Anticonvulsant levels and reloading: Difference between revisions
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==See Also== | ==See Also== | ||
[[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
- If patient's optimal levels known = desired level
- If not, target upper end of therapeutic range:
- Phenytoin = 20 mcg/mL
- Phenobarbital = 40 mcg/mL
- Valproate = 100 mcg/mL
Treatment
- Iv load can be performed with phenobarbital, phenytoin/fosphenytoin, valproate, or levetiracetam.
- Oral loading often limited by neurotoxic adverse effects (n/v) , but can spread dose out over a day or more if necessary.
- (e.g. phenytoin PO 400 mg Q4 to reach the final dosage)
See Also
Source
DONALDSON 3/08 (from emedicine; Treiman 1997; Bourgeois, 1996)