Optimization of phenytoin therapy in adults with epilepsy in the Western Cape, South Africa
| Autor: | Peter I. Folb, P. N. Valodia, B. M. Kies, M. A. Seymour |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Adult
Male Phenytoin medicine.medical_specialty Pediatrics Adolescent medicine.medical_treatment Individuality Epilepsy Therapeutic index Pharmacokinetics Outpatients medicine Humans Outpatient clinic Pharmacology (medical) Aged Aged 80 and over Pharmacology Chemotherapy Dose-Response Relationship Drug medicine.diagnostic_test business.industry Middle Aged medicine.disease Surgery Anticonvulsant Therapeutic drug monitoring Anticonvulsants Female business medicine.drug |
| Zdroj: | Journal of Clinical Pharmacy and Therapeutics. 24:381-385 |
| ISSN: | 1365-2710 0269-4727 |
| DOI: | 10.1046/j.1365-2710.1999.00241.x |
| Popis: | SUMMARY Objective: To assess the extent to which adults with epilepsy were optimized and individualized on phenytoin monotherapy in the Western Cape, South Africa and to estimate the average optimized dose and serum phenytoin concentration, and the therapeutic range for this patient group. Methods: Patients were considered to be optimized on phenytoin if they were seizure-free or the best compromise was achieved between seizure reduction and side-effects. Results: 538 (233 black and 305 coloured) adult people with epilepsy were treated at nine epilepsy clinics as outpatients. Of these patients, 332 (226 male and 106 female, 149 black and 183 coloured) were included in the data analysis as they were considered to have reliable phenytoin levels. Phenytoin doses and steady-state serum concentrations were predicted using the Michaelis–Menten equation. Patients attended a clinical pharmacokinetic service for 7·7±5·3 (range 1–22) months. The average optimized dose was 305·8 (range 100–500) mg/day and the average optimized level was 62·7±23·9 (range 15–133) μmol/l. Most patients (61·9%) were optimized in the therapeutic range 40–79 μmol/l; 21·1% were optimized above and 17% below this range. In 1·6% of patients serum concentrations above 120 μmol/l were required. Dosage adjustments were made in 47·0% of patients, increased in 31·9% and reduced in 15·1%. Conclusion: These findings indicate that many patients (47%) attending outpatient clinics were not optimized on phenytoin therapy. |
| Databáze: | OpenAIRE |
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