Seizure: Loading Dose

Neurology PGY1 PGY2 PGY3 PGY4

There are several methods to orally load Anti Epileptic drugs (AED) in ED. Tintinalli’s has 2 approaches: 1.patient with active seizure 2. patient with history of seizure. Patient who had active seizure should receive Phenytoin 15- 25 mg/kg no more than 50 mg/min. For patient in no active seizure: Without a loading dose, phentoin may reach to therapeutic dose within 1-10 days. Another method is to give patient 18mg/kg as a single dose orally or divided into 3 doses given every 2 hours. If you would like to reach within 1-2 hours to therapeutic dose you can give10 to 20 mg/kg through IV with a rate of 25 mg/min.

So, Our discussion was should I do Orally or IV and what is the dose for each one. The ACEP Guideline is referring to only a very old article that came in AEM 2004, based on 45 patients in 3 different groups.

A Comparison of Phenytoin-loading Techniques in the …
You have free access to this content Academic Emergency Medicine Volume 11, Issue 3, Article first published online: 8 JAN 2008
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Again, we are not talking about a patient in active seizure, who needs to have AED to control seizure. Clinical Neurology, 9e Michael J. Aminoff 2015 recommends: Phenytoin Oral loading: 1,000 mg in two to four divided doses over 12-24 h ntravenous loading: 1,000-1,500 mg (15-18 mg/kg) not exceeding 50 mg/min.