Clomethiazole has been used in the stage of established status epilepticus, although its role in modern therapy is limited by the risks of accumulation. It is given by IV bolus followed by a continuous infusion. The drug is rapidly redistributed and has a very rapid and short-lived initial action. Dosage can be initially titrated against response, on a moment-by-moment basis, a unique property among the drugs used in status. The danger of clomethiazole is that it accumulates on prolonged use, with the risk of sudden cardio-respiratory collapse, hypotension and sedation. There is also a danger of respiratory arrest and hypotension if the maximum rate of injection is exceeded. Other side-effects include cardiac rhythm disturbances, vomiting and thrombophlebitis, and there is a tendency for seizure recurrence on discontinuing therapy. Prolonged therapy carries the risk of fluid overload and electrolyte disturbance. There is limited published experience in status, particularly in children, and insufficient published data for neonatal use. Hepatic disease reduces the metabolism and elimination of the drug, and prolonged contact with plastic tubing (for instance in drip sets) results in substantial resorption.
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