UMEM Educational Pearls

Category: Toxicology

Title: IM Midazolam vs IV Lorazepam for Seizure Pre-Hospital

Keywords: midazolam, lorazepam (PubMed Search)

Posted: 2/23/2012 by Fermin Barrueto, MD (Updated: 7/12/2024)
Click here to contact Fermin Barrueto, MD

You have seen the study comparing diazepam to lorazepam IV for the cessation of seizures. Lorazepam one that one. Now, for prehospital status epilepticus midazolam IM went head to head with IV lorazepam to see which would stop seizure more quickly.

This study was more about the practicality of starting an IV than it was of the pharmacokinetics or onset of action of a particular benzodiazepine. It was a large enough study to warrant publication in New Engl J Med last month and is worth noting.

Subjects whose seizures ceased before ED arrival (median):

Time to active treatment: 1.2 min IM Midazolam group;  4.8 min IV Lorazepam group

Median times active treatment to cessation of SZ:  3.3 min IM Midazolam and 1.6 min IV Lorazepam

Safety was equal in both groups. This study validates EMS initiating therapy with IM midazolam for the cessation of seizures while intravenous access is being attempted. 






Intramuscular versus intravenous therapy for prehospital status epilepticus.

Silbergleit R, Durkalski V, Lowenstein D, Conwit R, Pancioli A, Palesch Y, Barsan W; NETT Investigators.

N Engl J Med. 2012 Feb 16;366(7):591-600.