Seizure disorders diazepam

Anticonvulsant As adjunctive therapy in the management of partial seizures (clorazepate) adjunctively in status epilepticus and severe recurrent convulsive seizures (diazepam IV) adjunctively in convulsive disorders (diazepam oral). Preoperative For preoperative apprehension and anxiety (chlordiazepoxide, diazepam IV) prior to cardioversion for the relief of anxiety and tension and to diminish patient s recall (diazepam IV) adjunctively prior to endoscopic procedures for apprehension, anxiety, or acute stress reactions and to diminish patient s recall (diazepam) ... 

Exposed individuals with evidence of central nervous system depression or seizures should be evaluated for the presence of some other underlying disorder. Diazepam or phenobarbital may be administered to alleviate seizures. Supplemental oxygen can also be administered. If pulmonary edema occurs, conventional therapy should be considered. Additional information regarding the treatment of individuals exposed to cresols may be obtained from Bronstein and Currance (1988), Haddad and Winchester (1990), and Stutz and Janusz (1988). 

Nearly all central nervous system depressants have some capacity to suppress seizures by virtue of their depressant activity on the brain and spinal cord. Clonazepam and diazepam are two benzodiazepines that depress epileptiform activity and are used in the treatment of epilepsy and seizure disorders (see Chapter 32). 

Flumazenil (used to reverse the effects of benzodiazepines) may precipitate seizures and should not be used in patients treated for seizure disorders with diazepam... 

Diazepam, proprietary name Valium, is frequently used in emergency situations to gain control in status epdepticus. Unfortunately, tolerance to diazepam at the GABA receptor develops rapidly, and diazepam becomes ineffective within 2 to 3 days. Diazepam is therefore not used for long-term control of seizure disorders. 

Phenobarbital has selective antiseizure activity at low doses and has a long half-life suitable for maintenance treatment in seizure disorders (for characteristics of barbiturates, see sedative-hypnotics). Clonazepam is usually a backup drug in absence and myoclonic seizures it causes marked sedation at anticonvulsant doses. IV lorazepam and diazepam are both used in status epilepticus. 

Although diazepam is an effective agent for treatment of status epilepticus, its short duration of action is a disadvantage, leading to the more frequent use of lorazepam. Although diazepam is not useful as an oral agent for the treatment of seizure disorders, clorazepate is effective in combination with certain other drugs in the treatment of partial seizures. The maximal initial dose of clorazepate is 22.6 mg per day in three portions for adults and 15 mg per day in two doses in children. Clorazepate is not recommended for children under the age of 9. 

Other uses Thiopental is commonly used for the induction of anesthesia, and certain benzodiazepines (eg, diazepam, midazolam) are used as components of anesthesia protocols. Special uses include the management of seizure disorders (eg, clonazepam, phenobarbital) and muscle spasticity (diazepam). Longer-acting dmgs (eg, chlordiazepoxide, diazepam) are used in the management of withdrawal states in persons physiologically dependent on ethanol and other sedative-hypnotics. 

Diazepam is given oraiiy for adjunctive controi of convuisive disorders, as a rectai gei (Diastat) for refractory patients with epiiepsy on a stabie regimen of AEDs who require intermittent use of diazepam to controi bouts of increased seizure activity, and parenteraiiy as part of the regimen for the treatment of status epiiepticus or other severe, recurrent seizures. Rectai diazepam gei is an effective and weii-toierated therapy for acute repetitive seizures (59). 

I. Pharmacology. The neuronal membrane-stabilizing actions of phenytoin make this a popular drug for sustained control of aoute and ohronic seizure disorders and a useful drug for certain cardiac arrhythmias. Because of the relatively slow onset of anticonvulsant action, phenytoin is usually administered after diazepam. At serum concentrations considered therapeutic for seizure control, phenytoin acts similarly to lidocaine to reduce ventricular premature depolarization and suppress ventricular tachycardia. After intravenous administration, peak therapeutic effects are attained within 1 hour. The therapeutic serum concentration for seizure control is 10-20 mg/L. Elimination is nonlinear, with an apparent half-life averaging 22 hours. Fosphenytoin, a prodrug of phenytoin for intravenous use, is converted to phenytoin after injection, with a conversion half-life of 8-32 minutes. 

BZDs such as chlordiazepoxide (Librium) or diazepam (Valium) may be prescribed to treat anxiety, seizures, acute stress reactions, and panic attacks, or to alleviate the side effects of drug or alcohol withdrawal. Those BZDs with a more sedating effect, such as estazo-lam (ProSom) or triazolam (Halcion), may be prescribed for short-term treatment of sleep disorders. However, the newer generation of non-BZD agents—zolpidem (Ambi-en) and (Sonata)—are less potentially addictive hypnotic drugs than the BZDs. 

Drug of choice in absence seizures Is established to be teratogenic in humans Life-threatening skin disorders may occur Visual field defects occur in up to one-third of patients Withdrawal of antiseizure drugs can cause increased seizure frequency and severity. Withdrawal is least likely to be a problem with (A) Clonazepam Diazepam Ethosuximide Phenobarbital Phenytoin... 

THE DRUG SHOWN HERE IS DIAZEPAM, better known as Valium. It is commonly prescribed for a wide range of disorders, including anxiety, insomnia, seizures, muscle spasms, restless legs syndrome, and obsessive-compulsive disorder. Valium was invented by Leo Sternbach at Hoffmann-LaRoche Pharmaceuticals and first licensed for use in 1960. 

---