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Common emergency department practice when treating patients with recent seizures is to administer a loading dose of phenytoin. But which phenytoin loading method is best -- oral or intravenous? And is the newer agent, fosphenytoin, a better choice than phenytoin? These authors compared the pharmacokinetics of oral phenytoin, IV phenytoin, and IV fosphenytoin loading in adults who presented to an ED within 48 hours after having a seizure and whose phenytoin blood concentrations were subtherapeutic.
Forty-five patients were randomized to receive loading doses of oral phenytoin (20 mg/kg divided into maximum doses of 400 mg every 2 hours), IV phenytoin (18 mg/kg at an initial infusion rate of 50 mg/min), or IV fosphenytoin (18 mg/kg phenytoin e…