Tratamiento anticonvulsivante en Pediatrνa

Septiembre 2008


Fuente : Johns Hopkins:  The Harriet Lane Handbook, 18th ed. - 2008 - Mosby, An Imprint of Elsevier





Benzodiazepine; anxiolytic, anticonvulsant

Sedative/muscle relaxant:

Status epilepticus:


Hypotension and respiratory depression may occur. Use with caution in hepatic and renal dysfunction, glaucoma, shock, and depression. Do not use in combination with protease inhibitors. Concurrent use with CNS depressants, cimetidine, erythromycin, itraconazole, and valproic acid may enhance the effects of diazepam. Diazepam is a substrate for CYP 450 2B6, 2 C8, 2 C9, and 3A5–7; and minor substrate and inhibitor for CYP 450 2 C19 and 3A3/4. The active desmethyldiazepam metabolite is a CYP 450 2 C19 substrate.


Administer the conventional IV product undiluted no faster than 2 mg/min. Do not mix with IV fluids.


In status epilepticus, diazepam must be followed by long-acting anticonvulsants. Onset of anticonvulsant effect: 1–3 min with IV route; 2–10 min with rectal route.


For management of status epilepticus, see Chapter 1 , Table 1-5. For additional information, see Chapter 20 , Table 20-7 .





Various generics; previously available as Versed



Injection: 1, 5 mg/mL; some preparations may contain 1% benzyl alcohol

Oral syrup: 2 mg/mL; contains sodium benzoate

Titrate to effect under controlled conditions.


See Chapter 6 for additional routes of administration.


Sedation for procedures:


Sedation with mechanical ventilation:


Refractory status epilepticus:

Contraindicated in patients with narrow-angle glaucoma and shock. Use with caution in CHF, renal impairment (adjust dose; see Chapter 31 ), pulmonary disease, hepatic dysfunction, and in neonates. Causes respiratory depression, hypotension and bradycardia. Cardiovascular monitoring is recommended. Use lower doses or reduce dose when given in combination with narcotics or in patients with respiratory compromise.


Drug is a substrate for CYP 450 3A4. Serum concentrations may be increased by cimetidine, clarithromycin, diltiazem, erythromycin, itraconazole, ketoconazole, and protease inhibitors. Sedative effects may be antagonized by theophylline. Effects can be reversed by flumazenil. For pharmacodynamic information, see Chapter 6 .