First-line drug treatment for status epilepticus after establishing airway protection?

• A. IV diazepam
• B. IV phenytoin
• C. IV valproic acid
• D. IV lorazepam

Answer: (D)

Termination of ongoing seizures must happen quickly after airway protection, so a benzodiazepine given IV is chosen first. IV lorazepam is preferred because it provides rapid seizure inhibition and, unlike some other benzodiazepines, has a longer duration of action in the CNS. Its effects stay active longer, reducing the chance that seizures recur while agents are given to prevent further activity. Diazepam also works fast but is redistributed into body fat, leading to a shorter anticonvulsant window and a higher chance of seizure return before additional therapy takes effect. Phenytoin and valproic acid can help prevent rebound seizures and support longer-term control, but they don’t stop an active seizure as quickly as a benzodiazepine and carry risks such as hypotension with phenytoin or hepatotoxicity with valproate. So, the best first-line choice after airway protection is IV lorazepam.