de Oca G M, Gums J G, Robinson J D
Family Medicine, Mt. Sinai Hospital, Miami, FL.
Drug Intell Clin Pharm. 1988 Sep;22(9):708-10. doi: 10.1177/106002808802200915.
Phenytoin is used extensively in the treatment of various forms of epilepsy, and remains the drug of choice in partial and generalized tonic-clonic seizures. Because it demonstrates saturable, Michaelis-Menten pharmacokinetics, dosing of phenytoin within the therapeutic range can be very challenging, especially so in obese patients. We present case reports of two obese patients each requiring very large doses of phenytoin sodium (1000 mg/d) to sustain therapeutic serum concentrations and seizure control. There are very few reports in the literature regarding phenytoin pharmacokinetic changes in the obese. We can only theorize possible changes in these parameters. Further investigation in the form of controlled research trials need to be performed before final dosage recommendations can be given.
苯妥英广泛用于治疗各种类型的癫痫，并且仍然是部分性和全身性强直阵挛性发作的首选药物。由于它表现出饱和的米氏动力学，在治疗范围内给予苯妥英的剂量可能非常具有挑战性，尤其是在肥胖患者中。我们报告了两例肥胖患者的病例，他们各自需要非常大剂量的苯妥英钠（1000毫克/天）来维持治疗性血清浓度并控制癫痫发作。关于肥胖患者苯妥英药代动力学变化的文献报道非常少。我们只能推测这些参数可能的变化。在给出最终剂量建议之前，需要进行对照研究试验形式的进一步调查。
