Why we prefer levetiracetam over phenytoin for treatment of status epilepticus
Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine‐resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a...
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| Veröffentlicht in: | Acta neurologica Scandinavica 2018-06, Vol.137 (6), p.618-622 |
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| container_title | Acta neurologica Scandinavica |
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| creator | Zaccara, G. Giorgi, F. S. Amantini, A. Giannasi, G. Campostrini, R. Giovannelli, F. Paganini, M. Nazerian, P. |
| description | Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine‐resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time‐consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine‐resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment. |
| doi_str_mv | 10.1111/ane.12928 |
| format | Article |
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S. ; Amantini, A. ; Giannasi, G. ; Campostrini, R. ; Giovannelli, F. ; Paganini, M. ; Nazerian, P.</creator><creatorcontrib>Zaccara, G. ; Giorgi, F. S. ; Amantini, A. ; Giannasi, G. ; Campostrini, R. ; Giovannelli, F. ; Paganini, M. ; Nazerian, P. ; Tuscany study group on seizures in the emergency department and status epilepticus in adults ; the Tuscany study group on seizures in the emergency department and status epilepticus in adults</creatorcontrib><description>Over last fifty years, intravenous (iv) phenytoin (PHT) loading dose has been the treatment of choice for patients with benzodiazepine‐resistant convulsive status epilepticus and several guidelines recommended this treatment regimen with simultaneous iv diazepam. Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time‐consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine‐resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.</description><identifier>ISSN: 0001-6314</identifier><identifier>EISSN: 1600-0404</identifier><identifier>DOI: 10.1111/ane.12928</identifier><identifier>PMID: 29624640</identifier><language>eng</language><publisher>Denmark: Hindawi Limited</publisher><subject>Antiepileptic agents ; antiepileptic drugs ; Benzodiazepines ; convulsive status epilepticus ; Diazepam ; Drug dosages ; Drug therapy ; Epilepsy ; Etiracetam ; Fibrillation ; focal status epilepticus ; fosphenytoin ; Heart diseases ; Hypersensitivity ; Hypotension ; Intravenous administration ; lacosamide ; Patients ; Phenytoin ; valproate ; Valproic acid ; Ventricle</subject><ispartof>Acta neurologica Scandinavica, 2018-06, Vol.137 (6), p.618-622</ispartof><rights>2018 John Wiley & Sons A/S. 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Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time‐consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine‐resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. If levetiracetam would be ineffective, a further antiepileptic drug among those currently available for iv use (valproate, lacosamide, or phenytoin) can be added before starting third line treatment.</description><subject>Antiepileptic agents</subject><subject>antiepileptic drugs</subject><subject>Benzodiazepines</subject><subject>convulsive status epilepticus</subject><subject>Diazepam</subject><subject>Drug dosages</subject><subject>Drug therapy</subject><subject>Epilepsy</subject><subject>Etiracetam</subject><subject>Fibrillation</subject><subject>focal status epilepticus</subject><subject>fosphenytoin</subject><subject>Heart diseases</subject><subject>Hypersensitivity</subject><subject>Hypotension</subject><subject>Intravenous administration</subject><subject>lacosamide</subject><subject>Patients</subject><subject>Phenytoin</subject><subject>valproate</subject><subject>Valproic acid</subject><subject>Ventricle</subject><issn>0001-6314</issn><issn>1600-0404</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp1kMtKxDAUQIMoOo4u_AEJuNFFx5uHabIchvEBw7hRXJZOe4OVvkxSpX9vdNSFYDaXXA6HyyHkhMGMxXeZtzhj3HC9QyZMASQgQe6SCQCwRAkmD8ih9y_xx1Mp98kBN4pLJWFC1k_PI31H2ju06GiNbxgqlxcY8oZ2b3HVP2M7hq5qqe0cDQ7z0GAbaGepD3kYPMW-qrEPVTH4I7Jn89rj8fecksfr5cPiNlnd39wt5qukEFrrRGosCtAgzJXWiivLrSo5MsNA2FQqtjHcFEJtcqusBGQl1ykrxSYtFRitxZScb729614H9CFrKl9gXccU3eAzDpwbLTTwiJ79QV-6wbXxukiJKw7SqDRSF1uqcJ33MUbWu6rJ3ZgxyD4jZ9GcfUWO7Om3cdg0WP6SP1UjcLkF3mOY8X9TNl8vt8oPP56Eiw</recordid><startdate>201806</startdate><enddate>201806</enddate><creator>Zaccara, G.</creator><creator>Giorgi, F. 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S.</creatorcontrib><creatorcontrib>Amantini, A.</creatorcontrib><creatorcontrib>Giannasi, G.</creatorcontrib><creatorcontrib>Campostrini, R.</creatorcontrib><creatorcontrib>Giovannelli, F.</creatorcontrib><creatorcontrib>Paganini, M.</creatorcontrib><creatorcontrib>Nazerian, P.</creatorcontrib><creatorcontrib>Tuscany study group on seizures in the emergency department and status epilepticus in adults</creatorcontrib><creatorcontrib>the Tuscany study group on seizures in the emergency department and status epilepticus in adults</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Acta neurologica Scandinavica</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zaccara, G.</au><au>Giorgi, F. 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Clinical studies have never shown a better efficacy of PHT over other antiepileptic drugs. In addition, iv PHT loading dose is a complex and time‐consuming procedure which may expose patients to several risks, such as local cutaneous reactions (purple glove syndrome), severe hypotension and cardiac arrhythmias up to ventricular fibrillation and death, and increased risk of severe allergic reactions. A further disadvantage of PHT is that it is a strong enzymatic inducer and it may make ineffective several drugs that need to be used simultaneously with antiepileptic treatment. In patients with a benzodiazepine‐resistant status epilepticus, we suggest iv administration of levetiracetam as soon as possible. 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| source | Wiley Online Library Journals Frontfile Complete |
| subjects | Antiepileptic agents antiepileptic drugs Benzodiazepines convulsive status epilepticus Diazepam Drug dosages Drug therapy Epilepsy Etiracetam Fibrillation focal status epilepticus fosphenytoin Heart diseases Hypersensitivity Hypotension Intravenous administration lacosamide Patients Phenytoin valproate Valproic acid Ventricle |
| title | Why we prefer levetiracetam over phenytoin for treatment of status epilepticus |
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