Fosphenytoin Sodium Pharmacology
Fosphenytoin Sodium
Phenytoin acts on the motor cortex where it stabilizes neuronal membrane and inhibits the spread of seizure discharge. It prolongs the inactivated state of voltage sensitive neuronal sodium ion channel either by increasing the efflux or decreasing the influx of sodium ion across the cell membrane and inhibits the high frequency discharge.
At high concentrations Phenytoin
1. Enhances calcium binding to phospholipids in neuronal membrane and results in a more stable neuronal membrane.
2. It enhances the concentration of inhibitory neurotransmitter GABA
3. It inhibits the excitatory glutamate receptors.
All these indicate that Phenytoin limits the development of maximal seizure activity and reduce the spread of the seizure process from the active focus.
Antiarrhythmic action: Phenytoin exerts its action by normalizing sodium entry to Purkinje`s fibers in patient with cardiac glycoside induced arrhythmias.
2.Dizziness
3.Ataxia
4.Pruritis
5.Somnolence
6.Headache
7.Nausea
8.Vomiting
9.Tremor
10.Incoordination
11.Heart failure
12.Paresthesia
13.Dry mouth
14.Rash
15.Dermatitis
16.Abdominal discomfort
17.Constipation
18.Anorexia
2.Atrioventricular block
3.Sinus Bradycardia
4.Sino Atrial block
5.Adams-Stokes syndrome
2.Myocardial infarction
3.Hypotension
4.Renal impairment
5.Diabetic mellitus
6.Hypoalbuminemia
7.Porphyria
NEONATES: contraindicated
2.Prevention and treatment of seizure during neurosurgery
3.Short term substitution for oral Phenytoin therapy
Status epilepticus:
Loading dose: (IV) 15 - 20 mg Phenytoin sodium equivalent (PE)/kg
Infusion rate: 100 - 150 mg / minute
Maintenance dose: 4 - 6 mg PE /kg/day
Prevention and treatment of seizure during neurosurgery:
Loading dose: (IV/IM) 10 - 20 mg Phenytoin sodium equivalent (PE)/kg
Infusion rate below 150 mg / minute
Maintenance dose: 4 - 6 mg PE /kg/day
Short term substitution for oral Phenytoin therapy:
Total oral Phenytoin sodium daily dose (200 - 400 mg / day) is given as single IM or IV at an infusion rate below 150 mg / minute
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