June 25, 2020

Comparison of Phenytoin (Dilantin®) Versus Fosphenytoin (Cerebyx®) for Second-Line Treatment of Status Epilepticus

Abstract, published in Seizure

Purpose: For status epilepticus, the choice of antiepileptic drugs for second-line treatment after benzodiazepine remains controversial: although both phenytoin and fosphenytoin are recommended, it not unknown which is better. Using a nationwide inpatient database in Japan, we compared the efficacy and safety of these two drugs.

Method: An observational study identified adult patients who had been admitted for status epilepticus and who had received intravenous diazepam (Valium®) on the day of admission from January 1, 2011 through December 31, 2015.

Results: The analysis examined data from 5265 patients: 2969 patients received phenytoin; 2296 received fosphenytoin, on the day of admission. No significant difference was found for use of a vasopressor, which is a drug to treat low blood pressure, or for mechanical ventilation, on the day of admission; in-hospital mortality; length of hospital stay; or total hospitalization cost. Higher age, comorbidity of cardiac diseases and lower body mass index were associated significantly with increased vasopressor use, whereas the dose of phenytoin equivalents and the choice of fosphenytoin were not.

Conclusions: This nationwide observational study found no evidence that fosphenytoin provides higher efficacy or safety than phenytoin for treatment of status epilepticus in adults after diazepam. Age, cardiac disease, and low body mass index were identified as independent risk factors for vasopressor use in both phenytoin and fosphenytoin.

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