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Benzodiazepines are a class of drugs that primarily is used to treat anxiety, however it is used to treat seizure disorders as well as other conditions. Medications like clonazepam (Klonopin), diazepam (Valium), and lorazepam (Ativan) are all medications that belong in the benzodiazepine class. Benzodiazepines as first line treatment of seizures, particularly midazolam and lorazepam, are frequently underdosed throughout the United States (Sathe & Coles, 2021).
Clonazepam (Klonopin) Clonazepam is one of the 1, 4-benzodiazepine drugs commonly used in epilepsy management, and recommended for second-line adjunctive treatment for various types of seizures (Song, 2020). It works by enhancing the gamma-aminobutyric acid (GABA-A) receptors in the brain. GABA-A aids in reducing the excitability of neurons, which will have a calming effect on the brain. It is used to treat seizures, anxiety, or panic disorders. This medication is rapidly absorbed after oral administration; the bioavailability is about 90%. Plasma concentrations of clonazepam are reached within 1-4 hours. Klonopin is metabolized in the liver, and it will take between 1 – 2 days for half of the dose to leave your system.
Diazepam (Valium) like clonazepam, this medication works by enhancing the activity of certain neurotransmitters in the brain. Diazepam is used to treat alcohol withdrawal symptoms, muscle spasms, stiffness, and anxiety disorders. When used in combination with other medications it can also treat seizures. After oral administration of this medication more than 90% is absorbed and the peak plasma concentration is reached at about 1-1.5 hours. If the medication is administered with a moderately fat meal, absorption will be delayed and decreased. Diazepam is metabolized in the liver to its active metabolite and is then excreted in the urine.
Lorazepam (Ativan) Ativan is commonly used to treat anxiety, insomnia, or sleep difficulty that is due to anxiety, stress, status epilepticus, and as a medication that they give right before anesthesia. This medication acts on the brain and nerves to produce a calming effect. It enhances the effects of GABA, which helps to terminate a seizure (Kamdar & Hussein, 2020). Ativan can be taken by mouth with or without food. The dosage will be based on your medical conditions, age, and response to treatment. It is metabolized by the liver to inactive metabolites and is considered to be the best tolerated by patients with liver disease. It is then eliminated mainly by the kidneys. It is readily absorbed with an absolute bioavailability of 90%.
References
Kamdar, H. A., & Hussein, O. (2020). Lorazepam timing for acute convulsive seizure control (LoTASC). Seizure, 83, 41–47. https://doi.org/10.1016/j.seizure.2020.09.024
Sathe, A. G., & Coles, L. D. (2021). Patterns of benzodiazepine underdosing in the Established Status Epilepticus Treatment Trial. Epilepsia, 62(3), 795–806. https://doi.org/10.1111/epi.16825
Song, L. (2020). Clonazepam add-on therapy for drug-resistant epilepsy. Cochrane Database of Systematic Reviews. Published. https://doi.org/10.1002/14651858.cd012253.pub3
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