Phenytoin (Dilantin) Correction for Albumin / Renal Failure
Use in patients with albumin ≤3.2 g/dL (32 g/L).
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Adjust phenytoin dosing based on values.
If consistently out of range, consider other antiepileptics.
Concomitant use of valproic acid and some other drugs displaces phenytoin from plasma proteins and can lead to erratic levels.
Whenever possible, a free phenytoin level should be utilized over a corrected level.
A therapeutic phenytoin level is generally considered to be 10-20 mg/L (40-80 µmol/L). Levels above this may cause nystagmus, ataxia, lethargy, confusion, and coma.
- Andrew Michalak, MD