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Pharmacotherapy Overview of Seizure Management in the Adult Emergency Department

Departments of Pharmacy Services and Emergency Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, uidrees1{at}jhmi.edu

Michael Londner, MD, MPH, MBA

Department of Emergency Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland

Seizures are a common cause of emergency department visits, and approximately 28% of epilepsy patients present to an emergency department annually for treatment. This article will provide an overview of the pharmacotherapeutic management of seizures and anticonvulsant therapy for patients who present to the adult emergency department, including practical information for pharmacists covering or cross-covering this practice area. The benzodiazepines are reviewed as a class, including dosing strategies, pharmacodynamic considerations, and advantages and disadvantages of lorazepam, diazepam, and midazolam. Indications for the use of phenytoin and fosphenytoin will be reviewed, as well as dosing, adverse effects, and cost-effectiveness data. In addition, dosing, administration, pharmacokinetics, and adverse effects of phenobarbital, carbamazepine, and valproate will be discussed. Clinical indications for serum anticonvulsant concentration monitoring and subsequent calculation of loading doses from serum concentrations are reviewed. Since status epilepticus is a life-threatening emergency, its therapeutic management is reviewed, including the use of continuous infusion midazolam, pentobarbital, and propofol. There are many opportunities for clinical pharmacists to collaborate with other members of the health care team to optimize efficacy and minimize adverse effects of anticonvulsant agents in the emergency department setting.

Key Words: Status epilepticus • seizure • anticonvulsant • pharmacology • emergency department • phenytoin • loading dose

Journal of Pharmacy Practice, Vol. 18, No. 5, 394-411 (2005)
DOI: 10.1177/0897190005280050


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