{ "schema_version": 1, "kind": "condition", "id": "seizure-first-aid", "name": "Acute seizure first aid & status epilepticus initial stabilization", "category": "chronic", "sources": "Egyptian National Drug Formulary - Nervous System Disorders 2025 · Buccolam 10 mg oromucosal solution SmPC section 4.2 (eMC product 7460) · Egyptian National Drug Formulary - Nervous System 2025 (levetiracetam monograph) · Egyptian National Drug Formulary - Nervous System 2025 (phenytoin monograph) · Wylie T, Sandhu DS, Murr NI. Status Epilepticus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Nervous System Disorders 2025 · Buccolam 10 mg oromucosal solution SmPC section 4.2 (eMC product 7460) · Egyptian National Drug Formulary - Nervous System 2025 (levetiracetam monograph) · Egyptian National Drug Formulary - Nervous System 2025 (phenytoin monograph) · Wylie T, Sandhu DS, Murr NI. Status Epilepticus. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan-.", "verified_date": "2026-08", "treatments": [ { "id": 1610, "generic": "Diazepam", "line": 1, "is_adjunct": false, "form": "rectal", "strength_mg": 10.0, "adult_dose": "5 to 10 mg IV (slow injection) or IM initially; may repeat at 10 to 15-minute intervals up to max 30 mg", "adult_duration": "single dose", "dose_source": "Egyptian National Drug Formulary - Nervous System Disorders 2025", "rationale": "Diazepam is a benzodiazepine that enhances GABA-A mediated inhibition in the brain to terminate an ongoing seizure; the rectal route allows rapid administration outside hospital while emergency transport is arranged for a seizure that will not stop.", "cautions": [ "Monitor airway, breathing, and oxygen saturation closely (risk of respiratory depression).", "Ensure emergency medical transport/hospital referral if seizure lasts >5 minutes.", "Sedation and muscle weakness occur post-dose." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "0.2-0.4 mg/kg IV; second dose may be given after 10 minutes if required (max 10 mg/dose)", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "EPIVAL 10MG/2ML 3 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 15.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "NEURIL 10MG/2ML 5 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 40.0, "pack_count": null, "unit_price": null, "strength_mg": 10.0, "exact_strength": true, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "seizure-first-aid" }, { "id": 1611, "generic": "Midazolam", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 10.0, "adult_dose": "10 mg oromucosal (buccal) as a single dose", "adult_duration": "single dose", "dose_source": "Buccolam 10 mg oromucosal solution SmPC section 4.2 (eMC product 7460)", "rationale": "Rapid non-intravenous benzodiazepine alternative for acute seizure control", "cautions": [ "High risk of respiratory depression; resuscitation equipment must be accessible.", "A carer gives ONE dose. If the seizure has not stopped ten minutes later, that is a call for an ambulance, not a second dose - a second dose needs medical advice first.", "Insert it slowly into the pocket between gum and cheek. If the volume is large for the child, half into one side, then half into the other." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Buccal, by age band: 3-6 months 2.5 mg (hospital only), over 6 months to 1 year 2.5 mg, 1 to under 5 years 5 mg, 5 to under 10 years 7.5 mg, 10 years and over 10 mg.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": 3.0, "peds_age_max_months": null, "peds_age_bands": [ { "label": "3 to 6 months", "age_min_months": 3, "age_max_months": 6, "dose_text": "2.5 mg buccally - in hospital only at this age" }, { "label": "Over 6 months to 1 year", "age_min_months": 7, "age_max_months": 11, "dose_text": "2.5 mg buccally" }, { "label": "1 to under 5 years", "age_min_months": 12, "age_max_months": 59, "dose_text": "5 mg buccally" }, { "label": "5 to under 10 years", "age_min_months": 60, "age_max_months": 119, "dose_text": "7.5 mg buccally" }, { "label": "10 years and over", "age_min_months": 120, "age_max_months": 216, "dose_text": "10 mg buccally" } ], "peds_doses": null, "brands": [ { "trade_name": "MIDAZOLAM 5MG/ML 5 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SUNNY MEDICAL", "price_egp": 42.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MIDAZOLAM 15MG/3ML 5 AMP.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SUNNY MEDICAL", "price_egp": 62.5, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DORMICUM 5MG 10 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "F.HOFFMAN LA ROCHE > EGYPTIAN PHARMACEUTICAL TRADING COMPANY", "price_egp": 83.5, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MIDATHETIC 15MG/3ML 3 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 84.0, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "DORMICUM 15 MG 5 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "F.HOFFMAN LA ROCHE > EGYPTIAN PHARMACEUTICAL TRADING COMPANY", "price_egp": 88.5, "pack_count": null, "unit_price": null, "strength_mg": 15.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "MIDATHETIC 5MG/ML 10 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AMOUN", "price_egp": 140.0, "pack_count": null, "unit_price": null, "strength_mg": 5.0, "exact_strength": false, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "seizure-first-aid" }, { "id": 1612, "generic": "Levetiracetam", "line": 2, "is_adjunct": false, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "Adults 16 years and over: 250-500 mg twice daily, increased by 250-500 mg twice daily at 2-week intervals to a usual 1000-1500 mg twice daily", "adult_duration": "Long-term; when stopping, withdraw gradually using the same step sizes as at initiation", "dose_source": "Egyptian National Drug Formulary - Nervous System 2025 (levetiracetam monograph)", "rationale": "67 live products - the largest genuinely therapeutic orphan after esomeprazole. This is the drug the patient is continued on after the acute seizure has been stopped, and there is no chronic epilepsy condition in the dataset for it to attach to.", "cautions": [ "The emergency drugs in this condition are the benzodiazepines; levetiracetam is the agent given afterwards to prevent recurrence.", "The intravenous LOADING dose used for established status epilepticus is deliberately not stated here. NICE NG217 7.1.9 names levetiracetam as a second-line IV option in convulsive status epilepticus not responding to 2 doses of a benzodiazepine, but states no mg figure in that recommendation; NG217 also records that in April 2022 this was an off-label use of levetiracetam. Look up a dose before giving intravenous levetiracetam.", "Behavioural and mood effects are common and dose-related: irritability, aggression, agitation, depression and, rarely, suicidal ideation. Ask the family, not just the patient.", "Reduce the dose in renal impairment - 500-1000 mg twice daily at CrCl 50-79, 250-750 mg twice daily at 30-49, 250-500 mg twice daily below 30, and 500-1000 mg once daily on dialysis with a 250-500 mg supplement after each session.", "Do not stop abruptly - withdrawal seizures.", "The intravenous route is only for when oral administration is temporarily not feasible." ], "peds_mgkg_low": 10.0, "peds_mgkg_high": 30.0, "peds_max_mg": 1500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "The 10-30 mg/kg/dose above is the 4-to-under-16 band. Younger children start lower - read the band you need. 4 to under 16 years: 10 mg/kg twice daily, increased by 10 mg/kg twice daily every 2 weeks to 30 mg/kg twice daily. 6 months to under 4 years: 10 mg/kg twice daily up to 25 mg/kg twice daily. 1 to under 6 months: 7 mg/kg twice daily up to 21 mg/kg twice daily. Syrup 100 mg/mL. Reduce in renal impairment per the formulary table.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": [ { "label": "1 to under 6 months", "age_min_months": 1, "age_max_months": 5, "dose_text": "7 mg/kg twice daily, up to 21 mg/kg twice daily" }, { "label": "6 months to under 4 years", "age_min_months": 6, "age_max_months": 47, "dose_text": "10 mg/kg twice daily, up to 25 mg/kg twice daily" }, { "label": "4 to under 16 years", "age_min_months": 48, "age_max_months": 191, "dose_text": "10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily" } ], "peds_doses": [ { "weight_kg": 10, "low_mg": 100, "high_mg": 300, "capped": false }, { "weight_kg": 20, "low_mg": 200, "high_mg": 600, "capped": false }, { "weight_kg": 30, "low_mg": 300, "high_mg": 900, "capped": false }, { "weight_kg": 40, "low_mg": 400, "high_mg": 1200, "capped": false } ], "brands": [ { "trade_name": "KEPILEPSY 500MG 10 F.C.TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 34.0, "pack_count": 10, "unit_price": 3.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LEVNOSEIZ 500 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "GYPTO PHARMA", "price_egp": 120.0, "pack_count": 30, "unit_price": 4.0, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRINOVUME 500MG 10 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SIGMA > HOCHSTER PHARMACEUTICAL INDUSTRIES", "price_egp": 40.0, "pack_count": 10, "unit_price": 4.0, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SUNSEIZ 500 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SUN PHARMA EGYPT LIMITED", "price_egp": 171.0, "pack_count": 30, "unit_price": 5.7, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "LIPTITAM XR 500 MG 20 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ORGANOPHARMA > ORGANO", "price_egp": 148.0, "pack_count": 20, "unit_price": 7.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TIRATAM 500 MG 30 F.C.TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ANDALOUS PHARMA", "price_egp": 222.0, "pack_count": 30, "unit_price": 7.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "SPRIALYPSY 500 MG 30 ORAL DISINTEGRATING TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MASH PREMIERE > SAS PHARMA", "price_egp": 138.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KEPRADIL XR 500MG 30 EXTENDED F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "HIKMA PHARMA", "price_egp": 201.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "KEPILEPSY 10GM/100ML ORAL SOLN. 120 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 10000.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "LEVEPEX 100MG/ML SYRUP 100ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "APEX PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 100.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "seizure-first-aid" }, { "id": 1613, "generic": "Phenytoin", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 250.0, "adult_dose": "Status epilepticus: intravenous loading dose 10-15 mg/kg given slowly at a rate not exceeding 50 mg/minute (50 mg over 2-3 minutes in an elderly patient with heart disease); then maintenance 100 mg intravenously or orally every 6-8 hours", "adult_duration": "Single loading dose, then maintenance until the patient is stabilised and transferred", "dose_source": "Egyptian National Drug Formulary - Nervous System 2025 (phenytoin monograph)", "rationale": "18 live products. Control of status epilepticus of the tonic-clonic type is the formulary's first listed parenteral indication, with an explicit loading dose and infusion rate - which is exactly what this condition covers and what the benzodiazepine rows do not.", "cautions": [ "This is a hospital drug. A GP's role in status epilepticus is a benzodiazepine, airway and glucose, and immediate transfer.", "Continuous ECG and blood pressure monitoring is mandatory during intravenous loading - hypotension and arrhythmia follow infusion that is too fast.", "CONTRAINDICATED (injection) in sinus bradycardia, sinoatrial block, second- and third-degree heart block and Adams-Stokes syndrome.", "Never give intramuscularly for status epilepticus - absorption is slow and erratic and it causes local toxicity.", "Never mix with glucose-containing solutions - phenytoin precipitates.", "Zero-order kinetics and a very narrow window: a small dose increase can tip a patient into toxicity (nystagmus, ataxia, slurred speech).", "Not effective in absence seizures and may worsen them.", "Converting oral to intramuscular requires a 50% dose increase; converting back requires a 50% decrease for the same number of days." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Neonates, infants and children: intravenous loading dose 15-20 mg/kg slowly at 1-3 mg/kg/minute or 50 mg/minute, whichever is slower, with continuous ECG, blood pressure and respiratory monitoring. The monograph states no paediatric maximum for the loading dose, so the numeric fields are left null rather than invented. Oral maintenance in children is 4-8 mg/kg/day in divided doses, maximum 300 mg daily. Caution from propylene glycol under 1 year.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "PHENTOLEPT 250MG/5ML 5 AMP. FOR I.M. & SLOW I.V.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "ALEXANDRIA > EGYPHARMA-EGYPT", "price_egp": 37.5, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "EPILOG 250MG/5ML 10 AMP. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PHENYTIN 250MG/5ML 10 AMPS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EL NILE.", "price_egp": 110.0, "pack_count": null, "unit_price": null, "strength_mg": 250.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "seizure-first-aid" } ] }