esomeprazole. This is the drug the patient is continued on after the acute seizure has been stopped, and there is no chronic epilepsy condition in the dataset for it to attach to.

Status epilepticus: intravenous loading dose 10-15 mg/kg given slowly at a rate not exceeding 50 mg/minute (50 mg over 2-3 minutes in an elderly patient with heart disease); then maintenance 100 mg intravenously or orally every 6-8 hours - Single loading dose, then maintenance until the patient is stabilised and transferred

Neonates, infants and children: intravenous loading dose 15-20 mg/kg slowly at 1-3 mg/kg/minute or 50 mg/minute, whichever is slower, with continuous ECG, blood pressure and respiratory monitoring. The monograph states no paediatric maximum for the loading dose, so the numeric fields are left null rather than invented. Oral maintenance in children is 4-8 mg/kg/day in divided doses, maximum 300 mg daily. Caution from propylene glycol under 1 year.

Egyptian National Drug Formulary - Nervous System 2025 (phenytoin monograph)

18 live products. Control of status epilepticus of the tonic-clonic type is the formulary's first listed parenteral indication, with an explicit loading dose and infusion rate - which is exactly what this condition covers and what the benzodiazepine rows do not.