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Related Experiment Videos

Inappropriate fosphenytoin use in the ED.

J Johnson1, K Wrenn

  • 1Department of Emergency Medicine, Vanderbilt University, Nashville, TN, USA.

The American Journal of Emergency Medicine
|July 12, 2001
PubMed
Summary

Intravenous fosphenytoin was inappropriately administered to 45% of patients who could have received oral phenytoin loading. This study highlights opportunities for optimizing antiepileptic drug use and reducing costs.

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Area of Science:

  • Emergency Medicine
  • Pharmacology
  • Clinical Pharmacy

Background:

  • Intravenous (IV) fosphenytoin is a prodrug of phenytoin, often used for rapid seizure control.
  • Oral phenytoin loading is a cost-effective alternative when feasible.

Purpose of the Study:

  • To assess the frequency of IV fosphenytoin use when oral phenytoin loading was a viable option.
  • To identify potential cost savings through appropriate drug administration.

Main Methods:

  • Retrospective chart review of patients receiving IV fosphenytoin in an emergency department.
  • Prospective derivation of criteria for appropriate oral phenytoin loading (e.g., awake, alert, no emesis).

Main Results:

  • 55 patients received IV fosphenytoin between February 1997 and June 1999.
  • 45% of these patients (25/55) met criteria for oral phenytoin loading.
  • Appropriate IV fosphenytoin use was observed in 55% of cases.

Conclusions:

  • Nearly half of IV fosphenytoin administrations in this urban university hospital ED were potentially inappropriate.
  • Optimizing the use of oral phenytoin loading can lead to significant cost reductions.
  • Clinical protocols should be reviewed to ensure appropriate IV fosphenytoin utilization.

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