If a patient has a history of epilepsy and is in status epilepticus but has not responded to lorazepam, which medication is appropriate next treatment?

In the case of a patient experiencing status epilepticus who has not responded to lorazepam, selecting the next appropriate treatment is critical for seizure control. Levetiracetam is an effective option due to its rapid onset and safety profile. Administering levetiracetam 3000 mg IV allows for a high dose that can quickly contribute to seizure cessation, making it a suitable choice in the management of status epilepticus.

Other medications can be considered, but levetiracetam is often favored in this scenario because it is well-tolerated, has minimal interactions with other medications, and lacks the potential for respiratory depression that some other antiepileptic drugs might have. This makes levetiracetam particularly valuable in emergency settings where rapid action is necessary and safety is a priority.

While valproic acid, phenobarbital, and phenytoin are also used to manage seizures, they may not be as rapidly effective in terminating status epilepticus as levetiracetam. For example, phenytoin requires careful dosing and monitoring of serum levels, and phenobarbital can cause significant sedation. Valproic acid can be effective but is typically not the first choice in acute situations due to its slower onset compared