Indication

Fosphenytoin is indicated for short-term parenteral administration when other means of Phenytoin administration are unavailable, inappropriate or deemed less advantageous. Fosphenytoin can be used for the control of generalized convulsive status epilepticus and
prevention and treatment of seizures occurring during neurosurgery or head injury. It can also be substituted, short-term, for oral Phenytoin. The safety and effectiveness of  Fosphenytoin in this use has not been systematically evaluated for more than 5 days.


Dosage & Administration

The dose, concentration in dosing solutions, and infusion rate of IV Fosphenytoin is expressed as Phenytoin Sodium equivalents (PE); (Fosphenytoin Sodium 1.5 mg equivalent to Phenytoin Sodium 1 mg) to avoid the need to perform molecular weight-based adjustments when converting between Fosphenytoin and Phenytoin Sodium doses. Products with particulate matter or discoloration should not be used. Prior to IV infusion, dilute Fosphenytoin in 5% Dextrose or 0.9% Saline solution for injection to a concentration ranging from 1.5 to 25 mg PE/ml. Status Epilepticus: By intravenous infusion (at a rate of 100-150 mg (PE)/minute), initially 15 mg (P/E)/kg then by intramuscular injection or by intravenous infusion (at a rate of 50-100 mg (PE)/minute), 4-5 mg (P/E)/kg daily in 1-2 divided doses, dose adjusted according to response and through plasma-phenytoin concentration. Child 5 years and over: By intravenous infusion (at a rate of 2-3 mg (PE)/kg/minute), initially 15 mg (PE)/kg then by intravenous infusion (at a rate of 1-2 mg (PE)/kg/minute), 4-5 mg (PE)/kg daily in 1-4 divided doses, dose adjusted according to response and through plasma-phenytoin concentration. Prophylaxis or treatment of seizures associated with neurosurgery or head injury: by intramuscular injection or by intravenous infusion (at a rate of 50-100 mg (PE)/minute, initially 10-15 mg (PE)/kg then by intramuscular injection or by intravenous infusion (at a rate of 50-100 mg (PE)/minute), 4-5 mg (PE)/kg daily (in 1-2 divided doses), dose adjusted according to response and through plasmaphenytoin concentration. Child 5 years and over: By intravenous infusion (at a rate of 1-2 mg (PE)/kg/minute), initially 10-15 mg (PE)/kg then 4-5 mg (PE)/kg daily in 1-4 divided doses, dose adjusted according to response and through plasma-phenytoin concentration. Temporary substitution for oral Phenytoin: By intramuscular injection or by intravenous infusion (at a rate of 50-100 mg (PE)/minute), same dose and dosing frequency as oral Phenytoin therapy. Child 5 years and over: By intravenous infusion (at a rate of 1-2 mg (PE)/kg/minute), same dose and dosing frequency as oral Phenytoin therapy. Dosing in Special Populations: Patients with Renal or Hepatic Disease: After IV Fosphenytoin administration to patients with renal and/or hepatic disease, or in those with hypoalbuminemia, Fosphenytoin clearance to Phenytoin may be increased without a similar increase in Phenytoin clearance. This has the potential to increase the frequency and severity of adverse events. Elderly: Age does not have a significant impact on the pharmacokinetics of Fosphenytoin following Fosphenytoin administration. Phenytoin clearance is decreased slightly in elderly patients and lower or less frequent dosing may be required.


Precautions

Phosphate Load: The phosphate load provided by Fosphenytoin (0.0037 mmol phosphate/mg PE Fosphenytoin) should be considered when treating patients who require phosphate restriction, such as those with severe renal impairment. General: Fosphenytoin is not indicated for the treatment of absence seizures. Phenytoin and other Hydantoins are contraindicated in patients who have experienced Phenytoin hypersensitivity. Phenytoin has been infrequently associated with the exacerbation of porphyria. Phenytoin may also raise the serum glucose concentrations in diabetic patients.


Product Details


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