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
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
|
Desired Level
- 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
Loading[1]
| Drug (With Selected References)
|
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 (Lamicta)l |
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
|
See Also
Source
- ↑ 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.
