Anticonvulsant levels and reloading: Difference between revisions

Revision as of 09:46, 4 October 2011

IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
Oral loading can be spread over day or more to avoid GI upset

Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]

Pt's optimal level = desired level
- If optimal level unknown target upper end of therapeutic range:
  - Phenytoin = 20 mcg/mL
  - Valproate = 100 mcg/mL
  - Phenobarbital = 40 mcg/mL

Phenytoin
- IV: 10-20mg/kg at max rate of 25mg/min
- PO: 18mg/kg as single dose or divided into 3 doses q2hr
Fosphenytoin
- IV: 10-20mg phenytoin equivalent at max rate of 150mg/min

DONALDSON 3/08 (from emedicine; Treiman 1997; Bourgeois, 1996)

Authors:

@@ Line 1: / Line 1: @@
 == Background ==
+*IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
+*Oral loading can be spread over day or more to avoid GI upset
 === Dose ===
@@ Line 25: / Line 27: @@
 === Desired Level ===
-#Pt's optimal level = = desired level
+*Pt's optimal level = desired level
-##If optimal level unknown target upper end of therapeutic range:
+**If optimal level unknown target upper end of therapeutic range:
-###Phenytoin = 20 mcg/mL
+***Phenytoin = 20 mcg/mL
-###Valproate = 100 mcg/mL
+***Valproate = 100 mcg/mL
-###Phenobarbital = 40 mcg/mL
+***Phenobarbital = 40 mcg/mL
-==Treatment==
+==Loading==
-#IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
+*Phenytoin
-#Oral loading can be spread over day or more to avoid GI upset
+**IV: 10-20mg/kg at max rate of 25mg/min
-##(e.g. phenytoin PO 400 mg Q4 to reach the final dosage)
+**PO: 18mg/kg as single dose or divided into 3 doses q2hr
+*Fosphenytoin
+**IV: 10-20mg phenytoin equivalent at max rate of 150mg/min
 ==See Also==
-[[Seizure (Peds)]]
+*[[Seizure (Peds)]]
+*[[Febrile Seizure]]
-[[Febrile Seizure]]
+*[[Dilantin Load]]
+*[[Depakote Loading]]
-[[Dilantin Load]]
-[[Depakote Loading]]
 ==Source==