Saturday, January 20, 2018

Propofol and rebound seizure

Q: Abrupt withdrawal of which of the following intravenous (IV) infusion drug may cause rebound seizures and should be "weaned off" with coverage of other anti-epileptic drugs during management of status epileptics?

A) Lorazepam
B) Propofol
C) Phenobabital
D) Phenytoin
E) Levetiracetam

Answer: B

Propofol should be weaned off as abrupt withdrawal of propofol may cause rebound seizures due to its very short half life. Coverage should be established with other longer-acting anti-epileptic drug. Lorazepam and Phenobarbital have relative longer half lives and provide good umbrella when short acting propofol is taken off.

Phenytoin and Levetiracetam are not given as IV infusion.


Stecker MM1, Kramer TH, Raps EC, O'Meeghan R, Dulaney E, Skaar DJ. Treatment of refractory status epilepticus with propofol: clinical and pharmacokinetic findings. Epilepsia. 1998 Jan;39(1):18-26.

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