SYSTEMATIC-APPROACH TO A DOSAGE REGIMEN FOR PHENYTOIN BASED ON ONE-POINT, STEADY-STATE PLASMA-CONCENTRATION

A systematic approach to individualizing the phenytoin (PHT) dose from a previous dose (D) and steady-state concentration (C-ss) pair was es tablished by the combined use of two methods based on recently reporte d population pharmacokinetic parameters. This system applies the Micha elis-Menten equation to the initial data pair (D-l-C-ssl) and solves f or (a) maximum metabolic rate constant (V-max) assuming the population mean for the Michaelis constant (K-m) (method 1), and (b) K-m assumin g the population mean for V-max (method 2). The derived estimates of V -max and K-m are then put through a series of filters, which results i n the selection of method 1 and/or method 2 or allocation of a third c ategory that needs further evaluation. A simulation study was performe d to find a series of filters. The presented approach was applied retr ospectively to the patients' data of 35 sets. Accurate predictions of the C-ss error within 5 mu g/ml were obtained in 84% of the 25 cases, and in 30% of the 10 cases excluded. This systematic approach gives be tter prediction performance in mean error, mean absolute error, and ro ot mean square error than a Bayesian feedback method.