Skip to main content

Seizure Rescue Medications

There are no clinical indications for one medication over another. The decision should be based on the patient/family and provider's preference

 

For Children's Mercy providers, the Discharge Seizure Rescue Medications Pathway powerplan is available for use when prescribing seizure rescue medications for home

 

Medication

 

 

Dosing

Available Options

 

Diazepam, rectal

(DiaStat)

 

 

 

 
  • 6 - 11 months: 2.5 mg
  • 1 - 5 years: 0.5 mg/kg
  • 6 - 11 years: 0.3 mg/kg
  • > 12 years: 0.2 mg/kg

When calculating dose, round upward to the next available dose

Pre-Filled Syringe

  • 2.5 mg (can deliver only 2.5 mg dose)
  • 10 mg (can deliver 5 mg, 7.5 mg, and 10 mg doses)
  • 20 mg (can deliver 12.5 mg, 15 mg, 17.5 mg and 20 mg doses)

Clonazepam, oral disintegrating tablet

 

  • Height of Man Rule: Size determines dosing (see schematic diagram below)
  • The wafer should be introduced between the cheek and gum and allowed to dissolve (the child should NOT swallow the wafer)

Read more about the trial of the Height of Man Rule

Oral Disintegrating Tablet (ODT)

  • 0.125 mg
  • 0.25 mg
  • 0.5 mg
  • 1 mg
  • 2 mg

 

Midazolam, intranasal

(Nayzilam)

 

 

 

 

 
  • 0.2 mg/kg (max 10 mg divided into both nostrils)
  • For children >12 years: 10 mg (5 mg device with one 5 mg spray into one nostril)

Nasal Spray Device

  • 5 mg
  • Note. For doses < 5 mg, prescribe injectable midazolam with nasal atomizer (only at Children's Mercy outpatient pharmacies)

 

Diazepam, intranasal

(Valtoco)

 

 

 

 
  • Currently approved for children > 6 years of age
  • Please refer to Intranasal Diazepam Dosing

Nasal Spray Devices

  • 5 mg
  • 7.5 mg (two 7.5 mg devices required for 15 mg dose)
  • 10 mg (two 10 mg devices required for 20 mg dose)

 

Intranasal Diazepam Dosing


 

 

Dose Based on Age and Weight

 

Administration

6 to 11 Years of Age

(0.3 mg/kg)

12 Years of Age and Older

(0.2 mg/kg)

Dose

(mg)

Number of Nasal Spray Devices

Number of Sprays

Weight (kg)

Weight (kg)

10 to 18

14 to 27

5

One 5 mg device

 One spray in one nostril

19 to 37

28 to 50

10

One 10 mg device

One spray in one nostril

38 to 55

51 to 75

15

Two 7.5 mg devices

One spray in each nostril

56 to 74

76 and up

20

Two 10 mg devices

One spray in each nostril

Height of Man Rule - Figure

Note. The "height of man rule" schematic diagram concerning clonazepam dosing of children with prolonged seizures. Please note that the carried child, as depicted, is older and should really be a baby or young infant cradled in one's arms. 

References

Dissolving Oral Clonazepam Wafers in the Acute Treatment of Prolonged Seizures - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/The-height-of-man-rule-schematic-diagram-with-regard-to-dosing-of-children-with_fig1_43299399 [accessed 1 Feb, 2024]

Samanta, D. (2021). Rescue therapies for seizure emergencies: Current and future landscape. Neurological Sciences, 42(10), 4017-4027. https://doi.org/10.1007/s10072-021-05468-9

Troester, M. M., Hastriter, E. V., & Ng, Y. T. (2010). Dissolving oral clonazepam wafers in the acute treatment of prolonged seizures. Journal of Child Neurology, 25(12), 1468-1472. https://doi.org/10.1177/0883073810368312

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Evidence Based Practice Menu
Children's Mercy Kansas City   /    Health Care Providers   /    Evidence Based Practice / Clinical Pathways    /    Clinical Practice Guidelines, Care Process Models, and Enhanced Recovery After Surgery Pathways   /    Seizure: First, Non-Febrile   /   Seizure Rescue Medications