Anticonvulsant levels and reloading: Difference between revisions
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| [[Valproate]] (Depacon) ||Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV | | [[Valproate]] (Depacon) ||Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV | ||
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==Levels== | ==Levels== | ||
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#[[Phenobarbital]] | #[[Phenobarbital]] | ||
#[[Valproate]] | #[[Valproate]] | ||
=== Desired Levels === | |||
*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 | |||
==Reloading== | |||
=== Dose === | |||
'''Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]''' | |||
=== Volume of Distribution === | === Volume of Distribution === | ||
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| 0.2 | | 0.2 | ||
|} | |} | ||
==See Also== | ==See Also== | ||
Revision as of 15:15, 25 November 2014
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]
Loading[1]
| Drug (with brand name) | Loading Dose and Route of Administration |
| Carbamazepine (Tegretol) | 8 mg/kg oral suspension;
single oral load; IV not available |
| Gabapentin (Neurontin) | 900 mg/day oral (300 mg tid) for 3 days;
IV not available |
| Lacosamide (Vimpat) | Oral and IV formulations available and safe;
loading dosages 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; IV 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 h orally;
or 18 mg/kg IV at maximum rate of 50 mg/min |
| Fosphenytoin (Cerebyx) | 18 PE/kg IV at maximum rate of 150 PE/min;
IM administration possible |
| Valproate (Depacon) | Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV |
Levels
Medications with verifiable levels include:
Desired Levels
- 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
- If optimal level unknown target upper end of therapeutic range:
Reloading
Dose
Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]
Volume of Distribution
| Agent |
Volume of Distribution |
| Phenytoin (dilantin) | 0.8 |
| Carbamazepine (tegretol) | 0.8 |
| Phenobarbital | 0.6 |
| Valproate (depakote) | 0.2 |