EARLY RECURRENCE OF WITHDRAWAL SYMPTOMS UNDER PHENYTOIN AND CHRONIC ALCOHOL-USE

We report the case of a 32-year-old male alcohol- and opioid-dependent patient, substituted with oral methadone for seven years. He was also maintained on phenytoin 100 mg t.i.d. because of generalized epilepsy during an alcohol withdrawal treatment in hospital. After several dru g-free intervals the patient had resumed consumption of opioids (200 m g methadone p.o. daily and an unknown quantity of street heroin intrav enously) and alcohol (a daily intake of 2 to 3 liters of beer). On adm ission, liver enzymes were pathologically high (ASAT 1.2 x normal, ALA T 1.3 x normal, gamma-glutamyl transferase 5.7 x normal; bilirubin and alkaline phosphatase were normal). Withdrawal symptoms, including shi vering, stomach pains, nausea, vomiting, diarrhea, and muscle pains, a ppeared within 2 - 3 hours of intake of methadone (administered over 2 4 hours in three doses of 80 mg, 60 mg, and 60 mg). Intermittent withd rawal symptoms persisted until the patient received a total of 320 mg of methadone (divided into five single doses), with which he felt comf ortable.