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Correlation between red cell and free plasma phenytoin levels in renal disease

From the Neuropharmacology Laboratory, Montreal Neurological Institute (Dr. Sherwin, Mrs. Harvey, and Dr. Leppik), and the Renal and Electrolyte Division, Royal Victoria Hospital (Dr. Gonda); Departments of Neurology and Neurosurgery, and Medicine, McGill University, Montreal, Canada.

Free phenytoin levels were determined in a group of patients with renal disease treated by hemodialysis or transplantation and in epileptic patients who were otherwise healthy. A highly significant correlation was observed between free drug levels and the phenytoin content of red blood cells in both groups. Considerable fluctuation in free phenytoin levels was observed during long-term maintenance hemodialysis. After transplantation, the degree of abnormality in plasma protein binding was not related to the functional adequacy of the cadaveric allografts. Free phenytoin levels must be monitored in patients with renal disease.

Dr. Sherwin's address is Montreal Neurological Institute, 3801 University Street, Montreal, Quebec, H3A 2B4.

This study was supported by the Medical Research Council of Canada.

Received for publication December 15, 1975.