title: Phenytoin causes phalangeal hypoplasia in the rabbit fetus at clinically relevant free plasma concentrations.
abstract: New Zealand White rabbits were treated orally with 0 (controls), 50, 100, or 150 mg/kg phenytoin on days 14-16 of pregnancy. Total and free plasma concentrations of phenytoin were determined in maternal plasma 2, 6, and 24 hr after the final dose in all animals. In addition, after administration of 150 mg/kg maternal plasma concentrations were also determined after 12 and 48 hr, the concentrations in amniotic fluid after 6 hr, and those in fetal tissue 6 and 24 hr after the final treatment. A high degree of plasma protein binding was observed in maternal blood. Treatment with 50 mg/kg resulted in free plasma concentrations of up to 5.0 mumol/l during the 24 hr period following the final dose. Significantly higher free plasma concentrations were observed at the two higher dose levels; up to 9.7 mumol/l at 100 mg/kg and 12.7 mumol/l at 150 mg/kg. Digital hypoplasia was not seen in the control group or the animals treated with 50 mg/kg. However, treatment with 100 mg/kg resulted in hypoplasia in a single or a few digits in approximately 50% of the fetuses, and 150 mg/kg provoked hypoplasia in almost all digits in all fetuses. These results show that even though the doses which caused digital defects in rabbits are much higher than those used therapeutically, the resulting free concentrations of phenytoin are similar to those which are associated with the same type of defects in humans. These data indicate that the pharmacologically induced fetal hypoxia/ischemia and vascular disruption preceding malformations of this type, which were observed in a previous study in rabbits, may be of human relevance.
authors.affiliation: Department of Toxicology, Uppsala University, Sweden.
authors.forename: B R
authors.initials: BR
authors.lastname: Danielsson
authors.forename: K
authors.initials: K
authors.lastname: Danielson
authors.forename: T
authors.initials: T
authors.lastname: Tomson
mesh_terms: D000014:Abnormalities, Drug-Induced; D000284:Administration, Oral; D000704:Analysis of Variance; D000818:Animals; D000927:Anticonvulsants / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000633:toxicity*; D005314:Embryonic and Fetal Development / Q000187:drug effects*; D005260:Female; D005333:Fetus / Q000737:chemistry; D005552:Forelimb / Q000002:abnormalities*; D006614:Hindlimb / Q000002:abnormalities*; D010672:Phenytoin / Q000008:administration & dosage / Q000097:blood / Q000493:pharmacokinetics / Q000633:toxicity*; D011247:Pregnancy; D011270:Pregnancy, Animal / Q000097:blood*; D011817:Rabbits; D012720:Severity of Illness Index
chemical_list: D000927:Anticonvulsants; D010672:Phenytoin