PHENYTOIN TOXICITY FROM SMOKING CRACK COCAINE ADULTERATED WITH PHENYTOIN

Drugs of abuse often are adulterated with agents designed to lower cos t or alter the intoxication. Recently, we began to hear of the intenti onal addition of phenytoin to crack cocaine. We report the cases of fi ve patients with measurable phenytoin levels attributable to smoking c rack cocaine adulterated with phenytoin. Three of these patients prese nted with signs, symptoms, and phenytoin levels consistent with phenyt oin toxicity. Clinicians should be aware of this practice when faced w ith cocaine users with altered mental status, ataxia, or nystagmus.