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October 17, 1977

Removal of Phenytoin by Hemodialysis in Uremic Patients

Author Affiliations

From the Department of Medicine, Divisions of Clinical Pharmacology (Dr Martin) and Nephrology (Dr Grausz), School of Medicine, and the Department of Pharmacy, Division of Clinical Pharmacy, School of Pharmacy (Drs Gambertoglio, Adler, and Tozer and Ms Roman), University of California, San Francisco. Dr Martin is now with Medizinische Universitaetsklinik, Basel, Switzerland, and Dr Adler is with University Hospital, University of California Medical Center, San Diego.

JAMA. 1977;238(16):1750-1753. doi:10.1001/jama.1977.03280170044025

The removal of phenytoin by hemodialysis was determined in seven uremic patients. Four patients were receiving phenytoin sodium for therapeutic purposes; three received one dose each intravenously to quantitate its disposition in uremia. The drug was measured in whole blood, plasma, saliva, and dialysate. Only 2% to 4% of the intravenous dose was recovered in the dialysate. Phenytoin clearance by dialysis was 7 to 14 ml/min; plasma clearance was 53 to 133 ml/min. Since hemodialysis contributes little toward shortening the 11-to-18-hour half-life of phenytoin in the uremic patient, no supplemental dose is necessary for uremic patients undergoing hemodialysis.

(JAMA 238:1750-1753, 1977)