期刊
NEUROLOGY
卷 60, 期 4, 页码 555-559出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/01.WNL.0000052997.43492.E0
关键词
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资金
- NINDS NIH HHS [P50-NS16308] Funding Source: Medline
Background: Approximately 6% of all elderly nursing home residents receive phenytoin. Phenytoin concentrations are often measured to guide therapy. Objective: To evaluate the intraresident variability among multiple measurements of total phenytoin serum concentrations in nursing home residents. Methods: This was an observational study of 56 elderly (greater than or equal to65 years) nursing home residents from 32 nursing homes who had at least 3 phenytoin concentrations measured while on the same dose of phenytoin for at least 4 weeks and who were not taking any interfering concomitant medications. These were a subset of 387 elderly nursing home residents from 112 nursing homes across the United States who had total phenytoin concentration measurements between June 1998 and December 2000. Results: The mean age was 80.1 years (range, 65 to 100 years) and 58.9% were women. The mean daily dose of phenytoin per resident was 4.9 +/- 1.5 mg/kg. Total phenytoin concentrations within an elderly nursing home resident varied as much as two- to threefold, even though there was no change in dose. The person with the smallest variability had a minimum concentration of 10.0 mug/mL and a maximum of 10.4 mug/mL. The person with the largest variability had a minimum concentration of 9.7 mug/mL and a maximum of 28.8 mug/mL. Conclusions: There is considerable variability in the total phenytoin concentrations in the elderly nursing home resident and measurement of a single total phenytoin concentration should not be used to guide treatment.
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