What are ‘as needed’ or rescue medicines or treatments?
"As needed" medicines are medicines or treatments that are given only if needed for specific situations. Some people also call them "rescue treatments."
- They generally start working in the brain quickly and can be used as a form of ‘rescue’ from seizure activity. In other words, they provide a way to stop seizures quickly to prevent emergency situations.
- A person who has an implanted vagus nerve stimulator can use a magnet to swipe over the VNS generator at the time of the seizure. This is a type of rescue treatment.
- Other times, medicines are prescribed as rescue treatments. They do NOT take the place of daily seizure medicines. They are prescribed for people who are also taking daily seizure medicine, by a doctor (or other prescribing health care professional).
- When ‘as needed’ medicines are prescribed for use outside of a hospital, the intent is to stop seizures before an emergency develops. Hopefully this will prevent you from needing an emergency room. However, rescue medicines do NOT take the place of emergency medical care. If a true medical emergency develops, emergency medical help should be obtained right away.
When can rescue medicines be used?
Since seizure emergencies are not common, most people with epilepsy will not need to use any treatment other than their daily amount of seizure medicine. However, sometimes seizures occur in different patterns or more often than normal. Stopping seizures early in these situations is the key to preventing a seizure emergency.
- When to use a rescue medicine may be different for each person. You need to know your typical type and pattern of seizures, and be able to recognize when seizures are occurring that are not typical for you.
- As part of being prepared, ask your health care provider if ‘as needed’ medicines are right for you and specifically when they should be used.
General situations when rescue medicines may be recommended:
- Seizures occur that are different than your usual type or pattern.
- Seizures that last longer than typical events.
- Seizure clusters that are different than usual – for example when more occur than normal or in a shorter period of time.
- Breakthrough seizures occur at high-risk times – for example during medicine changes or when sick.
What types of medicines can be used as a rescue treatment?
The most common type of rescue medicines 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. They are only given by an injection directly into the blood stream vein 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 can use the rectal form of diazepam. This is most often prescribed for children.
- Understanding Seizures and Emergencies
- Responding to Seizures
- Nasal Therapy for Seizure Emergencies
- New Research for Treatment of Seizure Emergencies
- Six Questions to Help Decide Whether Your Child Should Have Acute Rescue Medications for Breakthrough Seizures in the Community
- Innovations in Epilepsy Medicine