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Phenytoin dosing in obese patients: two case reports
G M de Oca1, J G Gums, J D Robinson
1Family Medicine, Mt. Sinai Hospital, Miami, FL.
Drug Intelligence & Clinical Pharmacy
|September 1, 1988
Summary
Obese patients often require high doses of phenytoin (1000 mg/d) for epilepsy treatment due to its complex pharmacokinetics. Further research is needed to establish optimal dosing for this population.
Area of Science:
- Pharmacology
- Clinical Pharmacy
- Neurology
Background:
- Phenytoin is a primary antiepileptic drug for partial and generalized tonic-clonic seizures.
- Its dosing is complicated by saturable, Michaelis-Menten pharmacokinetics.
- Obesity presents additional challenges in achieving therapeutic phenytoin levels.
Observation:
- Two obese patients required high-dose phenytoin sodium (1000 mg/d) to maintain therapeutic serum concentrations.
- These doses were necessary for effective seizure control in the observed cases.
Findings:
- Phenytoin pharmacokinetics may be altered in obese individuals, necessitating higher dosages.
- Limited literature exists on phenytoin pharmacokinetics specifically in obese populations.
Implications:
- Current understanding of phenytoin dosing in obese patients is insufficient.
- Further controlled trials are required to develop evidence-based dosing recommendations for obese epilepsy patients.