Anticonvulsant levels and reloading: Difference between revisions

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==See Also==
==See Also==
Neuro: Seizure Levels and Reloading
[[Seizure (Peds)]]


Peds: Seizure (Peds)
[[Febrile Seizure]]


Peds: Febrile Seizure
[[Dilantin Load]]


==Source==
==Source==

Revision as of 06:01, 4 July 2011

Background

Dose

Dose (mg) = weight^ (kg) X volume of distribution X [desired level - current level (mcg/mL)]

^Ideal body weight

Volume of Distribution

Agent
Volume of Distribution
Phenytoin (dilantin) 0.8
Carbamazepine (tegretol) 0.8
Phenobarbital 0.6
Valproate (depakote) 0.2

Desired Level

  1. If patient's optimal levels known = desired level
  2. If not, target upper end of therapeutic range:
    1. Phenytoin = 20 mcg/mL
    2. Phenobarbital = 40 mcg/mL
    3. Valproate = 100 mcg/mL

Treatment

  1. Iv load can be performed with phenobarbital, phenytoin/fosphenytoin, valproate, or levetiracetam.
  2. Oral loading often limited by neurotoxic adverse effects (n/v) , but can spread dose out over a day or more if necessary.
    1. (e.g. phenytoin PO 400 mg Q4 to reach the final dosage)

See Also

Seizure (Peds)

Febrile Seizure

Dilantin Load

Source

DONALDSON 3/08 (from emedicine; Treiman 1997; Bourgeois, 1996)