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Phenytoin removal during plasma exchange.

R L White, W R Garnett, J H Allen

    Journal of Clinical Apheresis
    |January 1, 1987
    PubMed
    Summary
    This summary is machine-generated.

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    Plasma exchange therapy can remove phenytoin, an anti-seizure medication, from the blood. This study quantified phenytoin removal during two plasma exchange sessions, indicating its potential impact on drug levels.

    Area of Science:

    • Pharmacology
    • Nephrology
    • Critical Care Medicine

    Background:

    • Plasma exchange (PEX) is an extracorporeal therapy used for various immune-mediated and hematologic disorders.
    • PEX involves the removal of patient plasma and its replacement with a substitute, which can also remove protein-bound substances like medications.
    • Phenytoin is an anti-epileptic drug commonly treated with plasma protein binding.

    Observation:

    • This case study details the monitoring of phenytoin serum concentrations during PEX therapy.
    • Measurements of total and free phenytoin levels were taken before and after each PEX session.
    • Phenytoin concentrations in aliquots from each exchange pass were also analyzed.

    Findings:

    • Total phenytoin serum concentration initially increased during the first PEX session.

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  • A decrease in total phenytoin serum concentration was observed during the second PEX session.
  • Approximately 27.7 mg and 30.4 mg of phenytoin were removed during the first and second PEX sessions, respectively.

    • Implications:

    • Plasma exchange can significantly reduce serum phenytoin levels.
    • Monitoring of phenytoin concentrations is crucial during PEX therapy to manage potential subtherapeutic levels.
    • These findings highlight the importance of considering drug removal during PEX for patients on protein-bound medications.