Adult Seizure (Actively Seizing/Postictal): Which medication and dose is first-line?

• A. Versed: 5 mg IV/IO/IN/IM (May Repeat 1x)
• B. Ketamine: 100 mg IV/IO/IM (Diluted)
• C. Diazepam: 10 mg IV
• D. Midazolam: 5 mg IM

Answer: (A)

When someone is actively seizing, the aim is to stop the seizure quickly with a drug that acts fast and can be given by several routes. A fast-acting benzodiazepine is the best choice because it enhances GABAergic inhibition in the brain, rapidly reducing neuronal firing and terminating the seizure. Midazolam given at 5 mg through IV, IO, intranasal, or intramuscular routes—and repeated once if needed—fits this goal perfectly: it works quickly, is easy to administer even if IV access is delayed, and the option to repeat ensures you can control ongoing seizure activity. Diazepam and ketamine don’t offer the same combination of speed, route flexibility, and practical repeat dosing in the emergency setting; diazepam can be slower to act via some routes and is less versatile, while ketamine isn’t a first-line anticonvulsant for acute seizures.