Intramuscular Midazolam As Safe As Intravenous Lorazepam

Safe, effective for treatment of seizures when administered by paramedics en route to hospital

WEDNESDAY, Feb. 15 (HealthDay News) -- Intramuscular midazolam is as safe and effective as intravenous lorazepam for treatment of patients with seizures by paramedics, according to a study published in the Feb. 16 issue of the New England Journal of Medicine.

Robert Silbergleit, M.D., from the University of Michigan in Ann Arbor, and colleagues conducted a double-blind, randomized, noninferiority study of children and adults treated by paramedics for status epilepticus. Intramuscular autoinjector or intravenous infusion was used to treat subjects whose convulsions had persisted for more than five minutes and who were still convulsing after paramedics arrived. Intramuscular midazolam was defined as noninferior to intravenous lorazepam with a margin of 10 percentage points.

The researchers found that seizures were absent without rescue therapy in 73.4 percent of the intramuscular-midazolam group and 63.4 percent in the intravenous-lorazepam group at the time of arrival in the emergency department (absolute difference, 10 percentage points; P < 0.001 for noninferiority and superiority). The need for endotracheal intubation and recurrence of seizures was similar in the two treatment groups. Among individuals whose seizures stopped before arrival in the emergency department, the median times to active treatment were 1.2 and 4.8 minutes in the intramuscular-midazolam and intravenous-lorazepam groups, respectively, with corresponding median times from active treatment to cessation of convulsions of 3.3 and 1.6 minutes. The rates of adverse events were similar in the two groups.

"For subjects in status epilepticus, intramuscular midazolam is at least as safe and effective as intravenous lorazepam for prehospital seizure cessation," the authors write.

One study author disclosed financial relationships with Upsher Smith Laboratories and the NeuroVista Corporation. The editorial author disclosed financial ties to the pharmaceutical industry.

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