Anticonvulsant levels and reloading: Difference between revisions

Revision as of 02:46, 19 July 2016

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]

Anticonvulsant (brand name)	PO Loading Dose	IV Loading Dose
Carbamazepine (Tegretol)	8mg/kg suspension in single oral load	NA
Gabapentin (Neurontin)	900mg/day oral (300mg tid) for 3 days	NA
Lamotrigine (Lamictal)	6.5mg/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)	1,500mg oral load	Up to 60mg/kg (rapid loading)
Phenytoin (Dilantin)	20mg/kg divided in maximum doses of 400mg every 2 hours	18mg/kg (max rate of 50mg/min)
Fosphenytoin (Cerebyx)	NA	18 PE/kg IV (max rate of 150 PE/min)
Valproate (Depacon)	NA	Up to 30mg/kg IV (max rate of 10mg/kg/min)

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

↑ ^1.0 ^1.1 Seizures ACEP Policy committee . Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the Emergency Department With Seizures. Ann Emerg Med. 2014;63(4):437–447.e15. doi:10.1016/j.annemergmed.2014.01.018.

Authors:

@@ Line 15: / Line 15: @@
 |-
 | [[Gabapentin]] (Neurontin)
-|900 mg/day oral (300 mg tid) for 3 days
+|900mg/day oral (300mg tid) for 3 days
 |NA
 |-
@@ Line 23: / Line 23: @@
 |-
 | [[Levetiracetam]] (Keppra)
-|1,500 mg oral load
+|1,500mg oral load
-|Up to 60 mg/kg (rapid loading)
+|Up to 60mg/kg (rapid loading)
 |-
 | [[Phenytoin]] (Dilantin)
-|20 mg/kg divided in maximum doses of 400 mg every 2 hours
+|20mg/kg divided in maximum doses of 400mg every 2 hours
-|18mg/kg (max rate of 50 mg/min)
+|18mg/kg (max rate of 50mg/min)
 |-
 |[[Fosphenytoin]] (Cerebyx)
@@ Line 36: / Line 36: @@
 | [[Valproate]] (Depacon)
 |NA
-|Up to 30 mg/kg IV (max rate of 10 mg/kg/min)
+|Up to 30mg/kg IV (max rate of 10mg/kg/min)
 |}