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3041871 
Journal Article 
Cardiac arrhythmias after small IV dose of phenytoin 
Barron, SA 
1976 
1 
New England Journal of Medicine
ISSN: 0028-4793
EISSN: 1533-4406 
IPA/77/235022 
Engl 
REF 3 
16 
English 
IPA COPYRIGHT: ASHP During the course of a research protocol calling for the IV administration of 250 mg of phenytoin, sudden marked sinus bradycardia (rate of 30 to 42/min), hypotension and syncope developed in 4 of 15 young, healthy volunteers despite administration of 35 to 40 mg at 60 sec intervals. In all 4 the arrhythmia occurred approximately 20 sec after the third aliquot was administered, and responded to IV atropine. No change in PR interval was observed. Electrocardiograms taken during the day before the study had been normal. In these subjects, in view of the relatively small amount administered before the arrhythmia occurred, the role of the diluent (propylene glycol and ethanol) must also be considered. Whatever the mechanism of production of the arrhythmia, the experience with these subjects prompts the suggestion that even the slow IV administration of phenytoin be performed with the patient closely monitored and appropriate antiarrhythmic drugs immediately available.