MARK A. GOLDBERG, M.D.
To the editor: The excellent summary of the clinical pharmacology of diphenylhydantoin by Easton (Ann Intern Med 77:421-423, 1972) unfortunately emphasizes the concept of "dilantinization" without adequate discussion of the theoretical and practical difficulties involved.
Therapeutic blood levels of diphenylhydantoin can be achieved more rapidly by large, loading oral doses, but it is rarely necessary to obtain such rapid control in the ambulatory patient with intermittent seizures. In addition, the ingestion of 1000 to 1200 mg in one day is frequently associated with gastrointestinal and neurologic symptoms that may be so unpleasant the patients are reluctant to take the drug
GOLDBERG MA. Use of Diphenylhydantoin. Ann Intern Med. ;78:305–306. doi: 10.7326/0003-4819-78-2-305_2
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Published: Ann Intern Med. 1973;78(2):305-306.
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