Loading doses of both phenytoin and fosphenytoin require dilution prior to intravenous administration 4, 7. Do not administer as a rapid iv infusion, as severe hypotension and bradycardia may occur. Prevention of intravenous drug incompatibilities in an intensive care unit. Intravenous phenytoin for status epilepticus in adults. Phenytoin sodium 50mgml solution for injection summary of.
However, intravenous phenytoin has three major disadvantages. Phenytoin toxicity depends on the route of administration, duration, exposure, and dosage. Loading dose of 10 15mgkg phenytoin by iv infusion. For this reason, serum phenytoin concentrations may increase modestly when iv phenytoin is substituted for oral phenytoin sodium therapy. Intravenous phenytoin for status epilepticus in adults indication. Drug information table hydantoins phenytoin dilantin therapeutic use administration tonicclonic seizures partial seizures give with meals to prevent gi symptoms inject iv form slowly, using correct dilution monitor vital signs during iv administration to prevent cardiac dysrhythmias and hypotension due to narrow. Phenytoin should be administered into a large vein and flushed thoroughly to avoid phlebitis iv cannula patency must be confirmed prior to administration. Phenytoin sodium 50mgml solution for injection summary. Iv compatibility question patient medications allnurses. Preparations containing phenytoin sodium are not bioequivalent to those containing phenytoin base such as epanutin infatabs and epanutin suspension.
The route of administration is the most important determinant of toxicity. If tonicclonic grand mal and absence seizures are present together, combined drug therapy is needed. In the united states, phenytoin is known by the brand names dilantin and phenytek an extended. The chemical name is sodium 5,5diphenyl2, 4imidazolidinedione, having the following structural formula. Drug incompatibilities in the adult intensive care unit of. Dilantin phenytoin sodium 100 mg extended oral capsule. Phenytoin prevents the electrical spread of a focus of irritable tissue from entering normal tissue. Iv drug storage, compatibility, and administration 10. Iv drug compatibility chart g ganciclovir sodium gemcitabine hydrochloride gemtuzumab ozogamicin gentamicin sulfate granisetron hydrochloride. Jun 27, 2019 phenytoin is not effective for absence petit mal seizures.
Phenytoin binds to feeding tube phenytoin binds to enteral formula au yeung sc et al. Supratherapeutic levels are required to control seizures in some cases. Heart monitoring should occur during and after iv infusion. This document does not contain all possible interactions. Therefore this book should be used as guidance only. Dreyfus experience with phenytoin is outlined in his book, a remarkable.
Monographs for commonly administered intravenous medications in home and community care 2 p a g e cefazolin stability compatibilities3 compatible with. This video series was created by the faculty of nursing at the university of alberta with support from elearning services faculty of nursing. Iv infusion should not exceed 50 mgmin in adults or mgkgmin or 50 mgmin, whichever is slower in children. Phenytoin has serious interactions with at least 83 different drugs. The reduction of potentiation prevents cortical seizure foci spreading to adjacent areas, stabilizing the threshold against hyperexcitability. Rr and ecg monitoring is essential for all iv infusions. Monographs for commonly administered intravenous medications. Phenytoin is a hydantoin derivative and a nonsedative antiepileptic agent with anticonvulsant activity. Pdf compatibility and stability of drug products and preparations. Therapeutic levels of phenytoin are 4080 umollitre. The intravenous form is used for status epilepticus that does not improve with benzodiazepines. The older formulation phenytoin in a basic solution including ethylene glycol is still used because its cost is substantially lower.
Pointofcare tools such as drug id, trissels iv compatibility, toxicology, and patient education. Phenytoin sodium phosphonoformate phytonadione piperacillin and tazobactam. Ismp canada safety bulletin volume issue 1 february 12, 20 intravenous phenytoin. Patients receiving phenytoin infusions require close haemodynamic monitoring. Hyperglycaemia has been reported in association with toxic levels. Its available as a generic drug and as the brandname drugs phenytek and dilantin. Ann pharmacother 2000 jpen j parenter enteral nutr. Phenytoin is the generic name of a widely used antiepileptic drug aed. The correct therapeutic dose of phenytoin should be determined by seizure control and clinical toxicity, not by serum drug levels. Phenytoin oral capsule is used to treat tonicclonic and complex partial seizures in people with epilepsy. Route onset peak duration phenytoin itoyn po 224hr1wk. The rate of administration for iv dilantin should be no greater than 50 mg per minute in adults and 1 to 3 mgkgmin or 50 mg per minute, whichever is slower. Analysis of an incident report received through the national system for incident reporting nsir. There have been two placebocontrolled studies in healthy men of the pharmacokinetic interaction of voriconazole with phenytoin 46 c.
Iv drug storage, compatibility, and administration. Phenytoin sodium is related to the barbiturates in chemical structure, but has a fivemembered ring. Mar 28, 2019 other measures, including concomitant administration of an iv benzodiazepine such as diazepam, or an iv shortacting barbiturate, will usually be necessary for rapid control of seizures because of the required slow rate of administration of phenytoin. Phenytoin has mild interactions with at least 121 different drugs. Complete listing of injectable drugs reported in the king guide online edition and print edition. Oct 28, 2019 because of required slow rate of iv phenytoin administration, concurrent use of an iv benzodiazepine usually is necessary for rapid control of seizures. Phenytoin potentially acts by promoting sodium efflux from neurons located in the motor cortex reducing posttetanic potentiation at synapses. Following the use of diazepam in patients having continuous seizures and in. This structure is also available as a 2d mol file or as a. Phenytoin 100mg filmcoated tablets summary of product characteristics smpc by aurobindo pharma.
Drug incompatibilities in the adult intensive care unit of a university hospital. Phenytoin 100mg filmcoated tablets summary of product. The rate of administration for iv dilantin should be no greater than 50 mg per minute in adults and 1 to 3 mgkgmin or 50 mg per minute, whichever is slower in pediatric patients. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Apr 07, 2020 e the saturated solubility of phenytoin, usp, in carbon dioxidefree, freshdeionized water at ph 7 at 25 c was reported to be 20 gml. It may also be used for certain heart arrhythmias or neuropathic pain. Iv phenytoin and throughout period when peak serum phenytoin levels occur 1530minafteradministration. I drank celery juice for 7 days and this is what happened no juicer required. Monitor cbc, serum calcium, albumin, and hepaticfunctiontestspriortoandmonthlyforthe. Find information on digoxin lanoxin in daviss drug guide including dosage, side effects, interactions, nursing implications, mechanism of action, half life, administration, and more.
Prevention of intravenous drug incompatibilities in an icu. Phenytoin is contraindicated in patients with a history of hypersensitivity to phenytoin, its inactive ingredients, or other hydantoins. A patient must have a central line available to receive these. In a patient having continuous seizure activity, as compared to the more common rapidly recurring seizures, i. Because of its effect on ventricular automaticity, phenytoin is contraindicated in sinus bradycardia, sinoatrial block, second and third degree av block, and patients with adamsstokes syndrome. If iv administration does not terminate seizures, the use of other anticonvulsants, iv. Intravenous, omega laboratories ltd, 19921231, not applicable, canada canada. Phenytoin sodium reference guide for safe and effective use from the american. One doesnt list 12 ns at all when you search for medfluid compatibility. The rate of administration for iv dilantin should be no greater than 50 mg per minute in adults and 1 to 3 mgkgmin. A longer time is required to achieve therapeutic levels.
Iv drug storage, compatibility, and administration 1016. Dilantin phenytoin sodium injection, usp is a readymixed solution of phenytoin sodium in a vehicle containing 40% propylene glycol and 10% alcohol in water for injection, adjusted to ph 12 with sodium hydroxide. Parenteral dilantin phenytoin sodium injection, usp fda. Iv drug compatibility chart the iv drug compatibility chart is based on information from the handbook of injectable drugs, 16th edition, by lawrence a.
Dec 11, 2018 phenytoin is 100% bioavailable by the iv route. Monitor serum concentrations when iv phenytoin is used for status epilepticus. If your institution subscribes to lexicomp online and you are seeing this page in error, please contact support. If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Monitorecgcontinuouslyduringtreatmentofarrhythmias. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first. Drug information table hydantoins phenytoin dilantin. Critical care intravenous drug administration guide. Iv infusion not recommended by many due to poor solubility and risk of crystal formation. Parenteral phenytoin sodium injection, usp warning. Find patient medical information for phenytoin oral on webmd including its uses, side effects and safety, interactions, pictures, warnings and user ratings. We conducted a randomized study to evaluate the comparative effect of intravenous iv phenytoin and intravenous valproate iv.
The dose is the same for all phenytoin products when initiating therapy. Proceedings of the epilepsy foundations 2017 cannabinoids in epilepsy therapy workshop. Phenytoin sodium has also been employed in the treatment of trigeminal neuralgia but it should only be used as second line therapy if carbamazepine is ineffective or patients are intolerant to carbamazepine. Jan 09, 2018 heart and blood vessels severe low blood pressure and abnormal heart rhythms can be seen with rapid infusion of iv phenytoin. Phenytoin has moderate interactions with at least 286 different drugs. Phenytoin administration has been associated with toxic effects. Phenytoin sodium injection is physically andor chemically incompatible with some drugs, but the compatibility depends on several factors e. Intravenous administration of formulary medications. In contrast, when we have an intravenous drug solution, it is unacceptable. Stay informed of new and updated iv drug compatibility and stability. My coworker says this is because if its tested with ns, it doesnt need to be tested with 12 but im not sure i buy that. It is useful for the prevention of tonicclonic seizures and focal seizures, but not absence seizures.
Drug information table hydantoins phenytoin dilantin therapeutic use administration tonicclonic seizures partial seizures give with meals to prevent gi symptoms inject iv form slowly, using correct dilution monitor vital signs during iv administration to prevent cardiac dysrhythmias and hypotension. The reduction of potentiation prevents cortical seizure foci spreading to adjacent areas. If bradycardia or hypotension occurs halve the infusion rate. Epilepsy pipeline 2014 session v, vi and lifetime accelerator award. Since the variation in the bioavailability and elimination of phenytoin does not allow accurate prediction of the steadystate plasma concentration, monitoring plasma levels may be of special importance. The mixing of phenytoin sodium with other drugs or with intravenous infusion solutions is not recommended because the solubility of phenytoin sodium is such that. Phenytoin pht, sold under the brand name dilantin among others, is an antiseizure medication. Due to these risks, oral phenytoin should be used if possible. Phenytoin may affect glucose metabolism and inhibit insulin release. If iv phenytoin is used in a nonemergent situation. The intravenous form is used for status epilepticus that does not improve with. Jun 10, 2014 this video series was created by the faculty of nursing at the university of alberta with support from elearning services faculty of nursing. Chapter 37 compatibility and stability of drug products and preparations 685 figure 37. Ecg, heart rate, blood pressure and respiratory function.
Continuous bp, rr and ecg monitoring is essential for all iv infusions. When based on the comparison of the auc for multiple oral dosing with the single iv dose area, average bioavailability was 85. Drug incompatibilities in the adult intensive care unit of a. Phenytoin pht, sold under the brand name dilantin among others, is an anti seizure medication. The other comes up as untested when you search a med and 12.
Rate of administration is critical phenytoin has been in use for decades, but healthcare providers should remain alert to potential risks. Incompatibilities are based on meeting any of the following criteria. Phenytoin induces cyp3a4 activity and is a substrate and inducer of cyp2c9 and cyp2c19. Phenytoin sodium injection, usp is a sterile solution containing in each ml phenytoin sodium 50 mg, propylene glycol 0. Generally, administered as 1g phenytoin diluted in 100ml sterile 0. Feb 01, 2016 in the case of ysite drug administration, the contact time is approximately 1 to 2 minutes depending on the infusion flow, whereas the contact time between drugs mixed in the same syringe or iv bag can last for hours or days, and chemical reactions can occur during that period. Compatibility and stability of drug products and preparations. The first was an open study of the effect of phenytoin 300 mgday on the steadystate pharmacokinetics of voriconazole 200. Phenytoin sodium injection usp, solution, intramuscular. Trissel, fashp, 2010, american society of healthsystem pharmacists.
Clinical pharmacology of parenteral use of antiepileptic drugs. Dec 10, 2018 phenytoin sodium injection, usp is a sterile solution containing in each ml phenytoin sodium 50 mg, propylene glycol 0. Severe low blood pressure and abnormal heart rhythms can be seen with rapid infusion of iv phenytoin. We have kings and trissels iv compatibility lookup on our system. Oct 04, 2014 we have kings and trissels iv compatibility lookup on our system. Other measures, including concomitant administration of an iv benzodiazepine such as diazepam, or an iv shortacting barbiturate, will usually be necessary for rapid control of seizures because of the required slow rate of administration of phenytoin.
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