Clinical Importance of Phenytoin Monitoring to Reduce Phenytoin-Related Toxicity in Saudi Patients with Epilepsy
Ghidaa Alwaf1, Hussam Younis2, Mohammed AL-Hartani2, Alaa H. Falemban3, Yosra Alhindi3, Wafaa Almalky3, Mohammed Shaikhomer5, Abdullah R. Alzahrani3,4,, Saeed S. Al-Ghamdi3,4, Safaa M. Alsanosi3, Nahla Ayoub*3,4
1Saudi Pharmaceutical Industries and Medical Appliances Cooperation, Jeddah, Saudi Arabia
2 King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
3 Department of Pharmacology and Toxicology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
4 Saudi Toxicology Society, Umm Al-Qura University, Makkah, Saudi Arabia
5 Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
*Corresponding Authors: Nahla Ayoub ([email protected]) Tel: +96653219008, Fax: +966125270000,https://orcid.org/0000-0003-4490-889X
Abstract
Background:Phenytoin toxicity can result from overdose, dosage changes, drug interactions, or physiological alterations. Symptoms range from nausea and confusion to severe cases involving coma and seizures, though fatalities are rare. To date, no literature has been found concerning phenytoin monitoring in Saudi epileptic patients. This study is the first to investigate phenytoin monitoring for toxicity prevention, optimal dosing, and adverse effect management in Saudi epileptic patients.Methods: A two-month, randomized, open-label, prospective monitoring study was conducted in Saudi epileptic patients treated with phenytoin. The patients (n=40) were subdivided into two groups (monitored and unmonitored) to check the prevalence of phenytoin toxicity after two months of monitoring.Results: Most patients’ current dose was 100 mg TID: 65% and 55% in the monitored and unmonitored groups, respectively. Statistical analysis showed significant differences between current doses of the patients in the monitored (P=0.010) and unmonitored groups (P=0.018). In addition, there was a significant difference between serum levels of phenytoin regarding the monitored and unmonitored groups in the first month and second month (P=0.0246 and P=0.04), respectively. Further, there was no significant difference between the kidney functions in the first second months in the monitored group (P=0.077), while there was a substantial difference in the unmonitored group (P=0.0241). Moreover, a significant difference between the monitored and unmonitored groups in the first and second months for serum creatinine (P<0.001 and P=0.032) was recorded.Conclusions: The current study reports that continuous phenytoin monitoring in Saudi epileptic patients reduces the incidence of phenytoin toxicity. Toxicity was observed in 5% of monitored patients compared to 15% of unmonitored patients.
Received: 04 December 2024, Accepted: 30 January 2025, Published: 12 February 2025
How to Cite
Alwaf, G., Younis, H., AL-Hartani, M., Falemban, A. H., Alhindi, Y., Almalky, W., Shaikhomer, M., Alzahrani, A. R., Al-Ghamdi, S. S., Alsanosi, S. M., & Ayoub, N., Clinical Importance of Phenytoin Monitoring to Reduce Phenytoin-Related Toxicity in Saudi Patients with Epilepsy.STJ,2024, 1,75-89.
https://doi.org/10.70957/uqu.edu.sa/s.toxicology.s/stj.2024.1.8
Copyright: © 2024 by the authors. Licensee Umm Al-Qura University, Makkah, Saudi ArabiaThis article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).