Difference between revisions of "Anticonvulsant levels and reloading"
Ostermayer (talk | contribs) (/* LoadingSeizures 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...) |
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*IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam | *IV load can be performed with phenobarbital, phenytoin, valproate, levetiracetam | ||
*Oral loading can be spread over day or more to avoid GI upset | *Oral loading can be spread over day or more to avoid GI upset | ||
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==Loading<ref>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>== | ==Loading<ref>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>== | ||
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| [[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 | ||
|} | |} | ||
| + | |||
| + | ==Reloading== | ||
| + | === Dose === | ||
| + | Dose (mg) = ideal body weight (kg) X Vd X [desired level - current level (mcg/mL)] | ||
| + | |||
| + | === Volume of Distribution === | ||
| + | |||
| + | {| style="width: 500px" border="1" cellpadding="1" cellspacing="1" | ||
| + | |- | ||
| + | | '''Agent<br/>''' | ||
| + | | '''Volume of Distribution<br/>''' | ||
| + | |- | ||
| + | | 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 | ||
==See Also== | ==See Also== | ||
| + | *[[Seizure]] | ||
*[[Seizure (Peds)]] | *[[Seizure (Peds)]] | ||
*[[Febrile Seizure]] | *[[Febrile Seizure]] | ||
Revision as of 17:06, 21 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
Loading[1]
| Drug (with brand name) | 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 |
Reloading
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:
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.