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Fosphenytoin in Infants

Masanori Takeoka, MD

Department of Neurology, Pediatric Neurology Service, Massachusetts General Hospital, Boston, MA

Kalpathy S. Krishnamoorthy, MD

Department of Neurology, Pediatric Neurology Service, Massachusetts General Hospital, Boston, MA

Teesta B. Soman, MD

Department of Neurology, Pediatric Neurology Service, Massachusetts General Hospital, Boston, MA

Verne S. Caviness, Jr, MD, DPhil

Department of Neurology, Pediatric Neurology Service, Massachusetts General Hospital, Boston, MA

In comparison with phenytoin preparations, which have a pH value of 11, fosphenytoin, a phosphorylated prodrug of phenytoin, has a pH value of only 8.6, which decreases the risk of cardiovascular and cutaneous side effects. The near-neutral pH value of fosphenytoin allows effective intravenous or intramuscular administration. A 1-mg phenytoin equivalent (PE) of fosphenytoin is converted to 1 mg of phenytoin in adults. We describe four infants whose seizures were treated with intravenous fosphenytoin. We had difficulty maintaining therapeutic serum phenytoin levels of 10 to 20 µg/mL on doses of 5 to 8 mgPE/kg/day, and many bolus doses of 5 to 10 mgPE/kg or maintenance doses of more than 10 mgPE/kg/day were given. Despite increased doses in three out of the four patients, a therapeutic serum phenytoin level was not maintained. From our experience, careful and individual dosing of fosphenytoin in this age group can be considered. (J Child Neurol 1998;13:537-540).

Journal of Child Neurology, Vol. 13, No. 11, 537-540 (1998)
DOI: 10.1177/088307389801301102
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