Anticonvulsant levels and reloading: Difference between revisions
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|- | |- | ||
| [[Carbamazepine]] (Tegretol) | | [[Carbamazepine]] (Tegretol) | ||
| | |8 mg/kg suspension in single oral load | ||
| | |not available | ||
|- | |- | ||
| [[Gabapentin]] (Neurontin) | | [[Gabapentin]] (Neurontin) | ||
| | |900 mg/day oral (300 mg tid) for 3 days | ||
| | |not available | ||
|- | |- | ||
| [[Lacosamide]] (Vimpat) | | [[Lacosamide]] (Vimpat) | ||
| | |dosages not studied | ||
| | |not studied | ||
|- | |- | ||
| [[Lamotrigine]] (Lamictal) | | [[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 | ||
| | |not available | ||
|- | |- | ||
| [[Levetiracetam]] (Keppra) | | [[Levetiracetam]] (Keppra) | ||
| | |1,500 mg oral load | ||
| | |rapid IV loading safe and well tolerated in doses up to 60 mg/kg | ||
|- | |- | ||
| [[Phenytoin]] (Dilantin) | | [[Phenytoin]] (Dilantin) | ||
| | |20 mg/kg divided in maximum doses of 400 mg every 2 hours | ||
| | |18 mg/kg at maximum rate of 50 mg/min | ||
|- | |- | ||
| [[Fosphenytoin]] (Cerebyx) | |[[Fosphenytoin]] (Cerebyx) | ||
| | |NA | ||
| | |18 PE/kg IV at maximum rate of 150 PE/min | ||
|- | |- | ||
| [[Valproate]] (Depacon) | | [[Valproate]] (Depacon) | ||
| | |NA | ||
| | |Up to 30 mg/kg IV at max rate of 10 mg/kg/min | ||
|} | |} | ||
Revision as of 14:01, 25 August 2015
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 | not available |
| Gabapentin (Neurontin) | 900 mg/day oral (300 mg tid) for 3 days | not available |
| Lacosamide (Vimpat) | dosages not studied | not studied |
| 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 | not available |
| Levetiracetam (Keppra) | 1,500 mg oral load | rapid IV loading safe and well tolerated in doses up to 60 mg/kg |
| Phenytoin (Dilantin) | 20 mg/kg divided in maximum doses of 400 mg every 2 hours | 18 mg/kg at maximum rate of 50 mg/min |
| Fosphenytoin (Cerebyx) | NA | 18 PE/kg IV at maximum rate of 150 PE/min |
| Valproate (Depacon) | NA | Up to 30 mg/kg IV at max rate of 10 mg/kg/min |
Reloading
Dose
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 |