title: Fluconazole-induced symptomatic phenytoin toxicity.
abstract: OBJECTIVE
  To report two cases of fluconazole-induced symptomatic phenytoin toxicity and review literature related to this interaction.
  
  
  METHODS
  Case reports and review articles identified by a computerized (MEDLINE) and manual (Index Medicus) search.
  
  
  RESULTS
  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.
authors.affiliation: Department of Veterans Affairs Medical Center (VAMC), Pharmacy Service, Houston, TX 77030.
authors.forename: R M
authors.initials: RM
authors.lastname: Cadle
authors.forename: G J
authors.initials: GJ
authors.lastname: Zenon
authors.forename: M C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.forename: R J
authors.initials: RJ
authors.lastname: Hamill
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000188:drug therapy; D000328:Adult; D000818:Animals; D004347:Drug Interactions; D015725:Fluconazole / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D012640:Seizures / Q000150:complications / Q000188:drug therapy
chemical_list: D010672:Phenytoin; D015725:Fluconazole