Classifications: hydantoin anticonvulsant agent; Therapeutic: anticonvulsant
Pregnancy Category: D
150 mg, 750 mg vials
Prodrug of phenytoin that converts to the anticonvulsant phenytoin after parenteral administration. Thought to modulate the
sodium channels of neurons, calcium flux across neuronal membranes, and enhance the sodiumpotassium ATPase activity
of neurons and glial cells.
The cellular mechanism of phenytoin is thought to be responsible for the anticonvulsant activity of fosphenytoin.
Control of generalized convulsive status epilepticus and the prevention and treatment of seizures during neurosurgery, or
as a parenteral short-term substitute for oral phenytoin.
Antiarrhythmic agent especially in treatment of digitalis-induced arrhythmia; treatment of trigeminal neuralgia (tic douloureux).
Hypersensitivity to hydantoin products, rash, seizures due to hypoglycemia, sinus bradycardia, complete or incomplete heart
block; AdamsStokes syndrome; pregnancy (category D).
Impaired liver or kidney function, alcoholism, hypotension, heart block, bradycardia, severe CAD, diabetes mellitus, hyperglycemia,
respiratory depression, acute intermittent porphyria; lactation.
Route & Dosage
Adult: IV Loading Dose 1520 mg PE/kg (PE = phenytoin sodium equivalents) administered at 100150 mg PE/min IV Maintenance Dose 46 mg PE/kg/d
Substitution for Oral Phenytoin Therapy
Adult: IV/IM Substitute fosphenytoin at the same total daily dose in mg PE as the oral dose at a rate of infusion not greater than 150
- Note: All dosing is expressed in phenytoin sodium equivalents (PE) to avoid the need to calculate molecular weight adjustments between
fosphenytoin and phenytoin sodium doses. Always prescribe and fill fosphenytoin in PE units.
- Follow institutional policy regarding maximum volume to inject into one IM site.
PREPARE: Direct: Dilute in DSW or NS to a concentration of 1.525 mg PE/mL.
ADMINISTER: Direct: Do not administer at a rate >150 mg PE/min.
INCOMPATIBILITIES Y-site: Fenoldopam, midazolam.
- Store at 2°8° C (36°46° F); may store at room temperature not to exceed 48 h.
Adverse Effects (≥1%)CNS:
Usually dose related. Paresthesia
, tinnitus, nystagmus, dizziness, somnolence, drowsiness,
ataxia, mental confusion, tremors, insomnia
, headache, seizures, increased reflexes, dysarthria, intracranial hypertension. CV:
Bradycardia, tachycardia, asystole, hypotension, hypertension, cardiovascular collapse, cardiac arrest
, heart block, ventricular fibrillation, phlebitis. Special Senses:
, blurred vision. GI: Gingival hyperplasia,
nausea, vomiting, constipation
, epigastric pain, dysphagia, loss of taste, weight loss, hepatitis
, liver necrosis. Hematologic: Thrombocytopenia
, leukocytosis, agranulocytosis
, eosinophilia; megaloblastic, hemolytic, or aplastic anemias
Fever, hyperglycemia, glycosuria, weight gain, edema, transient increase in serum
thyrotropic (TSH) level, hyperkalemia, osteomalacia
or rickets associated with hypocalcemia and elevated alkaline phosphatase
activity. Skin: Alopecia
, hirsutism (especially in young female); rash: scarlatiniform, maculopapular, urticarial, morbilliform (may be fatal);
bullous, exfoliative, or purpuric dermatitis; Stevens-Johnson syndrome
, toxic epidermal necrolysis
, keratosis, neonatal
hemorrhage, pruritus. Urogenital:
failure, Peyronie's disease. Respiratory:
Acute pneumonitis, pulmonary
Periarteritis nodosum, acute systemic lupus erythematosus, craniofacial abnormalities (with enlargement of lips). Other:
Lymphadenopathy, injection site pain, chills.
Diagnostic Test Interference
Fosphenytoin may produce lower than normal values for dexamethasone or metyrapone tests; may increase serum levels of glucose, BSP, and alkaline phosphatase and may decrease PBI and urinary steroid levels.
decreases effects; other anticonvulsants
may increase or decrease fosphenytoin levels; fosphenytoin increases metabolism
of corticosteroids, oral anticoagulants
, and oral contraceptives
, decreasing their effectiveness; amiodarone, chloramphenicol, omeprazole
increase fosphenytoin levels; antituberculosis agents, voriconazole
decrease fosphenytoin levels. Food: Folic acid, calcium, vitamin D
absorption may be decreased by fosphenytoin; fosphenytoin absorption may be decreased by enteral nutrition supplements. Herbal: Ginkgo
may decrease anticonvulsant effectiveness.
Completely absorbed after IM administration
30 min IM. Distribution:
9599% bound to plasma proteins
, displaces phenytoin
from protein binding sites; crosses placenta, small amount in
breast milk. Metabolism:
Converted to phenytoin
by phosphatases; phenytoin
is oxidized in liver to inactive metabolites. Elimination: Half-life
15 min to convert fosphenytoin to phenytoin
, 22 h phenytoin; phenytoin
metabolites excreted in urine.
Note: See phenytoin for additional nursing implications.
Assessment & Drug Effects
- Monitor ECG, BP, and respiratory function continuously during and for 1020 min after infusion.
- Discontinue infusion and notify physician if rash appears. Be prepared to substitute alternative therapy rapidly to prevent
- Lab tests: Monitor CBC with differential, platelet count, serum electrolytes, and blood glucose.
- Allow at least 2 h after IV infusion and 4 h after IM injection before monitoring total plasma phenytoin concentration.
- Monitor diabetics for loss of glycemic control.
- Monitor carefully for adverse effects, especially in patients with renal or hepatic disease or hypoalbuminemia.
Patient & Family Education
- Be aware of potential adverse effects. Itching, burning, tingling, or paresthesia are common during and for some time following