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Related Experiment Videos

Plasma total phenytoin: a possibly misleading test in developing countries.

C Fedler1, M J Stewart

  • 1Department of Chemical Pathology, SAIMR and the University of the Witwatersrand Medical School, Gauteng, South Africa.

Therapeutic Drug Monitoring
|April 27, 1999
PubMed
Summary

In South Africa, many rural black patients have low albumin levels, affecting phenytoin drug levels. Corrected phenytoin values, not total, should be reported in hypoalbuminemic populations for accurate dosing.

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Area of Science:

  • Pharmacology
  • Clinical Chemistry
  • Public Health

Background:

  • Phenytoin use is rising in rural South African populations.
  • Hypoalbuminemia is prevalent due to malnutrition and disease, impacting drug efficacy.
  • Low albumin concentrations affect the free fraction of phenytoin in the extracellular fluid.

Purpose of the Study:

  • To assess the extent of hypoalbuminemia in this population.
  • To compare measured total phenytoin with corrected phenytoin values.
  • To determine the clinical relevance of reporting corrected phenytoin levels.

Main Methods:

  • Patient albumin concentrations were measured.
  • Total phenytoin levels were determined by immunoassay.
  • Corrected phenytoin levels were calculated using the Sheiner-Tozer equation.

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Main Results:

  • A significant proportion of patients exhibited hypoalbuminemia.
  • Differences between total and corrected phenytoin values exceeded 20% in 37% of patients.
  • This highlights potential inaccuracies in total phenytoin reporting.

Conclusions:

  • Hypoalbuminemia significantly impacts phenytoin levels in this population.
  • Corrected phenytoin values are more clinically relevant than total values.
  • Reporting corrected phenytoin is recommended for hypoalbuminemic patient populations.