Fosphenytoin may cause hemodynamically unstable bradydysrhythmias

Bruce D. Adams, Neil H. Buckley, James Y. Kim, Lia B. Tipps

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)75-79
Number of pages5
JournalJournal of Emergency Medicine
Issue number1
StatePublished - Jan 2006


  • Bradycardia
  • Cardiac arrest
  • Fosphenytoin
  • Status epilepticus
  • Toxicity

ASJC Scopus subject areas

  • Emergency Medicine


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