Interaction of Oral Phenytoin with Enteral Feedings

• Published in: JPEN. Journal of parenteral and enteral nutrition Vol. 10; no. 3; pp. 322 - 323
• Main Authors: Saklad, Judith J., Graves, Richard H., Sharp, William P.
• Format: Journal Article
• Language: English
• Published: Thousand Oaks, CA Sage Publications 01-05-1986; SAGE Publications; ASPEN
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anticonvulsants. Antiepileptics. Antiparkinson agents; Biological and medical sciences; Emergency and intensive care: metabolism and nutrition disorders. Enteral and parenteral nutrition; Enteral Nutrition; Humans; Intensive care medicine; Intubation, Gastrointestinal; Male; Medical sciences; Middle Aged; Neuropharmacology; Pharmacology. Drug treatments; Phenytoin - adverse effects; Phenytoin - metabolism; Human; Anticonvulsant; Enteral administration; Oral administration; Feeding; Food drug interaction
• ISSN: 0148-6071; 1941-2444
• DOI: 10.1177/0148607186010003322

A 48-yr-old man with squamous cell carcinoma of the lung, hypercalcemia, and brain metastases with seizures was treated with phenytoin. Constant nasogastric infusion with Osmolyte was begun for hydration and nutritional status, necessitating an increase in his phenytoin dosage. Adequate seizure control and phenytoin levels were obtained on this adjusted regimen. However, on the 16th hospital day, the patient pulled out his nasogastric tube and received two doses of phenytoin without Osmolyte. The patient became lethargic, and his phenytoin level was 53 μg/ml. The patient was placed on bolus nasogastric feedings and a lower dose of phenytoin administered between feedings. Adequate seizure control and appropriate phenytoin levels were obtained with no further problems. The recommended management of the phenytoin-enteral feeding interaction is to flush and clamp the nasogastric tube for 2 hr before and 2 hr after the phenytoin dose. (Journal of Parenteral and Enteral Nutrition
10: 322-323, 1986)