Emergency Treatment of Seizures: Lorazepam and Diazepam Dosing

Initial Benzodiazepine Selection and Dosing

The American Academy of Pediatrics recommends an initial dose of lorazepam (Ativan) of 0.05-0.10 mg/kg IV/IM (maximum 4 mg per dose) for emergency treatment of seizures 1
The American Academy of Pediatrics recommends an initial dose of diazepam (Valium) of 0.1-0.3 mg/kg IV (maximum 10 mg per dose) for emergency treatment of seizures 2
Lorazepam may be repeated every 10-15 minutes if needed for continued seizures 1
Diazepam should be administered IV over approximately 2 minutes to avoid pain at the injection site 2
Rectal diazepam can be used when IV access is unavailable, at a dose of 0.5 mg/kg up to 20 mg 2

IV administration of lorazepam should be slow to minimize respiratory depression 1
IV diazepam should be administered slowly (over ~2 minutes) to avoid pain at the injection site 2
Rapid IV administration of diazepam may precipitate seizures 2

Diazepam should be followed immediately by a long-acting anticonvulsant (such as phenytoin/fosphenytoin) due to its short duration of action 2

Monitor oxygen saturation and respiratory effort closely with both medications 1, 2
Be prepared to provide respiratory support, as both drugs can cause apnea 1, 2
There is an increased risk of respiratory depression when benzodiazepines are combined with other sedative agents 1, 2
Flumazenil may be administered to reverse life-threatening respiratory depression, but will also counteract the anticonvulsant effects and may precipitate seizures 1, 2

Elderly patients require dose reduction (0.05-0.1 mg/kg for lorazepam) due to decreased drug metabolism and higher risk of respiratory depression 3
Paradoxical excitement or agitation may occur, especially in younger children 1, 2

Failure to prepare for potential respiratory depression, especially when combining with other sedatives 1, 2
Not following lorazepam with a long-acting anticonvulsant when treating status epilepticus 2
Administering diazepam IM (should be avoided due to tissue necrosis risk) 2
Not monitoring vital signs closely, particularly respiratory rate and oxygen saturation 3