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KMID : 0378019810240020053
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New Medical Journal
1981 Volume.24 No. 2 p.53 ~ p.58
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Effective Dosage of Phenytoin
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Abstract
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Since the introduction (1938) of phenytoin(DPH) in the dark age of epileptics who depended on barbiturates and bromides only, Its effect to the grand mal (GM) had been dramatic for many years in comparison to the two drugs.
As time went by, however, the epileptologists and electroencephalographers became doubtful about the efficacy and optimum dosage of DPH.
Some authorities in the field of epileptology claimed that the dosage of DPH should be no more or no less than 5 mg per kilogram of body weight.
It was not acceptable in the case of children with an idiopathic GM seizure in almost all cases.
Contrarily, in some cases of the adults, to a daily dosage of 400 mg of DPH for patient weighing 80kg,the serum level reached over 30 mcg/ml producing adverse reactions of DPH.
Revolutionarily, drug-drug interactions have nowadays, become very clear in addition to easy and prompt measurements of protein-bound A.E.D. level. And we have narrowly achieved the measurement of free DPH level also possible, which is closely related with the danger of DPH intoxication.
On the other hand lack of proper sobriety and compliance with physician´s instruction on the part of epileptics tends to show an unsatisfactory seizure control, pre-status or even status epileptics.
Fortunately a prompt A.E.D.-level check enables us to detect the cause of exacerbation and give a proper emergency care.
Many patients often complain of a minor or tribial abverse reaction of the drug, claiming individual variation of the drug metabolism.
They are overemphasized in terms of "chezil" (physical constitution) in Korea. However, these do not make phsicians confused. or anxious, thanks to the recent introduction of a quick A.E.D. serum level measurement in a matter of an hour.
The study which took 12 months comprises of strictly selected idiopathic GM patients. The author investigated the correlation between "Dosage based on age", age-dosage criteria and "Dosage based on weight",body weight-dosage criteria for an effective serum level of DPH.
The author also tried to figure out an effective A.E.D.-level in relation to the severity of EEG abnormalities in Korean GM patients.
In the case where drugs prohibiting DPH metabolims are being concurrently used (multiple drug therapy), the free DPH level especially turns out a matter of great concern. When a quick and handy method of me, measurement of this free level is developed, it would be an effective way of safeguarding the patients on the drugs, casting a new light on epileptics.
It would reveal a better efficacy of DPH and make us to be able to know a "new and correct use of DPH."
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