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PARENTERAL FOSPHENYTOIN: EFFICACY AND ECONOMIC CONSIDERATIONS

BACKGROUND- Only a limited number of antiepileptic drugs (AEDs) are available for intravenous (IV) or intramuscular (IM) administration, and all are associated with significant adverse effects when given by the parenteral route.SUMMARY- Fosphenytoin is a water-soluble parenteral prodrug of phenytoin. It can be administered by IV injection to provide a phenytoin loading dose for patients in status epilepticus. In addition, it can be injected by the IV or IM route for nonemergent loading dose administration or for short-term maintenance therapy when oral treatment is impossible. Studies evaluating fosphenytoin in epilepsy and neurosurgery patients have demonstrated its efficacy in controlling and preventing seizures. Direct comparative studies have established that IV and IM fosphenytoin may be acceptable substitutes for either IV or oral phenytoin. However, IV fosphenytoin was found to be better tolerated than IV phenytoin, and, in particular, caused less pain on injection and symptomatic hypotension. A pharmacoeconomics analysis demonstrated that although the direct acquisition cost is higher for IV fosphenytoin compared with IV phenytoin, IV fosphenytoin can provide significant cost-savings by reducing the risk of adverse events and the need for medical management.CONCLUSIONS- Fosphenytoin is an effective and well tolerated parenteral AED that can reliably produce therapeutic phenytoin concentrations. Its flexibility for administration by either IV or IM injection, along with its favorable safety profile and potential cost-benefits, make it an important addition to the therapeutic armamentarium for managing patients with seizure disorders.