Unbound phenytoin plasma concentrations in patients comedicated with sodium valproate--the predictive value of plasma albumin concentration

British Journal of Clinical Pharmacology
G J JohnsonR F Moulds

Abstract

1. Phenytoin protein binding in epileptic patients on phenytoin as monotherapy has been compared with protein binding in patients treated with both phenytoin and sodium valproate. In addition the relative value of assayed total phenytoin plasma concentrations and assayed unbound phenytoin plasma concentrations and the value of predicted unbound phenytoin plasma concentrations in predicting phenytoin toxicity has been assessed. 2. The mean phenytoin unbound fraction for patients taking sodium valproate (0.122) was significantly greater than for those on monotherapy (0.082). 3. There were six episodes of clinical toxicity. In five toxic episodes the assayed unbound phenytoin plasma concentration was a better reflection of toxicity than the assayed total phenytoin plasma concentration, and four of these occurred in patients on sodium valproate. 4. Unbound phenytoin plasma concentrations were predicted from a single regression equation correlating all assayed total phenytoin plasma concentrations with assayed unbound phenytoin plasma concentrations, from two separate regression equations for each group of patients, and from the correlation between phenytoin protein binding and plasma albumin concentration. 5. The unbound phenytoin ...Continue Reading

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Citations

Jan 12, 1999·British Journal of Pharmacology·O E Della PaschoaM Danhof
Aug 4, 2006·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Gerhard K WolfMichael L McManus
Nov 29, 2011·BMC Complementary and Alternative Medicine·Ibrahim Adekunle OreagbaMercy Amachree
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Sep 10, 2015·Antimicrobial Agents and Chemotherapy·Matthijs OyaertSteven Pauwels
May 22, 2002·Therapeutic Drug Monitoring·Hoan Linh BanhMichael R Sperling

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