Incidence of intravenous site reactions in neurotrauma patients receiving valproate or phenytoin

OBJECTIVE: To determine the incidence of intravenous site reactions to phen ytoin and valproate in a large population of patients with neurotrauma. DESIGN: Retrospective chart review of two double-blind, randomized clinical trials evaluating the use of antiepileptic drugs to prevent posttraumatic seizures in patients with neurotrauma: phenytoin versus placebo (n = 390), and valproate versus phenytoin with placebo (n = 385). Information collecte d from the charts included the number, type, and location of intravenous li nes and intravenous site events. SETTING: Tertiary care trauma and university teaching hospital. MAIN RESULTS: Intravenous site reactions occurred in 18% and 25% of patient s receiving valproate or phenytoin, respectively, with the majority of even ts (70%) occurring in the first intravenous site. Patients received the neu rosurgery study drug (NSSD) by either central or peripheral lines; all intr avenous site reactions occurred in peripheral administration sites. When pa tients who received the drug by central line during the course of therapy w ere excluded, the estimated incidence of site reactions was 21% and 30% for valproate and phenytoin, respectively (p = 0.056). The time to the first e vent was shorter with phenytoin compared with valproate (2.0 +/- 1.3 vs. 3. 0 +/- 1.9 d; p = 0.009). Fewer adverse events were noted with phenytoin in the phenytoin-without-valproate study than in the phenytoin-with:valproate study, with 4.3% and 8.2% of intravenous site events recorded in patients r eceiving placebo or phenytoin, respectively. There was no significant diffe rence in the number of intravenous lines per patient used during NSSD drug infusion for phenytoin versus placebo or phenytoin Versus valproate. CONCLUSIONS: Both intravenous phenytoin and valproate resulted in intraveno us site reactions, with the loading doses responsible the majority of the e vents.