To the Editor.—
The article by Ramsey et al (Archives 36:535-539, 1979) on the uptake of anticonvulsants in dog and cat brains is an extension of their earlier studies in human brain.1 The authors conclude in their abstract (but nowhere in the body of their report) that it would be appropriate to treat patients with status epilepticus initially with intravenous (IV) diazepam followed by "subsequent rapid use of IV phenytoin or phenobarbital." The recommended interval of time between termination of therapy with diazepam and the beginning of phenobarbital therapy remains unclear and it is assumed to be short or irrelevant.We are concerned because evidence exists that combined phenobarbital and diazepam therapy frequently causes hypotension and respiratory depression that may be difficult to reverse. For example, the occurrence of severe and sometimes fatal hypotension is clearly documented in the clinical literature2-4 and has been confirmed by our own experience.
Vijayan N, Gabor AJ. Therapy for Status Epilepticus. Arch Neurol. 1980;37(5):326–327. doi:10.1001/archneur.1980.00500540104031