The type of medicines used most commonly for ‘as needed’ treatment are from a group of medicines called benzodiazepines. These are generally fast-acting, which means they will start to work quickly once they get into the bloodstream. Some benzodiazepines can be swallowed in pill form, some can be placed under the tongue or placed between the cheek and the gum, and some can be given rectally or by a nasal spray. Giving them intravenously by an injection into a muscle or vein is only done in hospital settings.

The names of benzodiazepines that are most commonly used as rescue medications include: diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®). The availability of these medicines in different forms and how they are used may vary from country to country. In the United States, only rectal diazepam gel, commonly known by the brand name Diastat®, has been approved by the Food and Drug Administration (FDA) for out-of-hospital use for the treatment of acute repetitive seizures or clusters. The other ones have been used in out-of-hospital treatment but have not yet been approved by the FDA.

The main points to consider in using these medicines is how fast they will act, what forms may be available, who can give it, and how easy it may be to use. Other factors such as cost, possible side effects, and everyone’s comfort level in using the medicines must be talked about with your doctor.

People who may need a fast-acting medicine at specific times for breakthrough seizures and who are alert and able to swallow may use one of the pill forms of lorazepam or diazepam. People who are not able to swallow for some reason may be given a form that can be given under the tongue (sublingual), between the cheek and gum (buccally), or sprayed into a nostril (nasal spray). People who are not able to take an oral form of benzodiazepine can use the rectal form. This is most often prescribed for children.

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Topic Editor: Steven C. Schachter, MD and Patricia O. Shafer, RN, MN.
Last Reviewed:5/25/07