Anticonvulsant levels and reloading: Difference between revisions
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== Background == | ==Background== | ||
*IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam | *IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam | ||
*Oral loading can be spread over day or more to avoid GI upset | *Oral loading can be spread over day or more to avoid GI upset | ||
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==Reloading== | ==Reloading== | ||
'''Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]''' | *'''Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]''' | ||
=== Volume of Distribution === | ===Volume of Distribution=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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==See Also== | ==See Also== | ||
*[[Seizure]] | *[[Seizure]] | ||
*[[Seizure ( | *[[Seizure (peds)]] | ||
*[[Seizure with known seizure disorder]] | *[[Seizure with known seizure disorder]] | ||
*[[Anticonvulsants]] | *[[Anticonvulsants]] | ||
Revision as of 08:54, 3 April 2016
Background
- IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
- Oral loading can be spread over day or more to avoid GI upset
- May use IV vs PO reload at physican discretion[1]
Initial Loading[1]
| Anticonvulsant (brand name) | PO Loading Dose | IV Loading Dose |
| Carbamazepine (Tegretol) | 8 mg/kg suspension in single oral load | NA |
| Gabapentin (Neurontin) | 900 mg/day oral (300 mg tid) for 3 days | NA |
| Lamotrigine (Lamictal) | 6.5 mg/kg single oral load if on lamotrigine for >6 mo without a history of rash or intolerance in the past and only off lamotrigine for <5 days | NA |
| Levetiracetam (Keppra) | 1,500 mg oral load | Up to 60 mg/kg (rapid loading) |
| Phenytoin (Dilantin) | 20 mg/kg divided in maximum doses of 400 mg every 2 hours | 18 mg/kg (max rate of 50 mg/min) |
| Fosphenytoin (Cerebyx) | NA | 18 PE/kg IV (max rate of 150 PE/min) |
| Valproate (Depacon) | NA | Up to 30 mg/kg IV (max rate of 10 mg/kg/min) |
Reloading
- Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]
Volume of Distribution
| Agent | Volume of Distribution | Desired Level |
| Phenytoin (dilantin) | 0.8 | 20 mcg/mL |
| Carbamazepine (tegretol) | 0.8 | 12 mcg/mL |
| Phenobarbital | 0.6 | 40 mcg/mL |
| Valproate (depakote) | 0.2 | 100 mcg/mL |