View source for Anticonvulsant levels and reloading

== Background ==
*IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
*Oral loading can be spread over day or more to avoid GI upset
*May use IV vs PO reload at physican discretion<ref name="ACEP">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.</ref>

==Initial Loading<ref name="ACEP"></ref>==
{|class="wikitable"
|'''Anticonvulsant (brand name)'''
|'''PO Loading Dose'''
|'''IV Loading Dose'''
|-
| [[Carbamazepine]] (Tegretol)
|8 mg/kg suspension in single oral load 
|NA
|-
| [[Gabapentin]] (Neurontin) 
|900 mg/day oral (300 mg tid) for 3 days
|NA 
|-
| [[Lamotrigine]] (Lamictal) 
|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
|NA 
|-
| [[Levetiracetam]] (Keppra) 
|1,500 mg oral load
|Up to 60 mg/kg (rapid loading) 
|-
| [[Phenytoin]] (Dilantin) 
|20 mg/kg divided in maximum doses of 400 mg every 2 hours
|18 mg/kg (max rate of 50 mg/min) 
|-
|[[Fosphenytoin]] (Cerebyx) 
|NA
|18 PE/kg IV (max rate of 150 PE/min)
|-
| [[Valproate]] (Depacon) 
|NA
|Up to 30 mg/kg IV (max rate of 10 mg/kg/min)
|}

==Reloading==
=== Dose ===
'''Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]'''

=== Volume of Distribution ===

{| class="wikitable"
|-
| '''Agent'''
| '''Volume of Distribution'''
| '''Desired Level'''
|-
| Phenytoin (dilantin) 
| 0.8
| 20 mcg/mL
|-
| Carbamazepine (tegretol)
| 0.8
| 12 mcg/mL
|-
| Phenobarbital
| 0.6
| 40 mcg/mL
|-
| Valproate (depakote)
| 0.2
| 100 mcg/mL
|}

==See Also==
*[[Seizure]]
*[[Seizure (Peds)]]
*[[Seizure with known seizure disorder]]
*[[Anticonvulsants]]

==Source==
<references/>

[[Category:Drugs]]
[[Category:Neuro]]