Expert review of pharmacoeconomics & outcomes research
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Expert Rev Pharmacoecon Outcomes Res · Feb 2003
Cost-effectiveness of nonemergency use of phenytoin.
Parenteral phenytoin is an effective agent used to manage seizures, but it is associated with adverse effects and must be given intravenously. Fosphenytoin is higher in drug cost, but is more soluble, better tolerated and can be infused at rates three times that of phenytoin. When infusion rate is not an issue the adverse effect risk becomes a focus of concern, as well as cost. ⋯ Strategies developed to promote the safe use of intravenous phenytoin are based on patient selection, recommended administration methods and patient monitoring. When rapid attainment of serum phenytoin levels is required or in patients at high risk of adverse effects secondary to parenteral phenytoin, fosphenytoin is clearly preferred. This review will focus on the implications of the use of parenteral phenytoin products in the nonemergent setting where potential adverse effects of parenteral phenytoin may be avoided with use of established criteria for patient selection and administration.