Seizure: phenytoin capsules or suspension were probably equally effective

Clinical bottom line (level 1b-)

  1. Phenytoin capsules or suspension were probably equally effective in loading patients who are conscious following seizure
Osborn et al: Annals of Emergency Medicine 1987; 16 (4): 407-412
Expires October 2003

The study

Unblinded unconcealed randomised trial without intention-to-treat
Setting: Emergency department, USA

51 patients (aged 20-66, mean 38, 80% male) one or more seizures with an intact gag reflect and able to take oral medication

Excluded if
  • decreased level of consciousness
  • status epilepticus
  • frequent seizures requiring parenteral phenytoin
  • detectable serum level of phenytoin


    • Control Group: (n = 25, 25 analysed): phenytoin capsules po 18 mg/kg
    Experimental Group: (n = 26, 19 analysed): phenytoin oral suspension 18 mg/kg
    Therapeutic blood level ~1 mg/l
    86.2% followed for 24 hours

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    6-10 hours (mg/l) 12.3
    (5.0)     		9.8
    (3.4)     		2.5
    (-0.19 to 5.2)
    16-24 hours (mg/l) 15.1
    (7.0)     		12.8
    (3.0)     		2.3
    (-1.2 to 5.8)

  • No patients had a further seizure
  • Side effects: 4 patients had mild dizziness
  • Need to compare with iv. loading of phenytoin and have longer follow-up

    • Comments

    1. Many centres now use fosphenytoin, and overall loading a patient with phenytoin or fos-phenytoin should be reserved for status epilepticus. The practical implications today of the findings in this study thus are few.

    Citation

    1. Osborn HH, Zistfein J, Sparano R: Single-dose oral phenytoin Loading. Annals of Emergency Medicine 1987; 16 (4): 407-412
    Contributor: Chris Ball and Musab Hayatli, October 2000
    Reviewer: Michael Nielsen

    Clinical Question.
    Patient seizure
    Intervention or Exposure phenytoin capsules
    Comparison phenytoin suspension
    Outcome therapeutic drug levels