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IV loading dose For phenytoin-naïve patients, loading doses can be calculated as follows: Weight (kg) Dose (mg/mL) 40-49 750mg in 100mL Key Points . Phenytoin Dosing Calculator This initial program provides some general dosage guidelines based on population averages for the Michaelis-Menten parameters (Km and Vmax). Poisoning – Acute guidelines for initial management Resuscitation. Oral phenytoin may be used for maintenance therapy after the fosphenytoin loading dose. Levels for maintenance dose: Take a trough level 2 days after initiation, then again 3-5 days later. <> Clinical Guideline for the Use of Phenytoin in Epilepsy V1.0 Page 6 of 15 3. Fosphenytoin may be substituted at the same total daily dose as phenytoin. endobj
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1, – 5 However, phenytoin dosing can pose a challenge to clinicians because of its narrow therapeutic range and nonlinear pharmacokinetic profile. This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network . stream No further relevant information other than that which is included in other sections of the Summary of Product Characteristics. f52\2���H�o� d���i���"�xu,�p�E��MT�xF�tӉ3�4p@���`< ��-�K0��iLJ����1Yt�.�Y��FlW2�038�R�n��L,O��4��%@�����F�Xԅ��,�L�;�J�kH�gL��� :t�Pgd����Q$P ��^�bD��hH���Z�����F !�Ub~�d��U�v�1���UM�=l�bq�R� m�EE7�F Q�4�K�S[ӳr��T�AFI���[dv`���WE�2��.��ǔ9�:��o��r�G;�X�fa;x}�+ou/�ta �+�Ɠ��9D��p�]����#�G# U�.���u�o�Q�u��^f�v�3##RuI!��$�*�k|�����1�tDž��ʨ; a�3�Fnx�u&%'��@B��el|8��sELh�*E��iTt?r�H4~�* ��38B��9f?�f��� ��Q��VX@�W %���� An understanding of capacity-limited kinetics is essential to the proper dosing of phenytoin, the avoidance of side effects with chronic therapy, and the management of overdoses. The recommendations do not take into account the following: (1) existence of interacting drugs (3) inter-patient variability (3) existing disease states which may significantly alter the eventual therapeutic dose. Precautions .
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A 2 hour break pre and post feed (interaction with protein within feed) must be maintained, speak to the dieticians to tailor the feed. 3 0 obj <> x��]��6��n����н�e�))��<6������߇vOϸ����c�����PK"E6�.A&3ݔ�c�X/V��篪o�y���/~��o������귧O(�{ʪ��uW .j�W��۾�N��O�����'߽~����HEH������'�jԿ�2j�~}��IS�����>�eU��q�C~�/n�/��1�[����O~Tt���O����.֏��{��ߺ����X�Zt�eij^QXJ�+��j����ϻ�~8V���ٽi1�����2�z2!�h�&˓e̋P�~25�ӝ�W�BԂV&�״Cl�x�DHV7���4�g���i^"��a~��S��HT=��J1!��C�왚��"|JZº�襁%5״%@[�)�������{\w�LJ�3�h�W�ޭ������Q�����ŏo�������^qCB���� However, to prevent an incident similar to the one described here, precautions must be taken to address the risks of severe hypotension and cardiac arrhythmias related to the rate of IV administration. <>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 594.96 842.04] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Sample prescription – example 70kg patient: 3.1.
6. Detailed guidelines for the use of phenytoin as well as analyses of cost-effectiveness are out of scope. US BOXED WARNINGS: Cardiovascular risk associated with rapid Infusion Rates:-The rate of IV administration should not exceed 150 mg phenytoin sodium equivalents (PE) per minute because of the risk of severe … endobj 2 0 obj Pharmaceutical particulars. At higher levels in the therapeutic range, any increase in the daily dose will result in a disproportionate increase in the plasma level. Phenytoin dosing requirements are highly variable and must be individualized (see section 4.2). ��iY66�OQC����#D�"�h7��ume%��T�'���s�b����X�^�����!�l�s� r����"@��F��H p [���%m�iYǚ#���VtA�HkY_ȹ¸�5�ť�aw�@_��U��k�H6����qjB��=Gm�SX��Qt�15Qn3�ހJ�EE+6���+� �o���fH�q��s2Ң$$Z\�e�U��p Phenytoin is a commonly used medication for the treatment of status epilepticus and acute seizure control in the emergency department (ED). Phenytoin intoxication is usually benign and symptoms are dose-related.
endobj Phenytoin can play an important role in the control of seizures.
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stream Phenytoin sodium IV:100mg IV three times daily o Administer neat as a bolus over 2-5 minutes. �X� ��Z�6�5s�[Օ�8�A�AїB�I �ޏ�ú]�@�����Xg�~�*REd�T�d��Z����$�`�e�NJF5T�����Ӣ��"7��� 2�c0X)��$�����O�ex)D�.�tt}JIm�.�r�v�v���ɑ����^N���%h�.�L�;++�: �75U�A?�D�l����O�7������/�'����֍��L�M��39f"-�n���*ⳝ�����X& 6.1 List of excipients.
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