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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)
|
8mg/kg suspension in single oral load
|
NA
|
Gabapentin (Neurontin)
|
900 mg/day oral (300 mg tid) for 3 days
|
NA
|
Lamotrigine (Lamictal)
|
6.5mg/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
|
NA
|
Levetiracetam (Keppra)
|
1,500 mg oral load
|
Up to 60 mg/kg (rapid loading)
|
Phenytoin (Dilantin)
|
20 mg/kg divided in maximum doses of 400 mg every 2 hours
|
18mg/kg (max rate of 50 mg/min)
|
Fosphenytoin (Cerebyx)
|
NA
|
18 PE/kg IV (max rate of 150 PE/min)
|
Valproate (Depacon)
|
NA
|
Up to 30 mg/kg IV (max rate of 10 mg/kg/min)
|
Reloading
- 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
References
- ↑ 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.