Association of intravenous phenytoin toxicity with demographic, clinical, and dosing parameters

Tolerability, safety, and side effects of levetiracetam versus phenytoin in intravenous and total prophylactic regimen among craniotomy patients: A prospective randomized study

“…Total side effect rate is mostly reported around 25–27% for intravenous or oral PHT (Earnest et al., 1983; Appleton & Gill, 2003; Depondt et al., 2011) but has been cited at 9.1% (intravenous) (Coplin et al., 2002) and 55.9% (oral) (Ramsay et al., 2010). The most common reported intravenous side effects are burning pain at the site, 9.1–37% (Earnest et al., 1983; Henkin et al., 1996; Mattson, 1996; DeToledo & Ramsay, 2000; Coplin et al., 2002; Appleton & Gill, 2003); local cutaneous reaction (LCR)/purple glove syndrome (PGS), 1.3% strict PGS to 25.2% mild to moderate LCR (Burneo et al., 2001; O’Brien et al., 2001); hypotension, 1–14%, higher in SE (Earnest et al., 1983; Binder et al., 1996; Henkin et al., 1996; Mattson, 1996; DeToledo & Ramsay, 2000; De Santis et al., 2002; Appleton & Gill, 2003; Martinelli & Muhlebach, 2003); and drug intoxication, approximately 15% (Earnest et al., 1983). Important but less common side effects are allergy, 2% (rapid loading) (Martinelli & Muhlebach, 2003) and cardiac arrhythmia, 1–7% (Earnest et al., 1983; Mattson, 1996; Treiman et al., 1998; DeToledo & Ramsay, 2000; Appleton & Gill, 2003).…”

Incidence and risk factors of hypotension after intravenous fosphenytoin administration

“…7,8 Therefore, FOS can be administered rapidly with fewer local reactions and a reduced likelihood of hypotension. 11 Phenytoin has the same pro-dysarrhythmic properties as In addition, FOS has a higher protein binding affinity than phenytoin; therefore, rapid FOS infusion can induce a transient but significant increase in the serum concentration of free phenytoin, which can contribute to the development of adverse cardiovascular events. 11 Phenytoin has the same pro-dysarrhythmic properties as In addition, FOS has a higher protein binding affinity than phenytoin; therefore, rapid FOS infusion can induce a transient but significant increase in the serum concentration of free phenytoin, which can contribute to the development of adverse cardiovascular events.…”

“…In addition to propylene glycol, IV infusion of phenytoin itself depresses myocardial contractility and decreases peripheral vascular resistance. 11 Phenytoin has the same pro-dysarrhythmic properties as In addition, FOS has a higher protein binding affinity than phenytoin; therefore, rapid FOS infusion can induce a transient but significant increase in the serum concentration of free phenytoin, which can contribute to the development of adverse cardiovascular events. 12 One explanation for the high occurrence of hypotension in our study is that the IV infusion of FOS was mostly administered to pa- elderly patients.…”

Requirement for cardiac telemetry during intravenous phenytoin infusion: guideline fact or guideline fiction?

“…Given that the use of IV phenytoin as a treatment for arrhythmias is largely confined to the history books, we examined the published literature on the frequency of adverse cardiac events in patients who received IV phenytoin for a non‐cardiac indication. Twenty‐six studies reporting adverse effects were identified . They were published between 1958 and 2011 (Table ), comprising a study population of 2254 patients aged from 6 days to 94 years.…”