Adjustments to the maintenance dose of phenytoin should be made in small increments. Maintenance dose of phenytoin. 2016 May;263(5):861-870. doi: 10.1007/s00415-015-7967-1. doi: 10.1016/s0022-510x(96)05314-2. Two studies have examined the safety and efficacy of phenytoin oral loading doses. All rights reserved. Serum concentrations of phenytoin reached the therapeutic level (10 micrograms/ml) with an average of 2.62 +/- 1.25 h. The peak concentrations at 7.26 +/- 4.77 h was 11.95 +/- 2.8 micrograms/ml. These 2 patients required both higher loading dose and faster rate of administration than the other patients. Over a period of nine months twenty-five epileptic patients were treated with the oral loading dose of phenytoin. However, oral loading doses of phenytoin are not suitable for patients with a status epilepticus, who require immediate control of seizures. To avoid confusion, fosphenytoin doses are reported as "mgPE" (milligrams of phenytoin equivalents).

Mini loads for subtherapeutic subsequent levels are typically 10 mg/kg (quick disclaimer: you may see anywhere from 5 - 15 mg/kg given as a mini load.

The dose ranged from 12 to 23 mg/kg body weight during 1 to 12 hours. The first dose should be given 12–24 hours after the loading dose. Over a period of nine months twenty-five epileptic patients were treated with the oral loading dose of phenytoin. 2008 Jul 1;71(1):38-43. doi: 10.1212/01.wnl.0000316392.55784.57.Swadron SP, Rudis MI, Azimian K, Beringer P, Fort D, Orlinsky M.Acad Emerg Med. An IV was not placed.Drug references say that an oral loading dose (15-20 mg/kg) of phenytoin should be administered in 3 divided doses given every 2 hours to decrease GI adverse effects and to ensure complete oral absorption.
Patients that received phenytoin through the naso-gastric tube, in respect to oral administration, required higher doses to obtain therapeutic plasma levels of phenytoin. Elsevier Science Oral loading dose of phenytoin is safe, effective and can be considered in patients who need prompt control of seizures within a few hours, particularly in those areas where medical facilities are limited. -LOADING DOSE: Some clinicians use an oral loading dose in adults who require rapid steady-state serum levels and where IV administration is not desirable. We strive to reshape medical education and academia in their evolution beyond the traditional classroom.We aim to disrupt how medical providers and trainees can gain public access to high-quality, educational content while also engaging in a dialogue about best-practices in EM and medical education.ALiEM is not endorsed by, sponsored by, or affiliated with the University of California San Francisco or any institution.We frequently give 500 mg now and 500 mg more in 2 hours at discharge.

\\ Corrected\;phenytoin\;(equation\;1) = \frac{(Measured\;phenytoin)}{0.25 * Albumin + 0.1} $$\\ Dosing\;weight = (Ideal\;weight) + 1.33 * (Actual\;weight - Ideal\;weight)$$ [Article in Serbian] Sokić D, Janković SM.
These loading doses may be given on initiation of therapy, or in response to a subtherapeutic drug level in patients at high risk for seizure activity. Loading doses of phenytoin (Dilantin) are used to rapidly attain therapeutic drug concentrations. Press 'Calculate' to view calculation results. Maintenance Phenytoin Therapy 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. Phenytoin oral loading doses may be advantageous in stable patients with subtherapeutic phenytoin concentrations, particularly in those presenting to the emergency department without IV access. 2016 Dec;38(6):728-737. doi: 10.1097/FTD.0000000000000354.J Neurol. In the first part, 15 mg/kg of phenytoin was given orally as a single dose to 19 normal medical volunteers with informed consent.

This calculator uses the average of the following correction equations. Phenytoin typical doses are 3–5mg/kg/day. In order to determine the optimal single oral loading dose of phenytoin in patients with seizures, a two part study of phenytoin pharmacokinetics was conducted. Oral administration should be used, whenever possible.

For a 1 gm dose, that would be 400 mg, then 300 mg, then 300 mg administered every 2 hours (4 hour total administration time).Who has time for three doses spanned over 4+ hours in a busy ED?If you’re still uncomfortable giving a large single dose, there is also support for two-dose oral loading (which still cuts 2 hours off the ED stay compared to 3 doses).ALiEM is your digital connection to the cooperative world of EM. Phenytoin typical oral doses are 3 to 5mg/kg/day. For these patients, a single oral loading dose of phenytoin rapidly produced therapeutic concentration (10 micrograms/ml) within an average of 2.04 +/- 0.44 h in males and 2.35 +/- 1.6 h in females with minimal side-effects. 2008 Dec;49 Suppl 9:3-6. doi: 10.1111/j.1528-1167.2008.01920.x. COVID-19 is an emerging, rapidly evolving situation. Repeated oral smaller dose of phenytoin needs more time to achieve therapeutic level.

©2020 - ClinCalc LLC. This dosing regimen should be reserved for patients in a clinic or hospital setting where phenytoin serum levels can …

Because its molecular weight is different than that of phenytoin, one milligram of fosphenytoin does not equal one milligram of phenytoin.

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