In adults with established status epilepticus, i.e. seizures persisting after two doses of benzodiazepines, either intravenous valproic acid, intravenous phenobarbital or intravenous phenytoin can be used with appropriate monitoring. Intravenous valproic acid is preferred over intravenous phenobarbital or intravenous phenytoin because of its superior risk-benefit profile. The choice of these medications depends on local resource settings, including availability and facilities for monitoring. Where intravenous infusion may not be feasible, intramuscular phenobarbital remains an option, with appropriate monitoring. Phenytoin and valproic acid should not be given intramuscularly.