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Titre du document / Document title

Phenytoin-folic acid interaction

Auteur(s) / Author(s)

LEWIS D. P. (1) ; VAN DYKE D. C. ; WILLHITE L. A. ; STUMBO P. J. ; BERG M. J. ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Univ. Iowa, coll. pharmacy, Iowa City IA 52242, ETATS-UNIS

Résumé / Abstract

OBJECTIVE : To review information regarding the dual and interdependent drug-nutrient interaction between phenytoin and folic acid and other literature involving phenytoin and folic acid. DATA SOURCES : Information was retrieved from a MEDLINE search of English-language literature conducted from 1983 (time of the last review) to March 1995. Search terms included folic acid, phenytoin, and folic acid deficiency. Additional references were obtained from Current Contents and from the bibliographies of the retrieved references. STUDY SELECTION : All human studies examining the effects of phenytoin on serum folate concentrations and folic acid supplementation on serum phenytoin concentrations were selected. These included studies of patients with epilepsy and healthy volunteers as well as case reports. Case reports were included because of the extensive length of time needed to study this drug interaction. DATA EXTRACTION : Data extracted included gender, dosing, serum folate concentrations if available, pharmacokinetics, and adverse events. DATA SYNTHESIS : Serum folate decreases when phenytoin therapy is initiated alone with no folate supplementation. Folic acid supplementation in folate-deficient patients with epilepsy changes the pharmacokinetics of phenytoin, usually leading to lower serum phenytoin concentrations and possible seizure breakthrough. Folate is hypothesized to be a cofactor in phenytoin metabolism and may be responsible for the pseudo-steady-state, which is a concentration where phenytoin appears to be at steady-state, but in reality, is not. Phenytoin and folic acid therapy initiated concomitantly prevents decreased folate and phenytoin obtains steady-state concentrations sooner. CONCLUSIONS : Folic acid supplementation should be initiated each time phenytoin therapy commences because of the hypothesized cofactor mechanism, decreased adverse effects associated with folate deficiency, and better seizure control with no perturbation of phenytoin pharmacokinetics.

Revue / Journal Title

The Annals of pharmacotherapy    ISSN  1060-0280   CODEN APHRER 

Source / Source

1995, vol. 29, no7-8, pp. 726-735 (65 ref.)

Langue / Language

Anglais

Editeur / Publisher

Whitney, Cincinnati, OH, ETATS-UNIS  (1992) (Revue)

Mots-clés anglais / English Keywords

Folic acid

;

Anticonvulsant

;

Epilepsy

;

Vitamin deficiency

;

Human

;

Drug interaction

;

Pharmacokinetics

;

Chemotherapy

;

Treatment

;

Nervous system diseases

;

Central nervous system disease

;

Cerebral disorder

;

Mots-clés français / French Keywords

Phénytoïne

;

Folique acide

;

Anticonvulsivant

;

Epilepsie

;

Carence vitaminique

;

Homme

;

Interaction médicamenteuse

;

Pharmacocinétique

;

Chimiothérapie

;

Traitement

;

Système nerveux pathologie

;

Système nerveux central pathologie

;

Encéphale pathologie

;

Mots-clés espagnols / Spanish Keywords

Fólico ácido

;

Anticonvulsivante

;

Epilepsia

;

Carencia vitamínica

;

Hombre

;

Interacción medicamentosa

;

Farmacocinética

;

Quimioterapia

;

Tratamiento

;

Sistema nervioso patología

;

Sistema nervosio central patología

;

Encéfalo patología

;

Localisation / Location

INIST-CNRS, Cote INIST : 13925, 35400005367272.0160

Nº notice refdoc (ud4) : 3599890



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