Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability

Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZD...

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Veröffentlicht in:CNS drugs Jg. 36; H. 9; S. 951 - 975
Hauptverfasser: Kienitz, Ricardo, Kay, Lara, Beuchat, Isabelle, Gelhard, Sarah, von Brauchitsch, Sophie, Mann, Catrin, Lucaciu, Alexandra, Schäfer, Jan-Hendrik, Siebenbrodt, Kai, Zöllner, Johann-Philipp, Schubert-Bast, Susanne, Rosenow, Felix, Strzelczyk, Adam, Willems, Laurent M.
Format: Journal Article
Sprache:Englisch
Veröffentlicht: Cham Springer International Publishing 01.09.2022
Springer Nature B.V
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ISSN:1172-7047, 1179-1934, 1179-1934
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Abstract Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA) A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs—such as intranasal administration—have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE. Graphical Abstract
AbstractList Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA)A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA)A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.
Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA) receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.
Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA) A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs—such as intranasal administration—have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE. Graphical Abstract
Status epilepticus (SE) is an acute, life-threatening medical condition that requires immediate, effective therapy. Therefore, the acute care of prolonged seizures and SE is a constant challenge for healthcare professionals, in both the pre-hospital and the in-hospital settings. Benzodiazepines (BZDs) are the first-line treatment for SE worldwide due to their efficacy, tolerability, and rapid onset of action. Although all BZDs act as allosteric modulators at the inhibitory gamma-aminobutyric acid (GABA)A receptor, the individual agents have different efficacy profiles and pharmacokinetic and pharmacodynamic properties, some of which differ significantly. The conventional BZDs clonazepam, diazepam, lorazepam and midazolam differ mainly in their durations of action and available routes of administration. In addition to the common intravenous, intramuscular and rectal administrations that have long been established in the acute treatment of SE, other administration routes for BZDs-such as intranasal administration-have been developed in recent years, with some preparations already commercially available. Most recently, the intrapulmonary administration of BZDs via an inhaler has been investigated. This narrative review provides an overview of the current knowledge on the efficacy and tolerability of different BZDs, with a focus on different routes of administration and therapeutic specificities for different patient groups, and offers an outlook on potential future drug developments for the treatment of prolonged seizures and SE.
Author Gelhard, Sarah
Mann, Catrin
Rosenow, Felix
Zöllner, Johann-Philipp
Willems, Laurent M.
Schäfer, Jan-Hendrik
Siebenbrodt, Kai
Beuchat, Isabelle
Kienitz, Ricardo
Kay, Lara
von Brauchitsch, Sophie
Schubert-Bast, Susanne
Strzelczyk, Adam
Lucaciu, Alexandra
Author_xml – sequence: 1
  givenname: Ricardo
  orcidid: 0000-0003-2328-3413
  surname: Kienitz
  fullname: Kienitz, Ricardo
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 2
  givenname: Lara
  surname: Kay
  fullname: Kay, Lara
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 3
  givenname: Isabelle
  surname: Beuchat
  fullname: Beuchat, Isabelle
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Département des neurosciences cliniques, Centre hospitalier universitaire Vaudois, Lausanne University Hospital
– sequence: 4
  givenname: Sarah
  surname: Gelhard
  fullname: Gelhard, Sarah
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt
– sequence: 5
  givenname: Sophie
  surname: von Brauchitsch
  fullname: von Brauchitsch, Sophie
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt
– sequence: 6
  givenname: Catrin
  surname: Mann
  fullname: Mann, Catrin
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 7
  givenname: Alexandra
  surname: Lucaciu
  fullname: Lucaciu, Alexandra
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt
– sequence: 8
  givenname: Jan-Hendrik
  surname: Schäfer
  fullname: Schäfer, Jan-Hendrik
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt
– sequence: 9
  givenname: Kai
  surname: Siebenbrodt
  fullname: Siebenbrodt, Kai
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 10
  givenname: Johann-Philipp
  surname: Zöllner
  fullname: Zöllner, Johann-Philipp
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 11
  givenname: Susanne
  surname: Schubert-Bast
  fullname: Schubert-Bast, Susanne
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Department of Neuropaediatrics, Goethe-University Frankfurt
– sequence: 12
  givenname: Felix
  surname: Rosenow
  fullname: Rosenow, Felix
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 13
  givenname: Adam
  orcidid: 0000-0001-6288-9915
  surname: Strzelczyk
  fullname: Strzelczyk, Adam
  email: strzelczyk@med.uni-frankfurt.de
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
– sequence: 14
  givenname: Laurent M.
  orcidid: 0000-0001-8226-1674
  surname: Willems
  fullname: Willems, Laurent M.
  organization: Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt
BackLink https://www.ncbi.nlm.nih.gov/pubmed/35971024$$D View this record in MEDLINE/PubMed
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SubjectTerms Allosteric properties
Anesthesia
Anticonvulsants
Anticonvulsants - adverse effects
Benzodiazepines
Benzodiazepines - adverse effects
Caregivers
Clonazepam
Clonazepam - therapeutic use
Convulsions & seizures
Diazepam
Diazepam - therapeutic use
Drug dosages
Epilepsy
gamma-Aminobutyric Acid - therapeutic use
Humans
Intranasal administration
Intravenous administration
Lorazepam
Lorazepam - therapeutic use
Medicine
Medicine & Public Health
Metabolism
Midazolam
Mortality
Neurology
Neurosciences
Patients
Pharmacodynamics
Pharmacokinetics
Pharmacotherapy
Psychiatry
Psychopharmacology
Review
Review Article
Seizures
Seizures - drug therapy
Status Epilepticus - drug therapy
γ-Aminobutyric acid
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Title Benzodiazepines in the Management of Seizures and Status Epilepticus: A Review of Routes of Delivery, Pharmacokinetics, Efficacy, and Tolerability
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Volume 36
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