A systematic review published in Epilepsy & Behavior did not find evidence strong enough to support the preferred use of intravenous (IV) lorazepam over IV diazepam as first-line treatment of convulsive status epilepticus.
According to some expert consensus or guidelines, IV lorazepam is preferred over IV diazepam for the initial treatment of convulsive status epilepticus. Study authors assessed all the existing data on efficacy and tolerability of IV lorazepam vs. IV diazepam as first-line treatment of convulsive status epilepticus. They searched various databases to find randomized controlled trials comparing the two agents used as first-line treatment for generalized or focal convulsive status epilepticus. Review outcomes included seizure cessation after drug administration, continuation of status epilepticus requiring a different medication, seizure cessation after a single dose, the need for ventilator support, and clinically relevant hypotension.
A total of 656 patients identified in five trials were included for the analysis; 320 patients were randomized to IV lorazepam and 336 to IV diazepam. No statistically significant differences were found between IV lorazepam and IV diazepam for clinical seizure cessation (risk ratio [RR] 1.09, 95% CI: 1.00–1.20), continuation of status epilepticus requiring a different medication (RR 0.76, 95% CI: 0.57–1.02), seizure cessation after a single dose (RR 0.96, 95% CI: 0.85–1.85), need for ventilator support (RR 0.93, 95% CI: 0.61–1.43), and clinically relevant hypotension.
The authors concluded that although IV lorazepam demonstrates a favorable pharmacokinetic profile, the literature review did not show evidence to fully support its use over IV diazepam as initial treatment of convulsive status epilepticus.
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