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
|
See Also
Source
- ↑ 1.0 1.1 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.