fosphenytoin sodium

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fosphenytoin sodium

Cerebyx, Pro-Epanutin (UK)

Pharmacologic class: Hydantoin

Therapeutic class: Anticonvulsant

Pregnancy risk category D


Thought to regulate neuronal membrane by promoting sodium excretion from neurons. This action prevents hyperexcitability and excessive stimulation, which inhibits spread of seizure activity. Lacks general CNS depressant effect.


Injection: 150 mg in 2-ml vials (100 mg phenytoin sodium), 750 mg in 10-ml vials (500 mg phenytoin sodium)

Indications and dosages

Status epilepticus

Adults: 15 to 20 mg phenytoin sodium equivalent (PE)/kg I.V. at 100 to 150 mg PE/minute as a loading dose, then 4 to 6 mg (PE)/kg I.V. daily for maintenance

To prevent seizures during neurosurgery

Adults: 10 to 20 mg PE/kg I.M. or I.V. as a loading dose, then 4 to 6 mg PE/kg I.M. or I.V. daily for maintenance

Dosage adjustment

• Hepatic disease
• Renal impairment
• Elderly patients


• Hypersensitivity to drug
• Adams-Stokes syndrome
• Arrhythmias


Use cautiously in:
• hepatic or renal impairment, severe cardiac or respiratory disease
• elderly patients
• pregnant or breastfeeding patients (safety not established).


• Know that drug is a phenytoin prodrug and is given in PE units to avoid the need to perform molecular weight-based adjustments when converting between fosphenytoin and phenytoin sodium doses.
• For I.V. use, dilute in dextrose 5% in water or normal saline solution.
• Don't give faster than 150 mg PE/minute. Too-rapid infusion causes hypotension.

Check ECG, vital signs, and overall patient status continuously during infusion and for 10 to 20 minutes afterward.
• When giving I.M., rotate injection sites.

Adverse reactions

CNS: ataxia, agitation, dizziness, drowsiness, dysarthria, dyskinesia, speech disorder, extrapyramidal syndrome, headache, nervousness, weakness, confusion, hyperesthesia, paresthesia, cerebral edema, coma, intracranial hypertension

CV: hypotension, tachycardia

EENT: diplopia, nystagmus, tinnitus

GI: nausea, vomiting, constipation, dry mouth, anorexia

GU: pink, red, or reddish-brown urine

Hematologic: lymphadenopathy, aplastic anemia, agranulocytosis, leukopenia, megaloblastic anemia, thrombocytopenia

Hepatic: hepatitis

Metabolic: hypocalcemia, hypokalemia, hyperglycemia, increased glucose tolerance

Musculoskeletal: back or pelvic pain, osteomalacia

Skin: hypertrichosis, rash, pruritus, exfoliative dermatitis, Stevens-Johnson syndrome

Other: gingival hyperplasia, altered taste, fever, facial edema, weight loss, injection site pain, allergic reactions


Drug-drug.Amiodarone, benzodiazepines, chloramphenicol, cimetidine, disulfiram, estrogens, felbamate, fluconazole, fluoxetine, halothane, influenza vaccine, isoniazid, itraconazole, ketoconazole, methylphenidate, miconazole, omeprazole, phenothiazines, phenylbutazone, salicylates, sulfonamides, tolbutamide, trazodone: increased fosphenytoin blood level

Antidepressants, antihistamines, opioids, sedative-hypnotics: additive CNS depression

Barbiturates, carbamazepine, reserpine: decreased fosphenytoin blood level

Corticosteroids, cyclosporine, doxycycline, estrogens, felbamate, methadone, quinidine, rifampin: altered effects of these drugs

Dopamine: additive hypotension

Lidocaine, propranolol: additive cardiac depression

Streptozocin, theophylline: decreased efficacy of these drugs

Warfarin: initial increase in warfarin effects in patients stabilized on warfarin therapy, followed by decreased response to warfarin

Drug-diagnostic tests.Alkaline phosphatase, glucose, hepatic enzymes: increased levels

Dexamethasone, metyrapone: test interference

Glucose tolerance test: decreased tolerance

Potassium, thyroxine: decreased levels

Thyroid function tests: decreased values

Drug-behaviors.Acute alcohol ingestion: increased drug blood level, additive CNS depression

Chronic alcohol ingestion: decreased drug blood level

Patient monitoring

• Be prepared to slow administration or stop therapy if significant cardiovascular reactions occur.
• Monitor neurologic status carefully, especially for evidence of increasing intracranial pressure.

Assess for rash. Withhold drug and notify prescriber if it occurs.
• Monitor phenytoin blood level after drug has metabolized to phenytoin (about 2 hours after I.V. dose or 4 hours after I.M. dose).
• Monitor electrolyte levels.
• Evaluate blood glucose level. Watch for hyperglycemia in patients with diabetes.

Patient teaching

• Inform patient that he may experience sensory disturbances during I.V. administration.

Advise patient to immediately report adverse effects, particularly rash.
• Tell patient that drug may turn his urine pink, red, or reddish brown.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

fosphenytoin sodium

A drug used to treat STATUS EPILEPTICUS and to prevent seizures following neurosurgery and head injury. A brand name is Pro-epanutin.
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References in periodicals archive ?
Fischer et al found that fosphenytoin sodium, when undiluted in polypropylene syringes or mixed with NaCL 0.
Fischer JH, Cwik MJ, Luer MS et al: Stability of fosphenytoin sodium with intravenous solutions in glass bottles, polyvinyl chloride bags, and polypropylene syringes.
Fosphenytoin Sodium Injection is a prodrug of Phenytoin Sodium and is indicated in the short term use for the prevention and control of generalized seizures occurring during neurosurgery.
Przybyl, President and CEO of Akorn and Member Manager of Akorn-Strides, LLC, "We are excited to announce this product approval for Fosphenytoin Sodium Injection.
Fosphenytoin Sodium Injection is indicated for short-term parenteral administration when other means of phenytoin administration are unavailable, inappropriate or deemed less advantageous.
Fosphenytoin Sodium Injection can be used for the control of generalized convulsive status epilepticus and the prevention and treatment of seizures occurring during neurosurgery.
FDA approval for its abbreviated new drug application for fosphenytoin sodium to become final in Aug.
Food and Drug Administration has granted tentative approval for the Company's ANDA for Fosphenytoin Sodium Injection USP, 50 mg PE/mL (PE = phenytoin sodium equivalents).