Guidelines For Therapeutic Drug Monitoring
Guidelines For Therapeutic Drug Monitoring
Guidelines For Therapeutic Drug Monitoring
Phenytoin reporting.
All phenytoin results are reported in the following panel, with an Adjusted Phenytoin value,
calculated using the Scheiner-Tozer equation (see below) to take into account the effect of protein
binding.
Albumin-adjusted phenytoin is a better guide to biologically active phenytoin than total levels
when albumin is reduced. Interpret results with caution if albumin less than 20g/L or in the
presence of other factors that may influence phenytoin binding (eg other highly protein-bound
drugs, uraemia, hepatic impairment and pregnancy).
Scheiner-Tozer Equation
To adjust to an albumin concentration of 40g/L:
Adjusted Phenytoin = Phenytoin___
(Alb x 0.9) + 0.1
40
References
1) Clinical Chemistry 1998; 44 (5): 1085 – 1095
2) Guidelines to Monitoring Lithium: A statement of good practice 1998
see also
3) NICE guidelines for bipolar disorder (July 2006)
4) Fedler C and Stewart MJ. Plasma total phenytoin: a possibly misleading test in developing
countries. Ther Drug Monit. 1999, 21: 155-160
For Lamotrigine, Gabapentin, Topiramate and Vigabatrin see: Syva Drug Monitor Vol 2: issues 2,
5 and 10