Phenytoin
Trade name
DBL Phenytoin, Phenytoin (Juno)
Strength
50 mg/mL (volume: 2 mL, 5 mL)
IV administration
Flush the line with sodium chloride 0.9% prior to administration.
Administer into a central line or large peripheral vein. Infuse at a controlled rate using a syringe driver or infusion pump through a large gauge needle or IV catheter.
Use undiluted or dilute to 5 mg/mL or stronger and infuse at 1 mg/kg/minute with a maximum rate of 50 mg/minute.
Rates of up to 3 mg/kg/minute have been used but rapid administration is associated with cardiovascular adverse effects.
Solution should be filtered if possible, using an appropriate 0.2-0.5micron in-line filter.
Flush the needle and line with sodium chloride 0.9% after administration at the same rate of infusion to avoid local irritation of the vein.
Other routes of administration
IM: Not recommended.
SC: Not recommended.
Compatible IV fluids
Diluted solutions must be infused within 4 hours.
Sodium chloride 0.9%
Additional information
Extravasation risk: pH = 12.
Observe closely for anaphylactic reactions.
Rapid administration has resulted in hypotension and cardiovascular collapse.
Use only when facilities for cardiac monitoring and cardio-respiratory resuscitation exist.
Therapeutic Drug Monitoring required; refer to local guidelines.
Taper the infusion slowly when discontinuing treatment; abrupt discontinuation may cause increased seizure frequency.
Diluted phenytoin may precipitate over time, inspect solutions for infusion carefully. Do not use if precipitation or haziness occurs.
Potentially hazardous medication: may require special handling precautions; refer to RCH Safe handling of Hazardous Medicines Procedure or relevant local guideline.
Contains propylene glycol, which can cause CNS depression, hyperosmolality, metabolic acidosis and renal impairment.
Solution should be clear and colourless or slightly yellow. Ampoules that are a faint yellow colour do not have reduced potency and may be used.
Protect from light during storage.