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Phenytoin removal by continuous venovenous hemofiltration.

Kate M Oltrogge1, William J Peppard, Mohammed Saleh

  • 1University of Iowa Hospitals and Clinics.

The Annals of Pharmacotherapy
|November 22, 2013
PubMed
Summary
This summary is machine-generated.

Continuous venovenous hemofiltration (CVVH) can remove a significant amount of phenytoin, approximately 30% of the daily dose. Critically ill patients on CVVH may need higher phenytoin doses and close monitoring of drug levels.

Keywords:
acute kidney injuryantiepileptic drugscontinuous renal replacement therapycontinuous venovenous hemofiltrationphenytoinseizure

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Area of Science:

  • Pharmacokinetics
  • Nephrology
  • Critical Care Medicine

Background:

  • Phenytoin is an antiepileptic drug commonly used in critically ill patients.
  • Renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), are frequently employed in intensive care units.
  • The removal of phenytoin by CVVH has not been well-characterized.

Observation:

  • Two critically ill patients receiving CVVH experienced significant phenytoin removal.
  • Measured unbound phenytoin concentrations in serum and CVVH effluent decreased over time.
  • Calculated phenytoin clearance by CVVH ranged from 11 to 13 mL/min.

Findings:

  • CVVH demonstrated a much higher clearance of phenytoin compared to renal clearance in healthy individuals.
  • Approximately 30% of the total daily phenytoin dose was removed by CVVH in these cases.
  • Previous studies indicated minimal phenytoin removal by hemodialysis and lower hemofiltration rates.

Implications:

  • Critically ill patients undergoing CVVH may necessitate higher empiric doses of phenytoin to maintain therapeutic levels.
  • Close therapeutic drug monitoring of phenytoin is crucial for patients on CVVH.
  • These findings highlight the importance of considering RRTs in drug dosing adjustments for critically ill patients.