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Phenytoin malabsorption after jejunostomy tube delivery
D P Rodman1, T L Stevenson, T R Ray
1Department of Clinical Pharmacy Practice, School of Pharmacy, Auburn University, AL, USA.
Pharmacotherapy
|November 1, 1995
Summary
Phenytoin (PHT) levels dropped significantly when administered via jejunostomy tube, indicating a potential drug-nutrient interaction. This highlights the need for careful monitoring when using jejunostomy feeding with PHT.
Area of Science:
- Pharmacology
- Gastroenterology
- Clinical Pharmacy
Background:
- Phenytoin (PHT) is an anti-seizure medication with known interactions with enteral feeding products and nasogastric tubes.
- Limited data exists on PHT interactions specifically with jejunostomy feedings.
Observation:
- A patient on intravenous PHT with therapeutic serum concentrations was switched to an equivalent PHT suspension via jejunostomy tube.
- Serum PHT concentrations decreased to undetectable levels, a nearly 100% drop.
Findings:
- Jejunostomy tube administration of PHT suspension resulted in a drastic reduction in bioavailability.
- Potential factors include distal tube placement in the small bowel and altered gastrointestinal transit time.
Implications:
- This interaction may lead to subtherapeutic PHT levels and potential seizure breakthrough.
- Increased use of jejunostomy tubes necessitates heightened awareness and monitoring for PHT-enteral feeding interactions.