37,38 Neonates have an increased risk of toxicity because of decreased protein binding; phenobarbital is preferred
Painter MJ, Gaus LM
For example, this could be between 7am and 8am and between 7pm and 8pm
5 mg/kg) every 12 hours
Common phenytoin side effects may include: drowsiness, confusion; slurred speech; abnormal eye movement; or
Neonates: 5 mg/kg/day in 2 divided doses; 6 months to 16 years: 5 mg/kg/day in 2-3 divided doses; Neonates (less than 28 days) a dose reduction of phenytoin therapy is indicated if plasma levels are excessive; termination recommended if symptoms persist
Management of neonatal seizures involves accurate diagnosis of seizures, expedited evaluation and targeted treatment for their etiology, and medication to abolish the electrographic seizures
1981 Sep;31 (9):1107-12
After initial maintenance dose, subsequent doses should be individualized to achieve therapeutic phenytoin concentrations
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By the same principle, missing several doses or a small change in drug absorption can cause a significant change in serum phenytoin concentration
Changes in hepatic blood flow, increased portal venous flow, closure of ductus venosus
Parenteral: Recommended dose: 100 to 320 mg IM or IV once a day
Level of agreement: High