Fosphenytoin Sodium

Adults: The dose, the concentration of dosing solutions and the infusion rate of IV Fosphenytoin are all expressed as Phenytoin Sodium equivalents (Fosphenytoin Sodium 1.5 mg is equivalent to Phenytoin Sodium 1 mg). This way, no molecular weight-based adjustment is needed when converting between Fosphenytoin and Phenytoin Sodium doses. Products with particulate matter or discoloration should not be used. Before IV infusion, dilute Fosphenytoin in 5% Dextrose or 0.9% Saline solution for injection to a concentration of 1.5 to 25 mg PE/ml. Status Epilepticus: Give an intravenous infusion at a rate of 100 to 150 mg/minute, starting with 15 mg/kg. After that, give 4 to 5 mg/kg daily in 1 to 2 divided doses, either by intramuscular injection or by intravenous infusion (at a rate of 50 to 100 mg/minute). The dose is adjusted according to response and plasma-phenytoin concentration. Child 5 years and over: Give an intravenous infusion at a rate of 2 to 3 mg/kg/minute, starting with 15 mg/kg. Then give 4 to 5 mg/kg daily in 1 to 4 divided doses by intravenous infusion (at a rate of 1 to 2 mg/kg/minute), adjusting the dose according to response and plasma-phenytoin concentration. Prophylaxis or treatment of seizures associated with neurosurgery or head injury: Give by intramuscular injection or by intravenous infusion (at a rate of 50 to 100 mg/minute), starting with 10 to 15 mg/kg. After that, give 4 to 5 mg/kg daily (in 1 to 2 divided doses) by intramuscular injection or by intravenous infusion (at a rate of 50 to 100 mg/minute). The dose is adjusted according to response and plasma-phenytoin concentration. Child 5 years and over: Give an intravenous infusion at a rate of 1 to 2 mg/kg/minute, starting with 10 to 15 mg/kg, then 4 to 5 mg/kg daily in 1 to 4 divided doses. Adjust the dose according to response and plasma-phenytoin concentration. Temporary substitution for oral Phenytoin: Give by intramuscular injection or by intravenous infusion (at a rate of 50 to 100 mg/minute), using the same dose and dosing frequency as the oral Phenytoin therapy. Child 5 years and over: Give an intravenous infusion at a rate of 1 to 2 mg/kg/minute, with the same dose and dosing frequency as the oral Phenytoin therapy. Patients with Renal or Hepatic Disease: After IV Fosphenytoin is given to patients with renal and/or hepatic disease, or to those with hypoalbuminemia, the clearance of Fosphenytoin to Phenytoin may go up without a similar rise in Phenytoin clearance. This could increase the frequency and severity of adverse events. Elderly: Age has no significant effect on the pharmacokinetics of Fosphenytoin after it is given. Phenytoin clearance is decreased slightly in elderly patients, so a lower or less frequent dose may be required.