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Guidelines for Nonemergency Use of Parenteral Phenytoin Products
Proceedings of an Expert Panel Consensus Process
Patrick D. Meek, PharmD;
Stephanie N. Davis, PharmD;
D. Michael Collins, RPh, BS;
Barry E. Gidal, PharmD;
Paul A. Rutecki, MD;
Aaron H. Burstein, PharmD;
James H. Fischer, PharmD;
Ilo E. Leppik, MD;
R. Eugene Ramsay, MD;
for the Panel on Nonemergency Use of Parenteral Phenytoin Products
Arch Intern Med. 1999;159:2639-2644.
This document summarizes the proceedings of an expert panel consensus process addressing the nonemergency use of parenteral phenytoin products for management of seizures in pediatric and adult patients. The algorithm and consensus statements developed by the expert panel emphasize strategies for lowering the probability of adverse events associated with the use of parenteral phenytoin products. Specific patient characteristics are defined to guide administration and monitoring of parenteral phenytoin therapy. The algorithm provides a decision pathway for the selection of the product and the route of administration of phenytoin sodium or fosphenytoin sodium after it has been determined that a parenteral phenytoin product is appropriate. Key factors covered in the algorithm include a list of patient characteristics and considerations necessary to prevent parenteral phenytoin adverse effects during selection of administration route and recommendations for monitoring of parenteral phenytoin therapy once it has been initiated. Situations requiring rapid attainment of high phenytoin concentrations, such as in the management of acute seizures, are not addressed in these guidelines.
From the School of Pharmacy (Drs Meek and Gidal) and Department of Neurology (Drs Gidal and Rutecki), University of Wisconsin, and the Center for Drug Policy and Clinical Economics (Dr Davis) and the Department of Pharmacy (Mr Collins), University of Wisconsin Hospital and Clinics, Madison; the Department of Pharmacy Practice and Science, University of Maryland, Baltimore (Dr Burstein); the Department of Pharmacy Practice, University of Illinois, Chicago (Dr Fischer); MINCEP Epilepsy Care, University of Minnesota, Minneapolis (Dr Leppik); and the International Center for Epilepsy, University of Miami, Miami, Fla (Dr Ramsay).
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