Difference between revisions of "Anticonvulsant levels and reloading"
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{|class="wikitable" | {|class="wikitable" | ||
|'''Anticonvulsant (brand name)''' | |'''Anticonvulsant (brand name)''' | ||
| − | |'''Loading Dose | + | |'''PO Loading Dose''' |
| + | |'''IV Loading Dose''' | ||
|- | |- | ||
| − | | [[Carbamazepine]] (Tegretol) | + | | [[Carbamazepine]] (Tegretol) |
| − | IV: not available | + | |PO: 8 mg/kg suspension in single oral load |
| + | |IV: not available | ||
|- | |- | ||
| − | | [[Gabapentin]] (Neurontin) | + | | [[Gabapentin]] (Neurontin) |
| − | IV: not available | + | |PO: 900 mg/day oral (300 mg tid) for 3 days |
| + | |IV: not available | ||
|- | |- | ||
| − | | [[Lacosamide]] (Vimpat) | + | | [[Lacosamide]] (Vimpat) |
| − | IV: not studied | + | |PO: dosages not studied |
| + | |IV: not studied | ||
|- | |- | ||
| − | | [[Lamotrigine]] (Lamictal) | + | | [[Lamotrigine]] (Lamictal) |
| − | IV: not available | + | |PO: 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) | + | | [[Levetiracetam]] (Keppra) |
| − | IV: rapid IV loading safe and well tolerated in doses up to 60 mg/kg | + | |PO: 1,500 mg oral load |
| + | |IV: rapid IV loading safe and well tolerated in doses up to 60 mg/kg | ||
|- | |- | ||
| − | | [[Phenytoin]] (Dilantin) | + | | [[Phenytoin]] (Dilantin) |
| − | IV: 18 mg/kg at maximum rate of 50 mg/min | + | |PO: 20 mg/kg divided in maximum doses of 400 mg every 2 hours |
| + | |IV: 18 mg/kg at maximum rate of 50 mg/min | ||
|- | |- | ||
| − | | [[Fosphenytoin]] (Cerebyx) ||PO: | + | | [[Fosphenytoin]] (Cerebyx) | |
| − | IV: 18 PE/kg IV at maximum rate of 150 PE/min | + | |PO: |
| − | + | |IV: 18 PE/kg IV at maximum rate of 150 PE/min | |
|- | |- | ||
| − | | [[Valproate]] (Depacon) | + | | [[Valproate]] (Depacon) |
| − | IV: Up to 30 mg/kg IV at max rate of 10 mg/kg/min | + | |PO: |
| + | |IV: Up to 30 mg/kg IV at max rate of 10 mg/kg/min | ||
|} | |} | ||
Revision as of 13:53, 25 August 2015
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
- May use IV vs PO reload at physican discretion[1]
Initial Loading[1]
| Anticonvulsant (brand name) | PO Loading Dose | IV Loading Dose |
| Carbamazepine (Tegretol) | PO: 8 mg/kg suspension in single oral load | IV: not available |
| Gabapentin (Neurontin) | PO: 900 mg/day oral (300 mg tid) for 3 days | IV: not available |
| Lacosamide (Vimpat) | PO: dosages not studied | IV: not studied |
| Lamotrigine (Lamictal) | PO: 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) | PO: 1,500 mg oral load | IV: rapid IV loading safe and well tolerated in doses up to 60 mg/kg |
| Phenytoin (Dilantin) | PO: 20 mg/kg divided in maximum doses of 400 mg every 2 hours | IV: 18 mg/kg at maximum rate of 50 mg/min |
| Fosphenytoin (Cerebyx) | | PO: | IV: 18 PE/kg IV at maximum rate of 150 PE/min |
| Valproate (Depacon) | PO: | IV: Up to 30 mg/kg IV at 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
| 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 |