Interaction of nitrofurantoin with diphenylhydantoin

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Application and Methodology of the Non-destructive 19F Time-domain NMR Technique to Measure the Content in Fluorine-containing Drug Products
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Application and Methodology of the Non-destructive 19F Time-domain NMR Technique to Measure the Content in Fluorine-containing Drug Products

Published on: August 22, 2017

R Heipertz, H Pilz

    Journal of Neurology
    |August 25, 1978
    PubMed

    Insights

    Antimicrobial nitrofurantoin reduced levels of the anti-seizure drug diphenylhydantoin (DPH), leading to seizure recurrence. This interaction highlights the importance of monitoring drug levels during co-treatment.

    Area of Science:

    • Pharmacology
    • Clinical Neurology
    • Drug Interactions

    Background:

    • Epilepsy management in patients with brain tumors requires careful consideration of anticonvulsant therapy.
    • Diphenylhydantoin (DPH) is a commonly used antiepileptic drug for controlling motor seizures.

    Observation:

    • A patient with a brain tumor experiencing left-sided motor seizures controlled by 300 mg/d DPH.
    • Introduction of nitrofurantoin for antimicrobial therapy led to decreased serum DPH levels and seizure recurrence.
    • Concurrently, serum gamma-glutamyl transpeptidase (gammaGT) levels increased, with both effects reversing upon nitrofurantoin cessation.

    Findings:

    • Nitrofurantoin significantly reduced serum DPH levels, potentially through increased metabolism or impaired absorption.
    • The observed increase in gammaGT suggests hepatic enzyme induction, supporting the hypothesis of enhanced DPH metabolism.
    • This interaction underscores a clinically significant pharmacokinetic alteration.

    Implications:

    • Clinicians must be aware of potential interactions between nitrofurantoin and diphenylhydantoin.
    • Monitoring serum DPH levels and seizure activity is crucial when initiating or terminating nitrofurantoin therapy.
    • This case emphasizes the need for vigilant patient management to ensure effective anticonvulsant control.

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