Critical ill patient ,10kg , on epanutin 8mg/kg/day ,drug level 23ug/ml(normal 10_20)how to update dose ?
No specific guide for pediatrics in this situation.
In critically ill patients, it’s highly recommended to monitor for drug interactions.
Note that if the patient albumin level is below 3.5, you should calculate the corrected phenytoin level for hypoalbuminemia.
Generally speaking, you can try to lower the dose by 50% and monitor the response and the levels in the blood. If the corrected is too high, you can stop phenytoin and try another agent.
Some pharmacogenomic studies suggest different approaches depending on the gene type, for example; CYP2C9 poor metabolizer: Use usual initial or loading doses, reduce usual maintenance dose by 50%, and adjust according to therapeutic drug monitoring, response, and tolerability.
