Can't Maintain Dilantin Level!

[jstkathy5]

Wow. I guess doing a search with the 'right' word is the key: Look at this:

Hypermetabolism of phenytoin as a cause of treatment failure.

Lebrun LH, Villeneuve JP.
Hypermetabolism of phenytoin is not frequently recognized as a cause of treatment failure. We report the case of a 37-year-old male in whom detailed pharmacokinetic investigation revealed that hypermetabolism, rather than lack of compliance or poor absorption, was responsible for low plasma levels of phenytoin. An increase of his daily dose of phenytoin to 800 mg resulted in adequate plasma levels and good seizure control. Additional studies with two model drugs metabolized by the liver--aminopyrine and antipyrine--showed that he was also a fast metabolizer for these substrates, suggesting a nonspecific induction of hepatic drug metabolizing enzymes. Low plasma phenytoin levels should not be systematically ascribed to lack of compliance, and increased phenytoin metabolism should be considered as an occasional cause of treatment failure.

[bezara]

because of the phenytoin hypermetabolism you may want to ask your doctor to consider phenytek. for more info.go to
http://www.phenytek.com

[WHM]

Because Dilantin efficacy depends on a consistent level in your bloodstream...

If you are having trouble taking your medication on a CONSISTENT schedule, and are only taking it once a day, check with your doctor about taking a half-dose, twice a day, instead.

That, in fact, is how my doctors recommended I take it, some 30 years ago... and it has always served me well. I take 230mg in the morning, 300mg in the evening, 12 hours apart.

Some people can do OK with a single daily dose, but it is very important that it be taken at a consistent time. Splitting it into two doses gives you more "room for error."

Bill

[jstkathy5]

I had considered talking to my doc about breaking up the times I take it as well, since it apparently has 'peak' times. However, if it is a function of hypermetabolism, it probably wouldn't make any difference because my body would 'hypermetabolize' it no matter when I took it.

So the logical way to go is to try taking them, as you said, twice a day. I found out that there are 200 and 300 mg 'extend' tabs which I didn't know about, so maybe those would work:1-200 tab in the morning and 1-300 tab
at night.

Thanks for your input Bill!

[mrsdoubtfyre]

interferes with phenytoin levels..

Women who start taking a high dose of folic acid along with phenytoin (Dilantin or Phenytek) should have the level of phenytoin in their blood checked to see whether the folic acid is causing the level of phenytoin to be lower than expected. Having a low blood level could increase the risk of seizures.

from http://www.epilepsy.com/info/women_folicacid.html

[jstkathy5]

Thanks for the info. Fortunately I don't take folic acid! One less thing to worry about.