Fosphenytoin
Status epilepticus, Seizure prophylaxis
Indications
- Status epilepticus
- Seizure prophylaxis
Adult dosing
- status epilepticus: dose: 20; unit: mg PE/kg; route: IV at max 150mg PE/min; weightBased: true; maxDose: 1500; maxDoseAbsolute: true
Pediatric dosing
- status epilepticus: dose: 20; unit: mg PE/kg; route: IV at max 150mg PE/min; weightBased: true; maxDose: 1500; maxDoseAbsolute: true
Contraindications
- Sinus bradycardia, sinoatrial block, second/third-degree AV block
- Adams-Stokes syndrome
Clinical pearls
- Dose expressed in PE (phenytoin equivalents) — not the same as phenytoin mg
- Monitor for hypotension and cardiac arrhythmia during and 30 min after infusion
- Requires continuous cardiac monitoring and BP checks q5min during infusion
- Purple glove syndrome less common than with phenytoin but still possible
Source and review
- AES Guidelines 2016; Neurocritical Care Society. Last reviewed: 2024-11-01