Population Pharmacokinetics of Phenytoin in Patients with Traumatic Brain Injury

Srisaeng, K.; Kanjanasilp, Juntip; Sriphong, Peeraya; Kittivaravach, Chumlong; Wongsrikaew, Prawatwong

doi:10.12982/cmujns.2015.0084

Cited by 1 publication

(3 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They concluded that the slightly higher value of Vm was associated with increased metabolism rate of phenytoin during early phase of acute brain injury. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%

“…Although the exact mechanism of decreased plasma concentration of phenytoin in HT patients is unclear, it is hypothesized that an increase in hepatic metabolism and unbound plasma concentration may involve in this phenomenon. [ 8 16 22 ] The previous studies demonstrated that the clearance of drugs may also be increased as a consequence of potential drug–drug interaction, high daily intake of protein (by increase in oxidative drug metabolism), fluid shifts, or pH changes after severe brain injury. [ 22 23 ]…”

Section: Discussionmentioning

confidence: 99%

“…These are blood–brain barrier disruption and changes in drug penetration, cytokine release, which can affect the cytochrome P450 enzyme system, alteration in protein binding and drug transportation, and hypothermia. [ 8 9 10 ] Although several studies have shown significant metabolism changes in patients after a severe head injury, few studies have focused on the effects of neurotrauma on drug metabolism. The understanding of possible pharmacokinetic alterations is important for the safe and effective drug use in this patient subset.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pharmacokinetic behavior of phenytoin in head trauma and cerebrovascular accident patients in an iranian population

et al. 2017

View full text Add to dashboard Cite

Objective:Acute brain injury is one of the leading causes of morbidity and mortality worldwide. Phenytoin has been commonly used as an anticonvulsant agent for the treatment or prophylaxis of seizures following acute brain injury. After a severe head injury, several pharmacokinetic changes occur. The aim of this study is the comparative evaluation of phenytoin serum concentration in patients with traumatic and nontraumatic brain injury (TBI).Methods:This prospective observational study was performed on twenty adult brain injury patients who were admitted to an Intensive Care Unit and required phenytoin for the treatment or prophylaxis of postinjury seizures. For all the patients, phenytoin serum concentration was determined in three scheduled time points. Phenytoin serum concentration and pharmacokinetic parameters were compared between patients with TBI and cerebrovascular accident (CVA).Findings:The Vmaxand Kmwere significantly higher in head trauma (HT) patients than the CVA group. The phenytoin concentration (Cp) and the Cp/dose ratio were significantly higher in the CVA group patients during the first sampling (P < 0.05). The Acute Physiology and Chronic Health Evaluation П (APACHE П) score was significantly lower than the baseline at the end of the study in each group of patients (P < 0.05). In addition, no significant correlation was observed between Vmax, Km, Cp, Cp/dose ratio, and APACHE II scores at the time of sampling.Conclusion:Due to significant differences in phenytoin plasma concentration and pharmacokinetic parameters between HT and CVA patients, close attention must be paid to the pharmacokinetic behavior of phenytoin in the efforts to improve the patient's outcome after a severe HT.

show abstract

“…They concluded that the slightly higher value of Vm was associated with increased metabolism rate of phenytoin during early phase of acute brain injury. [ 8 ]…”

Section: Discussionmentioning

confidence: 99%