Phenytoin toxicity

Awasthi, Avivar; Agrawal, Neeti; Chakraborty, Partha Pratim; Maiti, Animesh

doi:10.1136/bcr-2022-253250

Cited by 3 publications

(2 citation statements)

References 3 publications

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“…The results indicated that lower detection limits were achieved by TD-ESI/MS/MS than those of TD-ESI/MS for the detection of adulterant standards prepared in methanol and of those spiked in different herbal preparations (Table 4). Human serum >20 μg/mL acetaminophen, 49 >15 μg/mL caffeine, 50 > 1.5 μg/mL diazepam, 51 > 20 μg/mL phenytoin, 52 and >45 μg/mL phenylbutazone. 53 Such over- dose levels encountered in actual clinical practice are far higher than the LODs of TD-ESI/MS described in this study.…”

Section: Resultsmentioning

confidence: 99%

Rapid Characterization of Undeclared Pharmaceuticals in Herbal Preparations by Ambient Ionization Mass Spectrometry for Emergency Care

Lee,

Su,

Hsu

et al. 2024

J. Am. Soc. Mass Spectrom.

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In Asia, some herbal preparations have been found to be adulterated with undeclared synthetic medicines to increase their therapeutic efficiency. Many of these adulterants were found to be toxic when overdosed and have been documented to bring about severe, even life-threatening acute poisoning events. The objective of this study is to develop a rapid and sensitive ambient ionization mass spectrometric platform to characterize the undeclared toxic adulterated ingredients in herbal preparations. Several common adulterants were spiked into different herbal preparations and human sera to simulate the clinical conditions of acute poisoning. They were then sampled with a metallic probe and analyzed by the thermal desorption-electrospray ionization mass spectrometry. The experimental parameters including sensitivity, specificity, accuracy, and turnaround time were prudently optimized in this study. Since tedious and time-consuming pretreatment of the sample is unnecessary, the toxic adulterants could be characterized within 60 s. The results can help emergency physicians to make clinical judgments and prescribe appropriate antidotes or supportive treatment in a time-sensitive manner.

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Section: Resultsmentioning

confidence: 99%

Rapid Characterization of Undeclared Pharmaceuticals in Herbal Preparations by Ambient Ionization Mass Spectrometry for Emergency Care

Lee,

Su,

Hsu

et al. 2024

J. Am. Soc. Mass Spectrom.

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“…Phenytoin has a narrow therapeutic margin and should be closely monitored. The primary concern and unpredictable scenario is when patients develop toxicity despite usual therapeutic doses (200–400 mg/day) [ 3 ]. The drug follows a nonlinear pharmacokinetic profile.…”

Section: Introductionmentioning

confidence: 99%

Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences

Manoj,

Meher,

Winner G.

2024

Case Reports in Neurological Medicine

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Adverse drug reactions to commonly prescribed medications such as phenytoin, used for seizures, often go undetected due to various factors. This case report highlights a 52-year-old male diagnosed with late-onset epilepsy who was prescribed phenytoin. Despite the standard dosage, the patient experienced toxicity symptoms and a seizure, prompting admission for assessment. Laboratory tests and imaging were inconclusive, leading to a therapeutic drug monitoring (TDM) consultation, which revealed elevated phenytoin levels. Genetic testing for CYP2C9 polymorphisms was not feasible but noted as significant, especially in populations with higher prevalence. Phenytoin was tapered, leading to the patient’s gradual recovery upon discontinuation and transition to valproate. The Naranjo scale predicted potential adverse drug responses (ADRs). This case underscores the significance of TDM, genetic considerations in drug metabolism, and the need to be vigilant in treating epilepsy to prevent such adverse events.

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Phenytoin

2023

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Phenytoin toxicity

Cited by 3 publications

References 3 publications

Rapid Characterization of Undeclared Pharmaceuticals in Herbal Preparations by Ambient Ionization Mass Spectrometry for Emergency Care

Rapid Characterization of Undeclared Pharmaceuticals in Herbal Preparations by Ambient Ionization Mass Spectrometry for Emergency Care

Ataxia and Seizures despite Phenytoin: A Case Report Highlighting the Importance of TDM and Genetic Influences

Phenytoin

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