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NEUROLOGY 1986;36:1367
© 1986 American Academy of Neurology

Altered phenytoin clearance with febrile illness

I. E. Leppik, MD, J. Fisher, PharmD, R. Kriel, MD and R. J. Sawchuk, PhD

Departments of Neurology (Dr. Leppik) and Pediatric Neurology (Dr. Kriel), St. Paul-Ramsey Medical Center, St. Paul; and the School of Medicine (Drs. Leppik and Kriel), the Departments of Pharmacy Practice (Dr. Fisher) and Pharmaceutics (Dr. Sawchuk), and the College of Pharmacy (Drs. Fisher and Sawchuk), the University of Minnesota, Minneapolis, MN.

A prospective study was performed of antiepileptic drug levels in 14 boys resident in a pediatric chronic care facility. Blood samples and 24-hour urine collections were obtained monthly. During febrile illness (temperature > 101 °F for more than 24 hours), six additional blood samples and two urine collections were obtained for each child. During 8 of 10 febrile illnesses, phenytoin (PHT) decreased more than 40% from pre-illness baseline. Mean PHT level before illness was 16.7 (± 4.5 µg/ml) and during illness, 8.2 (± 3.6 µg/ml), significantly lower (p < 0.001). Neither PHT binding nor absorption was altered by illness, so the most probable cause of the drop in PHT levels was induction of the hepatic oxidative enzyme system.

Address correspondence and reprint requests to Dr. Leppik, Department of Neurology, St. Paul-Ramsey Medical Center, St. Paul, MN 55101.

Supported by NINCDS contract no. N01-NS-5–2327, awarded to the Comprehensive Epilepsy Program of the University of Minnesota.

Accepted for publication February 4, 1986.






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