Fosphenytoin sodium injection can be substituted for oral phenytoin sodium therapy at the same total daily dose.

Phenytoin sodium capsules are approximately 90% bioavailable by the oral route. Phenytoin, supplied as fosphenytoin sodium injection, is 100% bioavailable by both the IM and IV routes. For this reason, plasma phenytoin concentrations may increase modestly when IM or IV fosphenytoin sodium injection is substituted for oral phenytoin sodium therapy.
Special Note
[formulation clarification] Info: phenytoin ER caps contain 8% less drug than chewable tabs and susp; monitor closely and consider dose adjustment if switching between products

Withdrawal: Abrupt withdrawal of phenytoin in epileptic patients may precipitate status epilepticus. When, in the judgment of the clinician, the need for dosage reduction, discontinuation, or substitution of alternative antiepileptic medication arises, this should be done gradually. However, in the event of an allergic or hypersensitivity reaction, rapid substitution of alternative therapy may be necessary

2) Switching Between Salt and Base a) There is approximately 8% increase in drug content with the free acid form of phenytoin compared with phenytoin sodium. Serum level monitoring and subsequent dose adjustments may be required when switching between salt and base [94] 3) Switching Between Oral and IM Routes of Administration a) In a patient currently receiving phenytoin sodium orally, the IM dose should be 50% greater than the oral dose. When returning to oral administration, the oral dose should be 50% of the original oral dose for 1 week due to sustained release from intramuscular tissue sites
75 mg fosphenytoin equivalent to 50 mg phenytoin

DOSES OF Fosphenytoin SODIUM INJECTION ARE ALWAYS EXPRESSED IN TERMS OF MILLIGRAMS OF PHENYTOIN SODIUM EQUIVALENTS (MG PE). 1 MG PE IS EQUIVALENT TO 1 MG PHENYTOIN SODIUM. DO NOT, THEREFORE, MAKE ANY ADJUSTMENT IN THE RECOMMENDED DOSES WHEN SUBSTITUTING Fosphenytoin SODIUM INJECTION FOR PHENYTOIN SODIUM OR VICE VERSA. FOR EXAMPLE, IF A PATIENT IS RECEIVING 1000 MG PE OF FosphenytoinSODIUM INJECTION, THAT IS EQUIVALENT TO 1000 MG OF PHENYTOIN SODIUM. Fosphenytoin sodium injection should always be prescribed in phenytoin sodium equivalents (PE) (see DOSAGE AND ADMINISTRATION). 1.5 mg of Fosphenytoin sodium is equivalent to 1 mg phenytoin sodium, and is referred to as 1 mg PE. The amount and concentration of Fosphenytoin is always expressed in terms of mg of phenytoin sodium equivalents (PE). Fosphenytoins weight is expressed as phenytoin sodium equivalents to avoid the need to perform molecular weight-based adjustments when substituting Fosphenytoin for phenytoin or vice versa.