Vigabatrin‐induced decrease in serum phenytoin concentration does not involve a change in phenytoin bioavailability

Publisher Website
Google Scholar
Abstract
The possibility that vigabatrin (VGB) decreases serum phenytoin (PHT) concentration by lowering the oral bioavailability of PHT was investigated in 21 patients with epilepsy. Each patient was switched from oral to intravenous PHT for 5 days before and after combined treatment with VGB. After VGB (2−3.5 g day−1 for at least 5 weeks), serum PHT concentrations decreased slightly from 87 ± 25 to 76 ± 31 μmol 1−1 (means ± s.d., P < 0.05), but in a subgroup of seven patients the decrease was more prominent (from 72 ± 22 to 49 ± 17 μmol 1−1 P < 0.005). At baseline (before VGB), serum PHT remained unaffected (85 ± 30 μmol 1−1) after switching PHT dosage to the intravenous route, indicating that the oral availability of the drug was virtually complete. During VGB treatment, serum PHT was also unchanged (74 ± 34 μmol 1−1) after switching from oral to intravenous therapy, and this was also true for the subgroup of patients showing a prominent interaction (48 ± 18 μmol l−1). The urinary recoveries of PHT and its metabolites pHPPH and mHPPH remained constant throughout the study. It is concluded that the oral availability of PHT is unaffected by VGB and that the VBG‐induced decrease in serum PHT is mediated by alternative mechanisms.