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Due to the complex pharmacokinetic profiles of phenytoin (PHT) and fosphenytoin (FOS), achieving sustained, targeted serum PHT levels in the first day of use is challenging. A population based approach was used to analyze total serum PHT (tPHT) level within 2-24h of PHT/FOS loading with or without supplementary maintenance or additional loading doses among PHT-naïve patients in the acute hospital setting. Adequate tPHT serum level was defined as ≥20μg/mL. Among 494 patients with 545 tPHT serum levels obtained in the first 2-24h after the loading dose (LD), tPHT serum levels of either weight-based loading dose, 63% and 51% respectively did not attain tPHT serum level of ≥20μg/mL even within the first 6h of treatment. For the 393 available concomitant free and total serum PHT levels, correlation was weak, r=0.36. Close laboratory surveillance and PHT/FOS dose adjustments are recommended to ensure adequate and sustained tPHT serum levels early in treatment. Free serum PHT level is the preferred method of drug monitoring. Copyright © 2017 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.


Olga Selioutski, Katherine Grzesik, Olga N Vasilyeva, Ágúst Hilmarsson, A James Fessler, Lynn Liu, Robert A Gross. Evaluation of phenytoin serum levels following a loading dose in the acute hospital setting. Seizure. 2017 Nov;52:199-204

PMID: 29073585

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