Phenytoin

Generic Name:	Phenytoin
Trade Name:	Dilantin
Action:	Anticonvulsant Antiarrhtymic
Indications:	Tonic-clonic and psychomotor seizures; status epilepticus Digitalis-induced arrhythmias especially paroxysmal atrial tachycardia Seizures secondary to preeclampsia and eclampsia
Administration Guidelines:
Usual Dosage Range and Route:	*IV push/infuse at a rate no greater than 50 mg/ minute* PROPHYLAXIS Loading Dose: 15-18mg/kg (1000mg). STATUS EPILEPTICUS or ACTIVE SEIZURE Loading dose: 18-20mg/kg (MAXIMUM = 25-30mg/kg) *LOADING DOSE IS USUALLY GIVEN PRIOR TO STARTING MAINTENANCE* Maintenance Dose: 100 - 300 mg IVP daily in two or three divided doses. RN IV push approved for doses <300mg
Standard Concentration:	Syringe-based variable flow, continuous microinfusion pump: 1000mg/20ml (50mg/ml) 1g/100ml 0.9% NaCl, stable for 2 hours only (0.22 micron in-line filter required
Special Considerations:	Levels drawn after loading doses should be taken 24 hours after the loading dose has been administered. Accurate history, up to including a serum concentration of phenytoin, should be considered when determining loading dose Administer undiluted IV Push doses through a patent IV of normal saline or flush pre and post with normal saline. Incompatible with dextrose solutions (do not mix or co-administer with D5W). Do not administer as a continuous infusion. Monitor BP during IV administration Avoid administration via hand, wrist or foot. Use best access site possible (large bore vein). If unavailable, consider oral route, or another agent. 0.22 micron in-line filter required for diluted drug. Dosage adjustments may be required in hepatic, cardiac, or renal disease. Monitor serum albumin levels. Calculating phenytoin level correction in hypoalbuminemia: Corrected level= Measured phenytoin level /[(albumin x 0.2) + 0.1] In renal failure: CrCL < 20 Corrected level= Measured phenytoin level /[(albumin x 0.1) + 0.1]
Precautions and Side Effects:	Hypotension, bradycardia and EKG changes Severe thrombophlebitis (Purple Glove Syndrome) CNS depression (nystagmus, somnolence, ataxia)

Please refer to NPROM 8-1-10