The 'apparent clearance' of free phenytoin in elderly vs. younger adults.

British Journal of Clinical Pharmacology
Daniel F B Wright, Evan J Begg

Abstract

The clearance of many drugs is reduced in the elderly, but the data regarding phenytoin are conflicting. Most studies have estimated phenytoin metabolic clearance using total drug concentrations (bound plus unbound), which may be confounded by protein binding effects. Free phenytoin concentrations are independent of protein binding and should more accurately reflect true metabolic clearance changes in elderly patients. The two studies reported in this paper suggest a trend towards reduced free phenytoin 'apparent clearance' in the elderly, although statistically significant results were not found. Other published studies have largely found similar trends, suggesting an age effect. To test the hypothesis that the 'apparent clearance' of free phenytoin is reduced in elderly patients. Two separate studies were conducted comparing free phenytoin 'apparent clearance' in elderly vs. younger adults. The first study was a retrospective analysis of free phenytoin concentrations measured at Christchurch Hospital from 1997 to 2006. In the second study free phenytoin concentrations were measured prospectively in ambulatory subjects who were taking phenytoin regularly. In the retrospective study (n= 29), free phenytoin 'apparent clearance' ...Continue Reading

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Aug 13, 2011·The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences·Andrew J McLachlan, Lisa G Pont
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