Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia

Seyyede-Sareh Javadi,1 Reza Mahjub,2 Abbas Taher,3 Younes Mohammadi,4 Maryam Mehrpooya1 1Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Pharmaceutics, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran...

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Autores principales:	Javadi SS, Mahjub R, Taher A, Mohammadi Y, Mehrpooya M
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Phenytoin Therapeutic drug monitoring Intensive Care patients Sheiner-Tozer equation. Therapeutics. Pharmacology RM1-950
Acceso en línea:	https://doaj.org/article/004de82a97fa4493b321332fe0dfc2c6
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spelling	oai:doaj.org-article:004de82a97fa4493b321332fe0dfc2c62021-12-02T00:04:24ZCorrelation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia1179-1438https://doaj.org/article/004de82a97fa4493b321332fe0dfc2c62018-12-01T00:00:00Zhttps://www.dovepress.com/correlation-between-measured-and-calculated-free-phenytoin-serum-conce-peer-reviewed-article-CPAAhttps://doaj.org/toc/1179-1438Seyyede-Sareh Javadi,1 Reza Mahjub,2 Abbas Taher,3 Younes Mohammadi,4 Maryam Mehrpooya1 1Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Pharmaceutics, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 3Department of Anesthesiology and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran; 4Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Purpose: In critically ill patients, monitoring free phenytoin concentration is a valuable method for phenytoin-dosage adjustment. However, due to technical difficulties and the high cost of these methods, the Sheiner–Tozer equation is routinely used for estimating free phenytoin concentration in clinical practice. There have been conflicting results concerning accuracy and precision of the Sheiner–Tozer equation for prediction of free phenytoin concentration in various patient populations. Therefore, this study was conducted to evaluate the accuracy and correlation of measured and calculated free phenytoin concentrations in neurointensive care patients with hypoalbuminemia. Methods: A total of 65 adult neurointensive care patients with hypoalbuminemia who were receiving phenytoin for prevention or treatment of seizures were recruited in this study. In addition to measuring free phenytoin concentration by HPLC, free phenytoin concentration was calculated using both conventional and revised Sheiner–Tozer equations. Eventually, the correlation and level of agreement between measured and calculated free phenytoin concentrations were evaluated. Results: The mean albumin concentration of studied patients was 2.63±0.57 g/dL. There was a significant but weak–moderate correlation between measured and calculated free phenytoin concentration using conventional and revised Sheiner–Tozer equations (r=0.45 and r=0.43, respectively). Conventional and revised Sheiner–Tozer equations were not able to predict free phenytoin concentrations accurately in 33.85% and 35.4% of patients, respectively. Although the sex of patients did not have a significant impact on the level of agreement, younger patients had a higher level of agreement. Conclusion: Although there was a moderate correlation between calculated and measured free phenytoin concentration, the Sheiner–Tozer equation was not able to predict free phenytoin concentration accurately in all patients, especially in older patients. Therefore, monitoring free phenytoin serum concentration besides clinical outcomes should be considered for phenytoin-dose adjustment in critically ill patients. Keywords: phenytoin, therapeutic drug monitoring, intensive care patients, Sheiner–Tozer equationJavadi SSMahjub RTaher AMohammadi YMehrpooya MDove Medical PressarticlePhenytoinTherapeutic drug monitoringIntensive Care patientsSheiner-Tozer equation.Therapeutics. PharmacologyRM1-950ENClinical Pharmacology: Advances and Applications, Vol Volume 10, Pp 183-190 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Phenytoin Therapeutic drug monitoring Intensive Care patients Sheiner-Tozer equation. Therapeutics. Pharmacology RM1-950
spellingShingle	Phenytoin Therapeutic drug monitoring Intensive Care patients Sheiner-Tozer equation. Therapeutics. Pharmacology RM1-950 Javadi SS Mahjub R Taher A Mohammadi Y Mehrpooya M Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
description	Seyyede-Sareh Javadi,1 Reza Mahjub,2 Abbas Taher,3 Younes Mohammadi,4 Maryam Mehrpooya1 1Department of Clinical Pharmacy, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 2Department of Pharmaceutics, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran; 3Department of Anesthesiology and Critical Care, Hamadan University of Medical Sciences, Hamadan, Iran; 4Modeling of Noncommunicable Diseases Research Center, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran Purpose: In critically ill patients, monitoring free phenytoin concentration is a valuable method for phenytoin-dosage adjustment. However, due to technical difficulties and the high cost of these methods, the Sheiner–Tozer equation is routinely used for estimating free phenytoin concentration in clinical practice. There have been conflicting results concerning accuracy and precision of the Sheiner–Tozer equation for prediction of free phenytoin concentration in various patient populations. Therefore, this study was conducted to evaluate the accuracy and correlation of measured and calculated free phenytoin concentrations in neurointensive care patients with hypoalbuminemia. Methods: A total of 65 adult neurointensive care patients with hypoalbuminemia who were receiving phenytoin for prevention or treatment of seizures were recruited in this study. In addition to measuring free phenytoin concentration by HPLC, free phenytoin concentration was calculated using both conventional and revised Sheiner–Tozer equations. Eventually, the correlation and level of agreement between measured and calculated free phenytoin concentrations were evaluated. Results: The mean albumin concentration of studied patients was 2.63±0.57 g/dL. There was a significant but weak–moderate correlation between measured and calculated free phenytoin concentration using conventional and revised Sheiner–Tozer equations (r=0.45 and r=0.43, respectively). Conventional and revised Sheiner–Tozer equations were not able to predict free phenytoin concentrations accurately in 33.85% and 35.4% of patients, respectively. Although the sex of patients did not have a significant impact on the level of agreement, younger patients had a higher level of agreement. Conclusion: Although there was a moderate correlation between calculated and measured free phenytoin concentration, the Sheiner–Tozer equation was not able to predict free phenytoin concentration accurately in all patients, especially in older patients. Therefore, monitoring free phenytoin serum concentration besides clinical outcomes should be considered for phenytoin-dose adjustment in critically ill patients. Keywords: phenytoin, therapeutic drug monitoring, intensive care patients, Sheiner–Tozer equation
format	article
author	Javadi SS Mahjub R Taher A Mohammadi Y Mehrpooya M
author_facet	Javadi SS Mahjub R Taher A Mohammadi Y Mehrpooya M
author_sort	Javadi SS
title	Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
title_short	Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
title_full	Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
title_fullStr	Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
title_full_unstemmed	Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
title_sort	correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/004de82a97fa4493b321332fe0dfc2c6
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Correlation between measured and calculated free phenytoin serum concentration in neurointensive care patients with hypoalbuminemia

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