| Phenytoin의 독성 혈중 농도가 유효 치료 영역까지 도달하는 시간에 대한 임상적 연구 |
| 박현미, 이영주, 김희태, 김승현, 김주한, 김명호, 문태순*, 신동진*, 장인진**, 신상구** |
| 한양대학교 의과대학 신경과학교실, 인천 중앙 길병원*, 서울대학교 의과대학 약리학과교실** |
| The Clinical Study on the Predictability of Time from Toxic Level to Therapeutic Concentration on Phenytoin Toxicity |
| Hyeon-Mi Park, Young-Ju Lee, Hee-Tae Kim, Seung-Hyun Kim, Ju-Han Kim, Myung-Ho Kim, Tae-Soon Moon*, Dong-Jin Shin*, In-Jin Jang**, Sang-Gu Shin**, M. D. |
| Department of Neurology, College of Medicine, Hanyang University Hospital, Chung-Ang Gil Hospital*, Department of Pharmacology, College of Medicine, Seoul National University Hospital** |
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| Abstract |
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It is important to predict time to reach therapeutic concentration in phenytoin toxicity. In tradition, frequent drug monitoring is inevitable until the therapeutic serum level is reached. A method of estimating Vmax and Vd of phenytoin with application to estimating time to reach therapeutic concentration of phenytoin is described. We evaluated the usefulness of that method in twelve patients with phenytoin toxicity whose initial levels ranging from 27.7 to 74.0 ug/ml. We compaired the observed time defined as the time of returning from the initial toxic level to the optimum therapeutic level by serial measurement of serum concentration with the calculated time by using the modified Michaelis-Menten equation (Km x In (C1/C2) +Cl-C2=Vmax/vd x T). We determined individual patient's Vmax (maximal metabolic rate of concentration), Vd(volume of distribution of concentration), and Km(constants of Michaelis-Menten equation) for phenytoin, using data obtained from two consecutive serum concentration and known value of Km in Korean. And then, we calculated the decline time of phenytoin. The calculated decline time did not differ significantly from observed decline time (P=0.830). It is possible to predict the time to the therapeutic range and to reduce the unnecessarily frequent drug monitoring. |
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