Rescue Seizure Medications (2023)

Rescue seizure medications are prescription medications used to stop a seizure while it is occurring. Emergency treatment ofseizures 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 antiseizure 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. Dosing is weight and age based. The 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 select 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

(Video) Anti-Seizure and Rescue Medications

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

Phenytoin

The oral form of this nonbenzodiazepine 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 healthcare provider 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:

  • Clusterseizures: 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. Nasal Valtoco, Nayzilam, and rectal diazepam gel are FDA-approved rescue medications 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.
  • Neonatalseizures: 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 antiseizure treatment on the way to the hospital, and IM midazolam is often used in this situation.

Taking Care of Someone Having an Epileptic Seizure

(Video) Learn About Seizure First Aid, Seizure Emergencies and Rescue Medications

A Word From Verywell

Rescue medications can be a necessary part of managing seizures. In some situations, your healthcare provider 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.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Scheuermeyer FX, Miles I, Lane DJ, Grunau B, Grafstein E, Sljivic I, Duley S, Yan A, Chiu I, Kestler A, Barbic D, Moe J, Slaunwhite A, Nolan S, Ti L, Innes G. Lorazepam versus diazepam in the management of emergency department patients with alcohol withdrawal. Ann Emerg Med. 2020 Dec;76(6):774-781. doi:10.1016/j.annemergmed.2020.05.029

    (Video) Lorazapam Seizure Medication Training

  2. Food and Drug Administration. Ativan label.

  3. Food and Drug Administration. Diastat label.

  4. Food and Drug Administration. Valtoco label.

  5. Food and Drug Administration. Nayzilam label.

  6. Silbergleit R, Lowenstein D, Durkalski V, Conwit R; NETT Investigators. Lessons from the RAMPART study--and which is the best route of administration of benzodiazepines in status epilepticus. Epilepsia. 2013 Sep;54 Suppl 6(0 6):74-7. doi:10.1111/epi.12284

  7. Crawshaw AA, Cock HR. Medical management of status epilepticus: Emergency room to intensive care unit. Seizure. 2020 Feb;75:145-152. doi:10.1016/j.seizure.2019.10.006. Erratum in: Seizure.

  8. Sharpe C, Reiner GE, Davis SL, Nespeca M, Gold JJ, Rasmussen M, Kuperman R, Harbert MJ, Michelson D, et al. NEOLEV2 INVESTIGATORS. Levetiracetam versus phenobarbital for neonatal seizures: A randomized controlled Trial. Pediatrics. 2020 Jun;145(6):e20193182. doi:10.1542/peds.2019-3182. Erratum in: Pediatrics.

  9. Jafarpour S, Hirsch LJ, Gaínza-Lein M, Kellinghaus C, Detyniecki K. Seizure cluster: definition, prevalence, consequences, and management. Seizure. 2019 May;68:9-15. doi:10.1016/j.seizure.2018.05.013

Rescue Seizure Medications (1)

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.

FAQs

What are rescue medications? ›

Rescue medication is a medicine intended to relieve your symptoms immediately. Rescue medications are most often used for severe allergies, for asthma, or for migraines, and they're also known by the terms quick-acting medication and fast-acting medication.

What are the two types of rescue medication for epilepsy? ›

Treatment. The two emergency medications used to prevent status in the community (outside of the hospital setting) are midazolam and diazepam: Buccal (oromucosal) midazolam – is given into the buccal cavity (the side of the mouth between the cheek and the gum). Rectal diazepam – is given rectally (into the bottom).

When should you administer seizure rescue medication? ›

Most seizures self-terminate within five minutes, but for seizures lasting longer, medication administration is warranted for seizure cessation. Seizures lasting more than 5 minutes are considered an emergency (Mayo Clinic, 2021). emergencies (Epilepsy Foundation, 2020). Rescue medication is given as needed.

Is midazolam a rescue medication? ›

Midazolam is a rescue medication that is approved for use: For short-term treatment of increased or frequent seizures called seizure clusters or acute repetitive seizures. In children over 12 years old and in adults. It is not supposed to be taken daily.

What is the difference between a controller medication and a rescue medication? ›

Two types of medication, known as “relievers” and “controllers,” are used in the treatment of asthma. Reliever medication works quickly and is used to treat acute symptoms. Controller medication works slowly over time and is taken regularly to try to prevent asthma attacks.

What is the best anti seizure medication? ›

Below are 10 of the most common.
  1. Lamotrigine (Lamictal) Lamotrigine (Lamictal) can be used for both focal onset and generalized seizures. ...
  2. Levetiracetam (Keppra, Spritam) ...
  3. Phenytoin (Dilantin) ...
  4. Zonisamide (Zonegran) ...
  5. Carbamazepine (Tegretol) ...
  6. Oxcarbazepine (Trileptal) ...
  7. Valproic acid derivatives. ...
  8. Topiramate (Topamax)
28 Apr 2022

What are 4 drugs to treat epilepsy? ›

Common types include:
  • sodium valproate.
  • carbamazepine.
  • lamotrigine.
  • levetiracetam.
  • topiramate.

How do you stop a seizure quickly? ›

The most commonly used medications are benzodiazepines because they get into the bloodstream quickly to start working on the brain to stop the seizure. They include: Diazepam, given orally (if the person is still awake) or rectally. Diastat, a diazepam rectal gel.

Can an EpiPen stop a seizure? ›

Drug delivery into muscle using an autoinjector—akin to the EpiPen used to treat serious allergic reactions—can be a fast, effective way to stop prolonged epileptic seizures. The finding provides a safe tool to treat people quickly during an emergency.

How long can a seizure last before brain damage? ›

A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. This is a medical emergency that may lead to permanent brain damage or death.

Will Ativan stop a seizure? ›

BENZODIAZEPINES. The benzodiazepines are some of the most effective drugs in the treatment of acute seizures and status epilepticus. The benzodiazepines most commonly used to treat status epilepticus are diazepam (Valium), lorazepam (Ativan), and midazolam (Versed).

Can seizures stop without medication? ›

Medication can control seizures in about two-thirds of people with epilepsy. The drugs are not a cure, but seizures don't always last a lifetime; in as many as half of people with epilepsy, the seizures may stop on their own. This means there's a subset of people taking anti-seizure medication who don't need it.

How long does midazolam take to stop a seizure? ›

Each drop of the 5 mg/mL solution contains approximately 0.3 mg midazolam. Absorption takes approximately 1–3 minutes and midazolam can take up to 10 minutes to abort the seizure. The dose can be repeated after five minutes if seizures persist.

What does midazolam do at end of life? ›

Parenteral benzodiazepines, such as midazolam, can be used to relieve muscle spasm and spasticity in the last days of life (Table 3).

What is the most serious side effect of midazolam? ›

Midazolam injection may cause serious or life-threatening breathing problems such as shallow, slowed, or temporarily stopped breathing that may lead to permanent brain injury or death.

What drugs are used in DPI? ›

Table I
DPIDrug deliveredFormulation storage
Rotahaler/DPhaler®SS, BDPCapsule
Cyclohaler®/Aerolizer®SS, BDP, IBR, BUD, FORCapsule
HandihalerTTCapsule
TurbuhalerFOR, TS, BUDReservoir
13 more rows

What brands are rescue inhalers? ›

What types of rescue inhalers are available?
  • Proair HFA.
  • Proair Digihaler.
  • ProAir Respiclick.
  • Proventil HFA.
  • Ventolin HFA.
  • Albuterol (generic)
10 Feb 2020

What kind of rescue inhalers are there? ›

Short-acting bronchodilator inhalers available in the United States include:
  • Albuterol (AccuNeb, Proair HFA, Proventil HFA, Ventolin HFA, also available as a generic solution for nebulizers)
  • Metaproterenol, available as a generic solution for nebulizers.
  • Levalbuterol (Xopenex HFA)
  • Pirbuterol (Maxair)
17 Dec 2021

What is the new drug for epilepsy? ›

The New Drugs in the Guidelines

Specifically, the AAN guidelines recommend four of the new drugs for newly-onset epilepsy: oxcarbazepine, gabapentin (Neurontin), lamotrigine, and topiramate (Topamax).

Can you stop a seizure before it happens? ›

In cases where the aura is a smell, some people are able to fight off seizures by sniffing a strong odor, such as garlic or roses. When the preliminary signs include depression, irritability, or headache, an extra dose of medication (with a doctor's approval) may help prevent an attack.

What drugs should epileptics avoid? ›

Tramadol or Ultram - a pain reliever commonly prescribed to treat moderate to severe pain. Oral contraceptives - which may reduce the effectiveness of your seizure medication or your seizure medication may reduce the effectiveness of your oral contraceptive. Certain antibiotics.

What drug can replace Keppra? ›

Levetiracetam has an average rating of 5.9 out of 10 from a total of 390 ratings on Drugs.com. 44% of reviewers reported a positive effect, while 33% reported a negative effect. Diazepam has an average rating of 8.5 out of 10 from a total of 781 ratings on Drugs.com.

What are 3 treatments for epilepsy? ›

Most people with epilepsy can become seizure-free by taking one anti-seizure medication, which is also called anti-epileptic medication. Others may be able to decrease the frequency and intensity of their seizures by taking a combination of medications.

What drug should be given first for the fastest suppression of the seizures? ›

Lorazepam is considered the benzodiazepine of choice for the initial treatment of seizures given its pharmacokinetic and safety profile. Initial doses should be 4 to 10 mg intravenously. A loading dose of 0.1 to 0.2 mg/kg should be given if seizures are not aborted within 2 to 3 minutes.

What is the main cause of a seizure? ›

Anything that interrupts the normal connections between nerve cells in the brain can cause a seizure. This includes a high fever, high or low blood sugar, alcohol or drug withdrawal, or a brain concussion. But when a person has 2 or more seizures with no known cause, this is diagnosed as epilepsy.

What can trigger a seizure? ›

Missed medication, lack of sleep, stress, alcohol, and menstruation are some of the most common triggers, but there are many more. Flashing lights can cause seizures in some people, but it's much less frequent than you might imagine.

Should you let a person sleep after a seizure? ›

Yes, let him sleep. When he has the seizure make sure he is on the floor where he will not injury himself. If he has been sick and has a lot of mucus make sure he is on his side so that the mucus and saliva does not choke him. Also time the seizure, anything over five minutes call the emt.

Do you give oxygen during a seizure? ›

Initial considerations for patients with an ongoing seizure: If the individual continues to have seizures in the emergency room, the one should follow the ABCs (airway, breathing, circulation) Administer oxygen if the individual is in status epilepticus, is cyanotic or is in respiratory distress.

Can Xanax stop a seizure? ›

Tegretol (carbamazepine) and Xanax (alprazolam) are used to treat seizures. Tegretol is also used to treat nerve pain such as trigeminal neuralgia and diabetic neuropathy and to treat bipolar disorder. Xanax is primarily used to treat panic attacks and anxiety disorders.

Can narcan stop seizures? ›

Narcan isn't FDA-approved to treat seizures. And it's currently not used off-label for this purpose. However, seizures can sometimes be a symptom of tramadol overdose.

What are rescue medications in clinical trials? ›

Rescue medications are fast-acting preparations of anticonvulsant therapies applied to control or end a seizure. Some rescue treatments can be given by parents or caretakers while others must be applied by emergency medical personnel.

What are rescue medications for asthma? ›

Short-acting beta-agonists are the most common quick-relief drugs for treating asthma attacks and are considered to be bronchodilators.
...
Some quick-relief asthma medicines include:
  • Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA)
  • Levalbuterol (Xopenex HFA)
  • Metaproterenol.
  • Terbutaline.

What is in a rescue pack for COPD? ›

A COPD rescue pack refers to a short course of steroids and antibiotics issued in advance, for a person with COPD to keep at home and use as part of their acute exacerbation plan. Rescue packs are in widespread use but it is very important that they are used correctly to prevent both steroid and antibiotic overuse.

What is prescribed for panic attacks? ›

SSRIs approved by the Food and Drug Administration (FDA) for the treatment of panic disorder include fluoxetine (Prozac), paroxetine (Paxil, Pexeva) and sertraline (Zoloft). Serotonin and norepinephrine reuptake inhibitors (SNRIs). These medications are another class of antidepressants.

What is the most common epilepsy drug? ›

AEDs are the most commonly used treatment for epilepsy. They help control seizures in around 7 out of 10 of people. AEDs work by changing the levels of chemicals in your brain. They do not cure epilepsy, but can stop seizures happening.
...
Types of AEDs
  • sodium valproate.
  • carbamazepine.
  • lamotrigine.
  • levetiracetam.
  • topiramate.

Is Accolate a rescue or control? ›

Accolate is a preventive drug. It is not a rescue medication and does not provide immediate relief of acute symptoms. Your doctor may also prescribe short-acting bronchodilators, like albuterol, for emergency relief of an acute asthma attack. Accolate can help reduce airway inflammation.

What is a control medication? ›

A controlled (scheduled) drug is one whose use and distribution is tightly controlled because of its abuse potential or risk. Controlled drugs are rated in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA).

What medication opens up airways? ›

About bronchodilators

Bronchodilators are a type of medication that make breathing easier. They do this by relaxing the muscles in the lungs and widening the airways (bronchi). They're often used to treat long-term conditions where the airways may become narrow and inflamed.

What are the 4 bronchodilators? ›

Types of bronchodilator
  • beta-2 agonists, such as salbutamol, salmeterol, formoterol and vilanterol.
  • anticholinergics, such as ipratropium and tiotropium.
  • theophylline.

Do you need a prescription for a rescue inhaler? ›

OTC inhalers are available at drugstores, and can be purchased by anyone. No prescription is needed. OTC inhalers offer temporary relief of more mild symptoms. Severe cases of asthma usually require Rx inhalers.

Is COPD classed as a terminal illness? ›

Is COPD considered a terminal illness? COPD is not a terminal illness but a chronic disease that gets worse over time . Although there is no cure for COPD, the illness can be successfully managed especially if it's recognized early.

How do you use rescue packs? ›

When should I take my COPD Rescue Pack? Take six tablets immediately and then continue with six tablets as a single dose each morning, with food, for a total of 7 days.

Does drinking a lot of water help COPD? ›

Water is very important for your body to be able to function properly. For example, water helps regulate your temperature, gets rid of wastes and lubricates your joints. It is very important for people with COPD because it helps to thin mucus making it easier to cough up.

What is the 3 3 3 rule for anxiety? ›

Follow the 3-3-3 rule.

Look around you and name three things you see. Then, name three sounds you hear. Finally, move three parts of your body — your ankle, fingers, or arm.

What is the first-line drug for panic disorder? ›

Imipramine and clomipramine are considered first-line treatment options for panic disorder.

What is the drug of choice for anxiety? ›

SSRIs and SNRIs are often the first-line treatment for anxiety. Common SSRI brands are Celexa, Lexapro, Luvox, Paxil, and Zoloft, and common SNRI brands are Pristiq, Cymbalta, and Effexor XR.

Videos

1. How to Use Rescue Therapies
(Epilepsy Foundation)
2. A Demonstration of Seizure Rescue Medications
(NH Family Voices)
3. Seizure Action Plans and Rescue Medications
(Dravet Syndrome Foundation)
4. Lorazapam Seizure Medication Training
(ValleyChildrens)
5. What’s Your Plan? Seizure Clusters and Rescue Medications
(CURE Epilepsy)
6. Epilepsy Rescue Medication- How To Administer
(Just A Different Life)
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