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The Annals of Pharmacotherapy: Vol. 28, No. 2, pp. 191-195.
© 1994 Harvey Whitney Books Company.
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Research Articles

Fluconazole-induced symptomatic phenytoin toxicity

RM Cadle, Zenon GJ 3rd, MC Rodriguez-Barradas, and RJ Hamill

OBJECTIVE: To report two cases of fluconazole-induced symptomatic phenytoin toxicity and review literature related to this interaction. DATA SOURCES: Case reports and review articles identified by a computerized (MEDLINE) and manual (Index Medicus) search. DATA SYNTHESIS: Fluconazole is a broad-spectrum triazole antifungal agent primarily eliminated by renal mechanisms, although hepatic cytochrome P-450 inhibition and hepatotoxicity have been observed. We report two cases of fluconazole-induced symptomatic phenytoin toxicity. Both patients received high doses of the drug; one patient developed phenytoin toxicity only after long-term coadministration. Previously reported cases have occurred primarily with high-dose fluconazole and short-term coadministration. CONCLUSIONS: Fluconazole can increase phenytoin serum concentrations leading to toxicity. Constant and continuous monitoring of serum phenytoin concentrations with fluconazole doses as low as 200 mg/d is warranted.


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Copyright © 1994 by Harvey Whitney Books Company.