Difference between revisions of "Anticonvulsant levels and reloading"
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|'''Loading Dose and Route of Administration''' | |'''Loading Dose and Route of Administration''' | ||
|- | |- | ||
| − | | Carbamazepine Tegretol||8 mg/kg oral suspension; | + | | [[Carbamazepine]] (Tegretol)||8 mg/kg oral suspension; |
single oral load; | single oral load; | ||
IV not available | IV not available | ||
|- | |- | ||
| − | | Gabapentin (Neurontin) ||900 mg/day oral (300 mg tid) for 3 days; | + | | [[Gabapentin]] (Neurontin) ||900 mg/day oral (300 mg tid) for 3 days; |
IV not available | IV not available | ||
|- | |- | ||
| − | | Lacosamide (Vimpat) ||Oral and IV formulations available and safe; | + | | [[Lacosamide]] (Vimpat) ||Oral and IV formulations available and safe; |
loading dosages not studied | loading dosages not studied | ||
|- | |- | ||
| − | | Lamotrigine ( | + | | [[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; | for >6 mo without a history of rash or intolerance in the past and only off lamotrigine for <5 days; | ||
| − | + | IV not available | |
|- | |- | ||
| − | | Levetiracetam (Keppra) ||1,500 mg oral load; | + | | [[Levetiracetam]] (Keppra) ||1,500 mg oral load; |
rapid IV loading safe and well tolerated in doses up to 60 mg/kg | rapid IV loading safe and well tolerated in doses up to 60 mg/kg | ||
|- | |- | ||
| − | | Phenytoin (Dilantin) ||20 mg/kg divided in maximum doses of 400 mg every 2 h orally; | + | | [[Phenytoin]] (Dilantin) ||20 mg/kg divided in maximum doses of 400 mg every 2 h orally; |
or 18 mg/kg IV at maximum rate of 50 mg/min | or 18 mg/kg IV at maximum rate of 50 mg/min | ||
|- | |- | ||
| − | | Fosphenytoin (Cerebyx) ||18 PE/kg IV at maximum rate of 150 PE/min; | + | | [[Fosphenytoin]] (Cerebyx) ||18 PE/kg IV at maximum rate of 150 PE/min; |
IM administration possible | IM administration possible | ||
|- | |- | ||
| − | | Valproate (Depacon) ||Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV | + | | [[Valproate]] (Depacon) ||Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV |
|} | |} | ||
Revision as of 22:34, 20 April 2014
Contents
Background
- IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam
- Oral loading can be spread over day or more to avoid GI upset
Dose
Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)]
Volume of Distribution
| Agent |
Volume of Distribution |
| Phenytoin (dilantin) | 0.8 |
| Carbamazepine (tegretol) | 0.8 |
| Phenobarbital | 0.6 |
| Valproate (depakote) | 0.2 |
Desired Level
- Pt's optimal level = desired level
- If optimal level unknown target upper end of therapeutic range:
- Phenytoin = 20 mcg/mL
- Valproate = 100 mcg/mL
- Phenobarbital = 40 mcg/mL
- If optimal level unknown target upper end of therapeutic range:
Loading[1]
| Drug (With Selected References) | Loading Dose and Route of Administration |
| Carbamazepine (Tegretol) | 8 mg/kg oral suspension;
single oral load; IV not available |
| Gabapentin (Neurontin) | 900 mg/day oral (300 mg tid) for 3 days;
IV not available |
| Lacosamide (Vimpat) | Oral and IV formulations available and safe;
loading dosages not studied |
| 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; IV not available |
| Levetiracetam (Keppra) | 1,500 mg oral load;
rapid IV loading safe and well tolerated in doses up to 60 mg/kg |
| Phenytoin (Dilantin) | 20 mg/kg divided in maximum doses of 400 mg every 2 h orally;
or 18 mg/kg IV at maximum rate of 50 mg/min |
| Fosphenytoin (Cerebyx) | 18 PE/kg IV at maximum rate of 150 PE/min;
IM administration possible |
| Valproate (Depacon) | Up to 30 mg/kg IV at max rate of 10 mg/kg/min IV |
See Also
Source
- ↑ 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.