Extended Release Agents

Carbatrol and Tegretol XR are extended-release forms of carbamazepine that permit bid or 12-h dosing. Fosphenytoin

Fosphenytoin (Cerebyx) is a prodrug of phenytoin that contains a disodium phosphate ester that is cleaved during hydrolysis, yielding a molecule of phenytoin. Phosphatases are ubiquitous and present in newborns, so fosphenytoin can be used at any age. It is water soluble and can be given IV and intramuscularly (IM)

without the side effect of infusion-related complications attributed to phenytoin extravasation. A 1 mg phenytoin equivalent (PE) is the therapeutic equivalent of 1 mg of phenytoin. Fosphenytoin can be infused at 3 mg PE/kg/min with therapeutic free phenytoin levels achieved by 7 to 8 min following infusion and 30 min following IM use. Rapid infusion in alert patients may produce perineal pruritis.

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