Ativan, Valium both good options for emergency treatment, experts say
By Steven Reinberg
TUESDAY, April 22, 2014 (HealthDay News) -- Researchers comparing two drugs used to treat epileptic seizures in children -- lorazepam (Ativan) and diazepam (Valium) -- found no difference between them in safety or effectiveness.
Although previous studies gave the edge to Ativan, Dr. James Chamberlain, lead researcher for the new study, gave several reasons why Valium might be as good or better.
"Unexpectedly, Ativan is not superior to Valium for treating pediatric seizures. It's been dogma in medicine that Ativan is better than Valium, but this study shows that they are just about equal," said Chamberlain, division chief of emergency medicine and trauma services at Children's National Medical Center in Washington, D.C.
Since Valium does not have to be refrigerated, it might be a better choice for paramedics who treat seizure patients before they arrive at a hospital, he said. "They can start Valium without having a refrigerator and feel comfortable that they are giving good medicine," Chamberlain explained.
"Also, parents have a form of rectal Valium they can use rapidly at home," he added.
Because both drugs have been around for decades they are not expensive, Chamberlain noted.
In their head-to-head comparison of the two drugs, the researchers randomly assigned 273 patients, ages ranging from 3 months to less than 18 years, who were seen in 11 pediatric emergency rooms for epileptic seizures, to receive either Valium or Ativan intravenously.
The investigators found that 72.1 percent of the patients who received Valium saw their seizure stop within 10 minutes of getting the drug and not recur within 30 minutes. This was also the case for 72.9 percent of those who received Ativan.
In each group, 26 patients needed assistance breathing, which was the researchers' measure of safety.
The researchers reported that the only significant difference between the drugs was that patients who received Ativan were more likely to be sedated and to stay sedated longer (67 percent) than those given Valium (50 percent).
The U.S. Food and Drug Administration has approved Valium, but not Ativan, for treating these seizures in children, the study authors noted.
Dr. Steven Pacia, director of the Epilepsy Center and the division of neurology at Lenox Hill Hospital in New York City, said, "This confirms what a lot of physicians have known -- that the drugs are pretty similar and effective."
Pacia added that these seizures are an emergency, so when using either drug, whether in the hospital or in the field, it is essential that treatment start as soon as possible. "The importance is giving it early and quickly and enough," he said.
The report was published in the April 23 issue of the Journal of the American Medical Association.
Dr. Michael Duchowny, a pediatric neurologist and director of the Epilepsy Center at Miami Children's Hospital, said, "This paper is important because Valium is much more widely available, so that it is equal to Ativan is important."
Duchowny added, "These drugs are used in emergency situations, so if you can get either of them they are both effective, but you don't have to feel that Valium is less effective."
Another expert, Dr. Cynthia Harden, director of the North Shore-LIJ Comprehensive Epilepsy Care Center in Great Neck, N.Y., said she doesn't think this study will change clinical practice.
Another drug, midazolam, also used to treat epileptic seizures in children, is becoming the drug of choice possibly replacing both Valium and Ativan, she said.
Midazolam has an advantage because it can be given as a liquid into the nose, making it ideal for paramedics and parents alike, Harden said.
"I think that midazolam is probably going to supersede everything, including rectal Valium," she said.
Prolonged epileptic seizure, called "status epilepticus," occurs about 10,000 times a year in children in the United States, according to study background information.
It is important to control these seizures to prevent permanent injury and life-threatening complications such as respiratory failure, the researchers pointed out.
To learn more about epilepsy, visit the U.S. National Library of Medicine.
SOURCES: James Chamberlain, M.D., division chief, emergency medicine and trauma services, Children's National Medical Center, Washington, D.C.; Michael Duchowny, M.D., pediatric neurologist, and director, Epilepsy Center, Miami Children's Hospital; Cynthia Harden, M.D., director, North Shore-LIJ Comprehensive Epilepsy Care Center, Great Neck, N.Y.; Steven Pacia, M.D., director, Epilepsy Center and division of neurology, Lenox Hill Hospital, New York City; April 23, 2014, Journal of the American Medical Association
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