2.50
Hdl Handle:
http://hdl.handle.net/10755/162807
Type:
Presentation
Title:
Fosphenytoin (Cerebyx) Loading Dose Administration in the Emergency Department
Abstract:
Fosphenytoin (Cerebyx) Loading Dose Administration in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:1997
Author:Fischer, Patricia
P.I. Institution Name:University of Illinois at Chicago, College of Pharmacy
Contact Address:833 South Wood Street, Room 164, Chicago, IL, 60612, USA
Co-Authors:Susan Henkin
Purpose: Administration of IV phenytoin (PHT) in the Emergency Department (ED) requires significant nursing resources. Fosphenytoin (FOS; Cerebyx), a phenytoin prodrug, overcomes many of the clinical complications associated with parenteral phenytoin providing greater flexibility (IM and IV routes), convenience (faster rate of IV infusion, IV fluid compatibility), and patient comfort (improved injection/infusion tolerance). Injection/infusion tolerance, general safety, and pharmacokinetics results from 6 prospective, multicenter clinical studies with fosphenytoin are reviewed, with particular emphasis to ED nursing practice.

Methods: Data from 543 patients from 3 double-blind IV and 3 open-label (1 IV; 2IM) studies conducted at 43 facilities were reviewed and summarized. Patients enrolled in these studies had status epilepticus (n=85 FOS) seizures (n=189 FOS, n=35 PHT), or neurosurgical/head injury (n=206 FOS, n=28 PHT), and required a phenytoin loading dose for the treatment/prophylaxis of seizures. Target loading doses for fosphenytoin and phenytoin ranged from 10 to 20 mg/kg phenytoin equivalents; target IV rates ranged from 50 to 150 mg/min with fosphenytoin and up to 50 mg/min with phenytoin.

Results: Therapeutic plasma phenytoin concentrations (>10 micrograms/mL) were rapidly achieved following IV and IM fosphenytoin loading doses. Intravenous fosphenytoin resulted in less pain/burning at infusion site than phenytoin (9% of patients vs. 90%, respectively), fewer disruptions to the infusion (14% vs. 48%), and was safely infused in less time (21 vs. 42 min.). Fosphenytoin provided improved IV fluid compatibility/stability. Larger than typical IM volumes (10 to 20 cc) were well tolerated, and 95% of fosphenytoin injections were without irritation. Central nervous system related adverse events were similar for both fosphenytoin and phenytoin. Transient groin itching/burning occurred occasionally with IV fosphenytoin. No clinically significant hypotension or arrhythmias were seen following either fosphenytoin or phenytoin.

Conclusions: Intramuscular and intravenous fosphenytoin loading doses are safe and significantly better tolerated by the patient than parenteral phenytoin. Therapeutic plasma phenytoin concentrations are rapidly achieved. Improved safety/tolerability profile and faster administration of fosphenytoin enhances the delivery of care the emergency nurse provides. [Research Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleFosphenytoin (Cerebyx) Loading Dose Administration in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162807-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Fosphenytoin (Cerebyx) Loading Dose Administration in the Emergency Department</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1997</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Fischer, Patricia</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Illinois at Chicago, College of Pharmacy</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">833 South Wood Street, Room 164, Chicago, IL, 60612, USA</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Susan Henkin</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Administration of IV phenytoin (PHT) in the Emergency Department (ED) requires significant nursing resources. Fosphenytoin (FOS; Cerebyx), a phenytoin prodrug, overcomes many of the clinical complications associated with parenteral phenytoin providing greater flexibility (IM and IV routes), convenience (faster rate of IV infusion, IV fluid compatibility), and patient comfort (improved injection/infusion tolerance). Injection/infusion tolerance, general safety, and pharmacokinetics results from 6 prospective, multicenter clinical studies with fosphenytoin are reviewed, with particular emphasis to ED nursing practice.<br/><br/>Methods: Data from 543 patients from 3 double-blind IV and 3 open-label (1 IV; 2IM) studies conducted at 43 facilities were reviewed and summarized. Patients enrolled in these studies had status epilepticus (n=85 FOS) seizures (n=189 FOS, n=35 PHT), or neurosurgical/head injury (n=206 FOS, n=28 PHT), and required a phenytoin loading dose for the treatment/prophylaxis of seizures. Target loading doses for fosphenytoin and phenytoin ranged from 10 to 20 mg/kg phenytoin equivalents; target IV rates ranged from 50 to 150 mg/min with fosphenytoin and up to 50 mg/min with phenytoin.<br/><br/>Results: Therapeutic plasma phenytoin concentrations (&gt;10 micrograms/mL) were rapidly achieved following IV and IM fosphenytoin loading doses. Intravenous fosphenytoin resulted in less pain/burning at infusion site than phenytoin (9% of patients vs. 90%, respectively), fewer disruptions to the infusion (14% vs. 48%), and was safely infused in less time (21 vs. 42 min.). Fosphenytoin provided improved IV fluid compatibility/stability. Larger than typical IM volumes (10 to 20 cc) were well tolerated, and 95% of fosphenytoin injections were without irritation. Central nervous system related adverse events were similar for both fosphenytoin and phenytoin. Transient groin itching/burning occurred occasionally with IV fosphenytoin. No clinically significant hypotension or arrhythmias were seen following either fosphenytoin or phenytoin.<br/><br/>Conclusions: Intramuscular and intravenous fosphenytoin loading doses are safe and significantly better tolerated by the patient than parenteral phenytoin. Therapeutic plasma phenytoin concentrations are rapidly achieved. Improved safety/tolerability profile and faster administration of fosphenytoin enhances the delivery of care the emergency nurse provides. [Research Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:34:29Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:34:29Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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