Fosphenytoin

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Fosphenytoin
Clinical data
Trade namesCerebyx, Pro-Epanutin
AHFS/Drugs.comMonograph
MedlinePlusa604036
License data
Routes of
administration		Intravenous, intramuscular
ATC code
Legal status
Legal status
  • US: WARNING[1]Rx-only
  • In general: ℞ (Prescription only)
Pharmacokinetic data
Bioavailability100% (IM)
Protein binding95–99%
MetabolismLiver
Elimination half-life15 minutes to convert to phenytoin
ExcretionKidney (as phenytoin)
Identifiers
  • (2,5-Dioxo-4,4-diphenyl-imidazolidin-1-yl)methoxyphosphonic acid
JSmol)
  • O=C3N(C(=O)C(c1ccccc1)(c2ccccc2)N3)COP(=O)(O)O
  • InChI=1S/C16H15N2O6P/c19-14-16(12-7-3-1-4-8-12,13-9-5-2-6-10-13)17-15(20)18(14)11-24-25(21,22)23/h1-10H,11H2,(H,17,20)(H2,21,22,23) checkY
  • Key:XWLUWCNOOVRFPX-UHFFFAOYSA-N checkY
 ☒NcheckY (what is this?)  (verify)

Fosphenytoin, also known as fosphenytoin sodium, and sold under the brand name Cerebyx among others, is a water-soluble phenytoin prodrug that is administered intravenously to deliver phenytoin, potentially more safely than intravenous phenytoin. It is used in the acute treatment of convulsive status epilepticus.

Fosphenytoin was developed in 1996.

United States Food and Drug Administration for a generic version of fosphenytoin.[3]

Medical uses

Fosphenytoin is approved in the United States for the short-term (five days or fewer) treatment of epilepsy when more widely used means of phenytoin administration are not possible or are ill-advised,

endotracheal intubation, status epilepticus or some other type of repeated seizures; cluster seizure, vomiting, and/or the patient is unalert or not awake or both.[5]

Other

In 2003, it was reported that even though anticonvulsants are often very effective in mania, and acute mania requires rapid treatment, fosphenytoin had no antimanic effect.[6]

Metabolism

One

millimole of phenytoin is produced for every millimole of fosphenytoin administered; the hydrolysis of fosphenytoin also yields phosphate and formaldehyde, the latter of which is subsequently metabolized to formate, which is in turn metabolized by a folate dependent mechanism.[4]

Side effects

Side effects are similar to intravenous phenytoin and include hypotension, cardiac

renal failure patients.[7]

History

Phenytoin, in both its acidic and sodium salt forms, is erratically bioavailable whether it is injected or taken orally due to its high

acidity, and its being only sparingly soluble in water.[8] Simply putting patients on other drugs is not always an option; this was especially true before 1993, when the number of anticonvulsants available was much more limited.[9]
One solution was to develop a prodrug that did not have these drawbacks.

Fosphenytoin was approved by the Food and Drug Administration (FDA) on August 5, 1996, for use in epilepsy.[10]

See also

References

  1. FDA
    . Retrieved 22 Oct 2023.
  2. ISBN 9780080457024
    .
  3. ^ "Fosphenytoin Sodium Approval History". Retrieved 20 October 2005.
  4. ^ a b Parke-Davis (2001). "Cerebyx: Fosphenytoin Sodium Injection - Labeling Revision" (PDF). Cerebyx Approval History. Warner-Lambert Company. Archived from the original (PDF) on October 17, 2003. Retrieved 20 October 2005.
  5. PMID 11447516
    .
  6. PMID 12716241
    .
  7. S2CID 6664220
    .
  8. PMID 6864479
    .
  9. ^ Tuen C. "Anticonvulsants before 1993". Neuroland. Archived from the original on 4 August 2019.
  10. ^ "Cerebyx Approval History". Retrieved 20 October 2005.

External links

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