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Metabolism: Phenytoin is biotransformed in the liver pfizer dilantin coupon dilantin bipolar dilantin replacement dilantin qt dilantin and warfarin by oxidative metabolism .
The major pathway involves 4-hydroxylation, dilantin which accounts for 80% of all metabolites .
Experiments in human liver microsomes have demonstrated that CYP2C9 plays the major role in the metabolism of phenytoin (90% of net intrinsic clearance), while CYP2C19 has dilantin vitamin d dilantin forms dilantin package insert dilantin and zofran dilantin normal level a minor involvement in this process (10% of the net intrinsic clearance) .
In experiments with human liver microsomes, the relative contribution of CYP2C19 dilantin to phenytoin metabolism increased with increasing phenytoin concentrations, above the concentrations considered to be in the therapeutic range (see DOSAGE AND ADDMINISTRATION, Recommended Dose and Dose Adjustment) .
Pharmacokinetic data on six patients (age range: 22-64 years) receiving phenytoin monotherapy showed that ticlopidine (a CYP2C19 inhibitor), administered for two weeks, dilantin decreased plasma clearance of phenytoin .
In a human liver microsome study, phenylbutazone (a CYP2C9 inhibitor) decreased clearance dilantin of phenytoin (see DRUG INTERACTIONS) .
Excretion: Most of the drug is eliminated in the bile as inactive metabolites which are dilantin then reabsorbed from the intestinal tract and excreted in the urine partly with glomerular filtration but more importantly by tubular secretion .
Less than 5% of phenytoin dilantin is excreted as the parent compound .
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