#EMconf: Phenytoin: Friend or Foe?
- Phenytoin (Dilantin) is a second line therapy for the actively seizing patient
-Use only if Fosphenytoin (Cerebyx) is not available
-First line: Lorazepam IV, Diazepam IV, Midazolam IM
- Dose → 20 mg/kg IV Rate
- 1 mg/kg/min
-Max rate of 50 mg/min
-Geriatrics → 50 mg over 2-3 minutes
-Pregnancy (Category D)
-Sinus Bradycardia AV Block - 2nd or 3rd degree
- Feared Complication: If administered too quickly, can lead to fatal hypotension and cardiotoxicity
- Fosphenytoin (Cerebyx)
-Prodrug of phenytoin
-Dosed as Phenytoin Equivalents (PE) Dose → 20 PE/kg IV Rate → 150 PE/min
Take Home Points:
-Phenytoin IV is a good second line agent for the actively seizing patient if benzodiazepines fail, but must be administered slowly (no faster than 50mg/min) due to risk of fatal hypotension and cardiac toxicity.
-If you have Fosphenytoin available, use it! It is safer and can be administered faster than Phenytoin.
Glauser, T., Shinnar, S., Gloss, D., Alldredge, B., Arya, R., Bainbridge, J., & ... Treiman, D. M. (2016). Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Currents, 16(1), 48-61.