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Phenytoin removal by plasmapheresis in thrombotic thrombocytopenic purpura
Author(s) -
Liu Edison,
Rubenstein Martin
Publication year - 1982
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1038/clpt.1982.107
Subject(s) - plasmapheresis , phenytoin , medicine , apheresis , thrombotic thrombocytopenic purpura , clinical pharmacology , anesthesia , hemodialysis , pharmacology , epilepsy , platelet , immunology , antibody , psychiatry
Phenytoin removal was followed in a patient undergoing plasmapheresis for thrombotic thrombocytopenic purpura. It was determined that 10% of total body phenytoin was removed with each two plasma volume exchanges, which is two to four times that reported with hemodialysis or peritoneal dialysis. During each 4‐ to 5‐hr apheresis, serum phenytoin levels fell an average of 3.2 µg/ml and the phenytoin clearance by plasmapheresis was 21.9 ± 2.1 ml/min (equal to the patient's endogenous clearance of 20.8 ml/min). Adjustment in drug doses were necessary such that, at steady state, the patient required 600 mg/day phenytoin to maintain therapeutic serum levels. These data indicate that plasmapheresis can clear the body of a significant amount of phenytoin and that increased doses may be required to maintain serum phenytoin levels. The potential use of apheresis in phenytoin overdose warrants further examination. Clinical Pharmacology and Therapeutics (1982) 31 , 762–765; doi: 10.1038/clpt.1982.107