Phenytoin kinetics in Japanese adult epileptics: phenotype of phenytoin slow metabolizers.

Phenytoin pharmacokinetics in 18 of 126 Japanese epileptic patients were investigated using the Michaelis-Menten equation. Five of these (4% of total) patients, who showed significantly high plasma concentrations of phenytoin even when administered a relatively low daily dose of phenytoin, were classified as slow metabolizers; 13 of these, who showed lower plasma concentrations, were classified as normal metabolizers. Comparison of slow and normal metabolizers revealed that the maximum rate of metabolism, Vmax, differed significantly between the two groups, the borderline Vmax value between the two groups being approximately 4.5-4.8 mg/kg/day. The mean Vmax value of slow metabolizers was calculated to be 70% that of normal metabolizers. It is possible that one means of phenotyping slow and normal phenytoin metabolizers is by analysis of phenytoin pharmacokinetics, with estimation of Vmax values.