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Enteral formula feeds interfere with phenytoin absorption
1Department of Paediatrics, University Hospital of Wales, Cardiff, UK.
Brain & Development
|March 1, 1994
Summary
Enteral feeding can reduce the effectiveness of oral phenytoin medication in children. Stopping feeds or switching to intravenous administration restored therapeutic phenytoin levels, ensuring better seizure control.
Area of Science:
- Pediatric Neurology
- Clinical Pharmacology
Background:
- Status epilepticus requires prompt and effective anticonvulsant therapy.
- Phenytoin is a commonly used antiepileptic drug for seizure management.
Observation:
- Two pediatric patients receiving enteral nutrition experienced subtherapeutic plasma phenytoin concentrations.
- Adequate oral phenytoin dosing did not achieve target therapeutic levels during continuous enteral feeding.
Findings:
- Plasma phenytoin levels increased to the target range (10-20 mg/l) upon cessation of enteral feeds.
- Intravenous administration of phenytoin also successfully achieved therapeutic levels.
- Enteral feeding likely impairs the oral absorption of phenytoin.
Implications:
- Clinicians should consider potential drug-nutrient interactions when administering oral phenytoin to patients on enteral feeds.
- Alternative administration routes (e.g., intravenous) or adjusted dosing may be necessary to maintain therapeutic phenytoin levels during enteral feeding.
- This interaction can compromise seizure control in vulnerable pediatric populations.