Critical Care >Principles of Neurosciences Critical Care

John M. Oropello, Stephen M. Pastores, Vladimir Kvetan+

Table 48A–1RSecond line antiepileptic drug dosing and serum levels.

AED Loading Dose (IV) Postload Level Timing Maintenance Dose Trough Level Level Correctiona Toxicities and Interactions

Cardiac arrhythmias,
5-7 mg/kg/d Q8H, adjust Total: 15-25 mg/L hypotension with infusion;
PHT 20 mg/kg 1 hour PHT/((Adj x Alb) +0.1)b
based on trough levels purple glove syndrome,
Free: 1.5-2.5 mg/L SJS, CYP450 inducer

5-7 PE/kg/day Q8H adjust Same as PHT, but safer

fPHT 20 PE/kg 2 hours Same as PHT Same as PHT
based on trough levels infusion

Hyperammonemia,
Total: 80-120 ug/mL hepatotoxicity,
VPA 40 mg/kg up to 3 gm 4-6 hours 30-60 mg/kg/day Q12H None clearly agreed on
pancreatitis, anti-platelet,
Free: 7-23 ug/mL inhibits

LEV 30-60 mg/kg up to 4.5 g n/a 2-6 g/d Q12H Not usually obtainedc n/a Minimal

Hypotension, respiratory
PHB 20 mg/kg n/a 1-4 mg/kg/d PO/IV Q12H 30-50 mg/L n/a depression, over sedation,
CYP450 inducer

AED, antiepileptic drug; PHT, phenytoin; fPHT, fosphenytoin; VPA, valproic acid; LEV, levetiracetam; PHB, phenobarbital; Adj, adjustment; Alb, albumin; SJS, Steven's Johnson syndrome; Q8H, every 8 hours;
Q12H, every 12 hours.

aCorrected for protein binding.

bAdj = 0.2, unless creatinine clearance <20 = 0.1.

cTypical therapeutic level 25 to 60 mcg/mL in SE/RSE.

Date of download: 02/02/23 from AccessMedicine: accessmedicine.mhmedical.com, Copyright © McGraw Hill. All rights reserved.