# Acute seizure first aid & status epilepticus initial stabilization - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - 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-. - Verified date: 2026-08 ## 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-. ## Treatment metadata - Diazepam — 10 mg — rectal - Midazolam — 10 mg — injection - Levetiracetam — 500 mg — oral.solid - Phenytoin — 250 mg — injection ## Complete treatment card ```text ACUTE SEIZURE FIRST AID & STATUS EPILEPTICUS INITIAL STABILIZATION 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 against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (2) - Status epilepticus means 5 minutes or more of continuous seizure activity, clinical or on the EEG [seizures · status epilepticus] - Seizures coming one after another with no recovery in between count the same way [seizures] SIGNS - what you find (4) - The convulsive form: generalised tonic-clonic movement of the limbs, with consciousness impaired - After it stops, a temporary one-sided deficit such as Todd paralysis may be found [paralysis] - The non-convulsive form: consciousness impaired, with at most subtle motor signs such as the eyes held deviated - In that form the EEG shows seizure activity even though there is little or nothing to see at the bedside [seizures] TESTS (9) - The convulsive diagnosis is made at the bedside, but urgent brain imaging and bloods are still needed to find the cause - A head CT fits most situations and is the easiest scan to get - Brain MRI finds malformations better in children, but is harder to arrange and may need sedation - Bloods: bedside glucose, sodium, potassium, calcium and magnesium, urea, creatinine, bicarbonate, a full blood count, and a lumbar puncture for CSF - Where epilepsy is already known, measure the antiepileptic drug levels - Suspected poisoning means toxicology: a urine screen, plus blood levels of the drug in question, theophylline or lithium for instance - Depending on the picture add liver function, tests for inborn errors of metabolism, and clotting studies - Do a pregnancy test in every woman who could be pregnant - Get an EEG; the non-convulsive form needs EEG monitoring to be diagnosed at all, on top of the same imaging and bloods IF NOT THIS - what else fits (6) - Acute poisoning or intoxication - Severe early oxygen starvation of the brain - Encephalopathy from a toxin or a metabolic upset - Ischaemic stroke - Non-epileptic seizures - Head injury Source StatPearls "Status Epilepticus" - disease-level clinical article Status traced to the source above 1. DIAZEPAM [1st line] Adult 5 to 10 mg IV (slow injection) or IM initially; may repeat at 10 to 15-minute intervals up to max 30 mg - single dose Peds 0.2-0.4 mg/kg IV; second dose may be given after 10 minutes if required (max 10 mg/dose) Source Egyptian National Drug Formulary - Nervous System Disorders 2025 Why 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. Caution 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. Egypt EPIVAL 10MG/2ML 3 AMP. EIPICO 15.00 EGP -> ? different route - not rectal NEURIL 10MG/2ML 5 AMP. MEMPHIS 40.00 EGP -> ? different route - not rectal 2. MIDAZOLAM [1st line] Adult 10 mg oromucosal (buccal) as a single dose - single dose Peds Age restriction: minimum 3 months 3 to 6 months: 2.5 mg buccally - in hospital only at this age Over 6 months to 1 year: 2.5 mg buccally 1 to under 5 years: 5 mg buccally 5 to under 10 years: 7.5 mg buccally 10 years and over: 10 mg buccally (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.) Choice Alternatives by route. Buccal or intranasal midazolam is the out-of-hospital standard and Egypt stocks 6 products against 2 for diazepam. Source Buccolam 10 mg oromucosal solution SmPC section 4.2 (eMC product 7460) Why Rapid non-intravenous benzodiazepine alternative for acute seizure control Caution 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. Egypt MIDAZOLAM 5MG/ML 5 AMP. SUNNY MEDICAL 42.50 EGP [? strength differs] MIDAZOLAM 15MG/3ML 5 AMP. SUNNY MEDICAL 62.50 EGP [? strength differs] DORMICUM 5MG 10 AMPS. F.HOFFMAN LA ... 83.50 EGP [? strength differs] MIDATHETIC 15MG/3ML 3 AMPS. AMOUN 84.00 EGP [? strength differs] DORMICUM 15 MG 5 AMPS. F.HOFFMAN LA ... 88.50 EGP [? strength differs] MIDATHETIC 5MG/ML 10 AMPS. AMOUN 140.00 EGP [? strength differs] 3. LEVETIRACETAM [2nd line] Adult 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 - Long-term; when stopping, withdraw gradually using the same step sizes as at initiation Peds 10-30 mg/kg/dose [child max 1500 mg] (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.) 1 to under 6 months: 7 mg/kg twice daily, up to 21 mg/kg twice daily 6 months to under 4 years: 10 mg/kg twice daily, up to 25 mg/kg twice daily 4 to under 16 years: 10 mg/kg twice daily, increased every 2 weeks to 30 mg/kg twice daily 3kg -> 30-90 mg/dose 4kg -> 40-120 mg/dose 5kg -> 50-150 mg/dose 6kg -> 60-180 mg/dose 7kg -> 70-210 mg/dose 8kg -> 80-240 mg/dose 9kg -> 90-270 mg/dose 10kg -> 100-300 mg/dose 11kg -> 110-330 mg/dose 12kg -> 120-360 mg/dose 13kg -> 130-390 mg/dose 14kg -> 140-420 mg/dose 15kg -> 150-450 mg/dose 16kg -> 160-480 mg/dose 17kg -> 170-510 mg/dose 18kg -> 180-540 mg/dose 19kg -> 190-570 mg/dose 20kg -> 200-600 mg/dose 21kg -> 210-630 mg/dose 22kg -> 220-660 mg/dose 23kg -> 230-690 mg/dose 24kg -> 240-720 mg/dose 25kg -> 250-750 mg/dose 26kg -> 260-780 mg/dose 27kg -> 270-810 mg/dose 28kg -> 280-840 mg/dose 29kg -> 290-870 mg/dose 30kg -> 300-900 mg/dose 31kg -> 310-930 mg/dose 32kg -> 320-960 mg/dose 33kg -> 330-990 mg/dose 34kg -> 340-1020 mg/dose 35kg -> 350-1050 mg/dose 36kg -> 360-1080 mg/dose 37kg -> 370-1110 mg/dose 38kg -> 380-1140 mg/dose 39kg -> 390-1170 mg/dose 40kg -> 400-1200 mg/dose 41kg -> 410-1230 mg/dose 42kg -> 420-1260 mg/dose 43kg -> 430-1290 mg/dose 44kg -> 440-1320 mg/dose 45kg -> 450-1350 mg/dose 46kg -> 460-1380 mg/dose 47kg -> 470-1410 mg/dose 48kg -> 480-1440 mg/dose 49kg -> 490-1470 mg/dose 50kg -> 500-1500 mg/dose Choice Alternatives. Levetiracetam needs no cardiac monitoring and has far fewer interactions than phenytoin; the ESETT trial found no difference in seizure termination. Source Egyptian National Drug Formulary - Nervous System 2025 (levetiracetam monograph) Why 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. Caution 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. Egypt KEPILEPSY 500MG 10 F.C.TAB. CHEMIPHARM 34.00 EGP (3.40/unit) LEVNOSEIZ 500 MG 30 F.C.TABS. GYPTO PHARMA 120.00 EGP (4.00/unit) TRINOVUME 500MG 10 F.C. TABS. SIGMA > HOCHS... 40.00 EGP (4.00/unit) SUNSEIZ 500 MG 30 F.C.TABS. SUN PHARMA EG... 171.00 EGP (5.70/unit) LIPTITAM XR 500 MG 20 F.C.TABS. ORGANOPHARMA ... 148.00 EGP (7.40/unit) TIRATAM 500 MG 30 F.C.TABS. ANDALOUS PHARMA 222.00 EGP (7.40/unit) SPRIALYPSY 500 MG 30 ORAL DISINTEGRATING TABS. MASH PREMIERE > SAS PHARMA 138.00 EGP KEPRADIL XR 500MG 30 EXTENDED F.C. TABS. HIKMA PHARMA 201.00 EGP KEPILEPSY 10GM/100ML ORAL SOLN. 120 ML CHEMIPHARM 48.00 EGP -> ? strength differs, ? different route - not oral solid LEVEPEX 100MG/ML SYRUP 100ML APEX PHARMA 50.00 EGP -> ? strength differs, ? different route - not oral solid 4. PHENYTOIN [2nd line] Adult 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 - Single loading dose, then maintenance until the patient is stabilised and transferred Peds 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. Source Egyptian National Drug Formulary - Nervous System 2025 (phenytoin monograph) Why 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. Caution 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. Egypt PHENTOLEPT 250MG/5ML 5 AMP. FOR I.M. & SLOW I.V. ALEXANDRIA > EGYPHARMA-... 37.50 EGP EPILOG 250MG/5ML 10 AMP. FOR I.V. INJ. MUP 50.00 EGP PHENYTIN 250MG/5ML 10 AMPS. EL NILE. 110.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)