Background: Fosphenytoin, phosphate ester pro-drug of phenytoin, was developed to overcome complications associated with parenteral phenytoin administration in treatment of acute symptomatic seizures, short-term prophylaxis and treatment of repetitive or prolonged seizures and status epilepticus.
Objective: To evaluate the current position of fosphenytoin in treatment algorithms compared to phenytoin.
Methods: This review focuses on pharmacokinetics and dynamics, clinical efficacy and tolerability of fosphenytoin in children and adults.
Conclusion: Published literature shows that intravenous fosphenytoin has a similar adverse effect profile than phenytoin when it is administered as recommended. There is no evidence of clear benefit that would justify the higher price of the fosphenytoin compared to phenytoin.