title: Fosphenytoin may cause hemodynamically unstable bradydysrhythmias.
abstract: The prodrug fosphenytoin (FOS) was recently introduced as an alternative to phenytoin (PTN) and has since become a first line therapy for status epilepticus. Unlike PTN, FOS generally has been considered to be safe from cardiac toxicity. To better characterize cardiac toxicity associated with FOS administration, we performed a review of the Food and Drug Administration's Adverse Event Reporting System databank for reports of possible FOS toxicity from 1997-2002. There were 29 applicable reports of adverse cardiac events likely related to FOS infusion, including 10 cardiac deaths. Among survivors, there were four cases of high-grade atrioventricular block, and five cases of transient sinus arrest. Our data suggest that FOS may produce more cardiac toxicity than previously thought. Clinicians should consider administering intravenous FOS in a monitored setting for selected high-risk patients.
authors.affiliation: Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas, USA.
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Adams
authors.forename: Neil H
authors.initials: NH
authors.lastname: Buckley
authors.forename: James Y
authors.initials: JY
authors.lastname: Kim
authors.forename: Lia B
authors.initials: LB
authors.lastname: Tipps
mesh_terms: D000293:Adolescent; D000328:Adult; D016907:Adverse Drug Reaction Reporting Systems; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects*; D001919:Bradycardia / Q000139:chemically induced*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000009:adverse effects / Q000031:analogs & derivatives*; D013226:Status Epilepticus / Q000188:drug therapy; D014481:United States; D014486:United States Food and Drug Administration
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin; C043114:fosphenytoin