Single-dose oral phenytoin loading

Osborn, Harold H; Zisfein, James; Sparano, Robert

doi:10.1016/s0196-0644(87)80360-8

Cited by 27 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The PHT dosage schedule used was sufficiently well tolerated and yielded therapeutic serum levels in 86, 100, 100, and 82% of subjects at 4, 8, 24, and 48 h, which compared well with the results Osborn et al (1987) which showed therapeutic levels in 57% (23 subjects), 64% (22 subjects), and 60% (5 subjects) at 4, 8, and 24 h after loading, respectively. The correlation of clinical nystagmus with serum level was reported for CBZ (Riva et al, 1985) and PHT (Kutt et al, 1964) and might be a clinically expedient gauge to estimate the second-day dosage.…”

Section: Discussionsupporting

confidence: 77%

“…The sister and the resident administered the acute and the 24and 36-h doses and the maintenance dose at (Osborn et al, 1987) and split of the PHT dose (Wilder et al, 1973;Galdames et al, 1988) were incorporated in a dosage-finding study of 24 subjects, which led to use of these dosing schedules.…”

Section: Subjects and Protocolmentioning

confidence: 99%

“…Studies of effective acute oral loading doses of phenytoin (PHT, Wilder et al, 1973;Gibberd and Webley, 1975;Evens et al, 1980;Bittencourt and Richens, 1985;Osborn et al, 1987;Leite et al, 1987;Galdames et al, 1988) (Table 1) and carbamazepine (CBZ, Schmidt et al, 1984;Bittencourt and Richens, 1985;Macphee et al, 1986;Leppik et al, 1988; Leite et al, 1987;Bourgeois et al, 1989;Miles et al, 1989, Van der Meyden et al, 1992) (Table 2) are sparse and incomplete.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Acute Oral Loading of Carbamazepine‐CR and Phenytoin in a Double‐Blind Randomized Study of Patients at Risk of Seizures

et al. 1994

View full text Add to dashboard Cite

The serum levels and side effects of an acute oral loading dose-schedule of carbamazepine (CBZ) divitabs [CBZ controlled release (CR)] and phenytoin (PHT) were assessed in patients at risk of seizures. CBZ-CR and PHT were administered to 42 adult patients (21 each) at a dosage of 20 mg/kg with a minimum and maximum dosage of 1,200 and 1,600 mg in patients weighting < 60 and > 80 kg, respectively. CBZ-CR was given as single loading dose; PHT was split, with two thirds of the dose administered at 0 h and one third administered 2 h later. The 24- and 36-h doses were assessed according to the nystagmus status at 24 h. Mean CBZ serum levels (percentage of subjects with level > 4 micrograms/ml shown in parentheses) were 0.0 (0%), 5.2 (62%), 6.7 (81%), 6.8 (95%), and 6.1 micrograms/ml (95%) at 0, 4, 8, 24, and 48 h after loading, respectively, and mean PHT levels (percentage of subjects with PHT level > 10 micrograms/ml in parentheses) were 0.1 (0%), 13.2 (86%), 16.3 (100%), 16.3 (100%), and 15.4 micrograms/ml (82%). One subject in the CBZ group and 3 in the PHT group vomited. Clinical effects did not differ significantly between treatment groups and are reported. Acute doses of CBZ-CR 20 mg/kg and PHT 20 mg/kg (two-thirds at 0 h and one-third at 2 h) provided therapeutic levels in most patients in < or = 4 h and were well tolerated.

show abstract

Section: Discussionsupporting

confidence: 77%

Section: Subjects and Protocolmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Acute Oral Loading of Carbamazepine‐CR and Phenytoin in a Double‐Blind Randomized Study of Patients at Risk of Seizures

et al. 1994

View full text Add to dashboard Cite

show abstract

“…[7][8][9][12][13][14] In previous studies, where accelerated oral loading regimens were used (using doses higher than those recommended by the manufacturer), only in one were therapeutic concentrations achieved faster than in the current study. The slower and incomplete absorption that occurs with larger single doses is presumably the result of the capacity-limited absorption of phenytoin.…”

Section: Discussionmentioning

confidence: 99%

A Comparison of Phenytoin-loading Techniques in the Emergency Department

Swadron

Rudis²,

Azimian

et al. 2004

Acad Emergency Med

View full text Add to dashboard Cite

Objectives: To compare the effectivenesses of three phenytoin-loading techniques. Methods: Patients with subtherapeutic phenytoin concentrations who presented within 48 hours of a seizure were randomized to receive either 20 mg/ kg of oral phenytoin (PO), divided in maximum doses of 400 mg every two hours, 18 mg/kg of intravenous phenytoin (IVP) at an initial infusion rate of 50 mg/min, or 18 mg/kg (phenytoin equivalents) of intravenous fosphenytoin (IVF) at an initial infusion rate of 150 mg/min. Results: A total of 45 patients were enrolled: 16 in the PO group, 14 in the IVP group, and 15 in the IVF group. The times required to reach therapeutic drug concentrations were (mean 6 standard deviation [SD]) 5.62 6 0.28 hours, 0.24 6 0.3 hours, and 0.21 6 0.28 hours, respectively. A total of 17, 27, and 32 adverse drug events were observed in the PO, IVP, and IVF groups, respectively, with significantly fewer events in the PO group (p ¼ 0.02, p ¼ 0.01). No significant difference was found between the numbers of necessary adjustments to the infusions in the two IV groups. The average time to safe emergency department discharge was significantly shorter for the IV groups compared with the PO group (p\0.001). Conclusions: Oral loading has fewer adverse drug events than either IV loading method, but its use may be limited when therapeutic concentrations are required quickly. Although IVF loading is faster, from an adverse-drug event perspective, no advantage of IVF over IVP was apparent.

show abstract

“…9 Final serum levels were not statistically different in that study, but increasing the oral dose from 400 mg to 1,600 mg decreased the amount absorped from 92% to 78%. Large amounts of phenytoin tend to coalesce in the acid pH of the stomach, and indeed in the ED single, large-dose, oral loading study by Osborn et al, 8 resulted in a few cases of vomiting.…”

mentioning

confidence: 99%

Fosphenytoin farewell?

Horowitz¹

2004

Annals of Emergency Medicine

View full text Add to dashboard Cite

Single-dose oral phenytoin loading

Cited by 27 publications

References 27 publications

Acute Oral Loading of Carbamazepine‐CR and Phenytoin in a Double‐Blind Randomized Study of Patients at Risk of Seizures

Acute Oral Loading of Carbamazepine‐CR and Phenytoin in a Double‐Blind Randomized Study of Patients at Risk of Seizures

A Comparison of Phenytoin-loading Techniques in the Emergency Department

Fosphenytoin farewell?

Contact Info

Product

Resources

About