Intravenous Fosphenytoin in Acute Mania
J Clin Psychiatry 2003;64(4):408-409
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objectives: Since several anticonvulsants are
therapeutic in mania and since acute mania requires rapid and
intensive treatment, we hypothesized that intravenous high-dose
phenytoin might be acutely antimanic. A new prodrug of phenytoin,
fosphenytoin, which has few cardiac or local vein side effects,
was used to test this hypothesis.
Method: Seven patients with a DSM-IV manic
episode and minimal prior drug treatment were given intravenous
fosphenytoin and were assessed at baseline and after 15, 30, 45,
and 60 minutes with the Young Mania Rating Scale, the Clinical
Global Impressions scale, and the Mini-Mental State Examination.
Data were gathered in 2002.
Results: No antimanic effects were observed. No
subject had any clear improvement in manic symptoms on the YMRS
at any timepoint assessed.
Conclusion: Intravenous fosphenytoin at doses
that are effective in status epilepticus appears to be
ineffective in acute mania.