Phenytoin

Excreted Unchanged %
2
Half-Life (Normalesrd) Hours
7-24/Unchanged
Plasma Protein Binding %
90
Volume Of Distribution L/Kg
0.7
Dose For Normal Renal Function
100 mg tid
Adjustment For Renal Failure Gfr, Ml/Min >50 [Recommended Level]
100% [B]
Adjustment For Renal Failure Gfr, Ml/Min 10-50 [Recommended Level]
100% [B]
Adjustment For Renal Failure Gfr, Ml/Min <10 [Recommended Level]
100% [B]
Supplement For Dialysis [Recommendation Level]: Ihd
IHD: None, [A]
Supplement For Dialysis [Recommendation Level]: Pd
PD: None, [B]
Supplement For Dialysis [Recommendation Level]: Crrt
CRRT: 100%, [B]
References
Borg&#229; O, Hoppel C, Odar-Cederl&#246; f I, Garle M. Plasma levels and renal excretion of phenytoin and its metabolites in patients with renal failure. Clin Pharmacol Ther. 1979; 26: 306-14. [PMID: 466924] / Frenchie D, Bastani B. Significant removal of phenytoin during high flux dialysis with cellulose triacetate dialyzer [Letter]. Nephrol Dial Transplant. 1998; 13: 817-8. [PMID: 9550689] / Hays DP, Primack WA, Abroms IF. Phenytoin clearance by continuous ambulatory peritoneal dialysis. Drug Intell Clin Pharm. 1985; 19: 429-31. [PMID: 4006737] / Lau AH, Kronfol NO. Effect of continuous hemofiltration on phenytoin elimination. Ther Drug Monit. 1994; 16: 53-7. [PMID: 8160256] / Liponi DF, Winter ME, Tozer TN. Renal function and therapeutic concentrations of phenytoin. Neurology. 1984; 34: 395-7. [PMID: 6538287] / Martin E, Gambertoglio JG, Adler DS, Tozer TN, Roman LA, Grausz H. Removal of phenytoin by hemodialysis in uremic patients. JAMA. 1977; 238: 1750-3. [PMID: 578272] / Reeves JH, Butt WW. A comparison of solute clearance during continuous hemofiltration, hemodiafiltration, and hemodialysis using a polysulfone hemofilter. ASAIO J. 1995; 41: 100-4. [PMID: 7727810] / Tiula E, Tallgren LG, Neuvonen PJ. Serum protein binding of phenytoin, diazepam and propranolol in chronic renal diseases. Int J Clin Pharmacol Ther Toxicol. 1987; 25: 545-52. [PMID: 3429058]
Toxicity Notes
Folate deficiency. Interstitial nephritis. Dosage should be individualized. Measure free levels. Seven to ten days may be required to achieve steady-state blood levels. Protein binding decreased and distribution volume increased in renal failure.