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fosphenytoin
generic
Black Box Warnings .
Cardiovascular Risk with Rapid Infusion
IV infusion should not exceed 150 mg phenytoin sodium equivalents per minute in adults or 2 mg PE/kg/min (or 150 mg PE/min, whichever is slower) in peds pts; incr. risk severe hypotension and cardiac arrhythmias above recommended infusion rate, but events also reported at or below recommended rate; monitor for cardiac adverse events during and after IV infusion; IV infusion rate reduction or discontinuation may be necessary
Adult Dosing .
Dosage forms: INJ
Special Note
- [prescribing info]
- Info: fosphenytoin doses expressed as phenytoin equivalents (PE) to avoid need for dose conversions between products; fosphenytoin should be prescribed and dispensed in PE units; each vial contains 75 mg per mL fosphenytoin equivalent to 50 mg per mL phenytoin
status epilepticus
- [4-6 mg PE/kg/day IM/IV divided qd-tid]
- Start: 15-20 mg PE/kg/dose IV x1; Max: 150 mg PE/min IV; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; taper dose gradually to D/C
seizures, neurosurgery-related
- [4-6 mg PE/kg/day IM/IV divided qd-tid]
- Start: 10-20 mg PE/kg/dose IM/IV x1; Max: 150 mg PE/min IV; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; taper dose gradually to D/C
seizure disorder, short-term tx
- [4-6 mg PE/kg/day IM/IV divided qd-tid]
- Start: 10-20 mg PE/kg/dose IM/IV x1; Max: 150 mg PE/min IV; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; switch to PO phenytoin ASAP
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised
Peds Dosing .
- Dosage forms: INJ
Special Note
- [prescribing info]
- Info: fosphenytoin doses expressed as phenytoin equivalents (PE) to avoid need for dose conversions between products; fosphenytoin should be prescribed and dispensed in PE units; each vial contains 75 mg per mL fosphenytoin equivalent to 50 mg per mL phenytoin
status epilepticus
- [<17 yo]
- Dose: 4-8 mg PE/kg/day IM/IV divided bid; Start: 15-20 mg PE/kg/dose IV x1; Max: 2 mg PE/kg/min up to 150 mg PE/min IV for start dose or up to 100 mg PE/min IV for maint. dose; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; taper dose gradually to D/C
seizures, neurosurgery-related
- [<17 yo]
- Dose: 4-8 mg PE/kg/day IM/IV divided bid; Start: 10-15 mg PE/kg/dose IM/IV x1; Max: 2 mg PE/kg/min up to 150 mg PE/min IV for start dose or up to 100 mg PE/min IV for maint. dose; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; taper dose gradually to D/C
seizure disorder, short-term tx
- [<17 yo]
- Dose: 4-8 mg PE/kg/day IM/IV divided bid; Start: 10-15 mg PE/kg/dose IM/IV x1; Max: 2 mg PE/kg/min up to 150 mg PE/min IV for start dose or up to 100 mg PE/min IV for maint. dose; Info: consider low start dose in CYP2C9 intermediate or poor metabolizers; begin maint. dose 12h after loading dose; adjust dose based on tx response and serum levels; switch to PO phenytoin ASAP
renal dosing
- [see below]
- renal impairment: not defined, caution advised
- HD/PD: not defined, caution advised
hepatic dosing
- [see below]
- hepatic impairment: not defined, caution advised