Unbound phenytoin concentrations may be more useful.Due to an increased fraction of unbound phenytoin in patients with hepatic disease, the interpretation of total phenytoin plasma concentrations should be made with caution. If the phenytoin concentration is >12 mg/mL, the dose may be increased by 30 mg/day. Following completion of the … Clinical Pharmacy, University of Florida Shands Hospital, University of Florida College of Pharmacy, Gainesville, FloridaClinical Pharmacy, University of Kentucky HealthCare, Lexington, KentuckyDepartment of Pharmacy Services, University of Kentucky College of Pharmacy, Lexington, KentuckyDepartment of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KentuckyClinical Pharmacy, University of Kentucky HealthCare, Lexington, KentuckyDepartment of Pharmacy Services, University of Kentucky College of Pharmacy, Lexington, KentuckyDepartment of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KentuckyPharmacy Services, St. Claire Regional Medical Center, Morehead, KentuckyClinical Pharmacy, Medical University of South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, South CarolinaKyle A. Weant, Pharmacy Services, Medical University of South Carolina, 150 Ashley Avenue, PO Box 250584, Charleston, SC 29425.Clinical Pharmacy, University of Florida Shands Hospital, University of Florida College of Pharmacy, Gainesville, FloridaClinical Pharmacy, University of Kentucky HealthCare, Lexington, KentuckyDepartment of Pharmacy Services, University of Kentucky College of Pharmacy, Lexington, KentuckyDepartment of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KentuckyClinical Pharmacy, University of Kentucky HealthCare, Lexington, KentuckyDepartment of Pharmacy Services, University of Kentucky College of Pharmacy, Lexington, KentuckyDepartment of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KentuckyPharmacy Services, St. Claire Regional Medical Center, Morehead, KentuckyClinical Pharmacy, Medical University of South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, South CarolinaKyle A. Weant, Pharmacy Services, Medical University of South Carolina, 150 Ashley Avenue, PO Box 250584, Charleston, SC 29425.Use the link below to share a full-text version of this article with your friends and colleagues.

Therapeutic drug monitoring. Phenytoin is a common anticonvulsant used for the acute treatment of seizures in the emergency department (ED).


Initial loading doses of phenytoin are usually 20 mg/kg of the appropriate dosing weight as above.
Emergency medicine pharmacists (EPhs) have been shown to optimize the care of patients receiving phenytoin therapy in other settings, demonstrating reductions in seizure activity, duration of therapy, and cost.Records of patients presenting to the ED that were at least 18 years old and were prescribed intravenous phenytoin were reviewed.





Emergency medicine pharmacists (EPhs) have been shown to optimize the care of patients receiving phenytoin therapy in other settings, demonstrating reductions in seizure activity, duration of therapy, and cost.Records of patients presenting to the ED that were at least 18 years old and were prescribed intravenous phenytoin were reviewed.





The loading dose is generally 10–20 mg/kg10.

To evaluate the impact of an EPh, intravenous phenytoin orders placed during the EPh's hours were compared with those placed outside of those hours.A total of 117 patients were included, 42 (36%) weighed 100 kg or more. Applies to the following strengths: 50 mg/mL; 50 mg; 100 mg; 30 mg; 25 mg/mL; 200 mg; 300 mg; sodiumDue to an increased fraction of unbound phenytoin in patients with renal disease, the interpretation of total phenytoin plasma concentrations should be made with caution. Phenytoin is a common anticonvulsant used for the acute treatment of seizures in the emergency department (ED).

If giving phenytoin to a patient on intermittent …



Patients weighing 100 kg or more were compared with those less than 100 kg.

We comply with the HONcode standard for trustworthy health information - To evaluate the impact of an EPh, intravenous phenytoin orders placed during the EPh's hours were compared with those placed outside of those hours.A total of 117 patients were included, 42 (36%) weighed 100 kg or more. Therapeutic drug monitoring — Medicines Formulary, Version 7 Principal Author: Gareth …





Maintenance dose: 200mg to 500mg daily .

Initially 3 to 4 mg / kg once daily PO Usual dose is 200 to 500mg daily PO, depending on plasma levels.

I'll just use 10 mg/kg …

Unbound phenytoin concentrations may be more useful.Due to an increased fraction of unbound phenytoin in patients with hepatic disease, the interpretation of total phenytoin plasma concentrations should be made with caution. © 2020 American College of Clinical Pharmacy

When appropriate convert to nasogastric or oral administration.



1000 mg given as 400 mg initially,



and/or Phenobarbitone bolus of 10-15 mg/kg at a rate of 100 mg/minute : Refractory status* General anaesthesia, with one of: o propofol (1-2mg/kg bolus, then 2-10mg/kg/hour) titrated to effect.

Maintenance intravenousphenytoin therapy of 3-5mg/kg/day in three divided doses (normally 100mg THREE TIMES A DAY) should be commenced 12 – 24 hours after loading dose.