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Published on: December 18, 2016
Inappropriate fosphenytoin use in the ED
The American Journal of Emergency Medicine
|July 12, 2001
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.
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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