Correlation of Free and Total Phenytoin Serum Concentrations in Critically Ill Patients

The Annals of Pharmacotherapy
Mitchell S BuckleyDale S Bikin

Abstract

Phenytoin is a common medication for seizure treatment and prophylaxis in the intensive care unit (ICU). The clinical utility of the Sheiner-Tozer equation for adjusting total phenytoin levels for hypoalbuminemia remains controversial. The purpose of this study was to evaluate the correlation of this formula in predicting phenytoin serum concentrations. A retrospective cohort study was conducted in the adult ICU between January 1, 2010, and June 21, 2013. Patients meeting the following study criteria were included: age ≥18 years, admission to the ICU, simultaneously drawn total and free serum phenytoin concentrations with albumin ≤48 hours of phenytoin draws. Study end points were the correlation as well as the level of agreement in the interpretation of the free and adjusted phenytoin concentrations using the Sheiner-Tozer formula in critically ill patients with hypoalbuminemia. A total of 238 patients were analyzed. Mean adjusted total phenytoin and free levels were 16.1 ± 8.1 and 1.5 ± 0.8 µg/mL, respectively (r = 0.817; P < 0.001). Absolute agreement with level interpretation between adjusted total phenytoin and free levels was 77% (κ = 0.633; P < 0.001). Adjusted phenytoin serum concentrations more frequently overestimated...Continue Reading

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Citations

Apr 17, 2016·The Annals of Pharmacotherapy·Mitchell S BuckleyDale S Bikin
Dec 24, 2019·Journal of Pharmacy Practice·Amanda Z WiebeJohn Skaggs
Sep 11, 2020·The Annals of Pharmacotherapy·Brian L Erstad

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