title: Effect of food on absorption of Dilantin Kapseals and Mylan extended phenytoin sodium capsules.
abstract: BACKGROUND
  Because of phenytoin's narrow therapeutic index and nonlinear pharmacokinetics, food-induced alterations in absorption may markedly influence drug concentrations and, in turn, safety and effectiveness. Potential food-associated differences between 100-mg Mylan (Mylan Pharmaceuticals) extended-release phenytoin sodium capsules and Parke-Davis 100-mg Dilantin Kapseals were examined.
  
  
  METHODS
  A single-dose, two-way crossover study was conducted in 24 healthy subjects to determine the effect of a high-fat meal on the pharmacokinetics of both formulations. Pharmacokinetic parameters were estimated by noncompartmental methods. The impact of switching products on steady-state phenytoin concentrations was investigated through simulation using pharmacokinetic data previously obtained from 30 epileptic patients.
  
  
  RESULTS
  Based on AUC(0-infinity), bioavailability of the Mylan product administered with food was 13% lower than that observed with Dilantin Kapseals. Simulations of substituting the Mylan product for Dilantin suggested that the 13% decrease in bioavailability would result in a median 37% decrease (range 19 to 58%) in plasma phenytoin concentrations when the drug is given with food; in 46% of patients, phenytoin concentrations would likely fall below the therapeutic range of 10 to 20 mg/L. Simulations of substituting Dilantin for the Mylan product suggested that the 15% increase in bioavailability would result in a median 102% increase (range 24 to >150%) in plasma phenytoin concentrations, with 84% of patients having phenytoin concentrations above the therapeutic range.
  
  
  CONCLUSIONS
  Results suggest that when taking phenytoin sodium with food, product switches may result in either side effects or loss of seizure control.
authors.affiliation: Department of Neurology and Neuroscience, College of Medicine, University of Florida, Gainesville, 32606, USA. epilepsy@worldnet.att.net
authors.forename: B J
authors.initials: BJ
authors.lastname: Wilder
authors.forename: I
authors.initials: I
authors.lastname: Leppik
authors.forename: T J
authors.initials: TJ
authors.lastname: Hietpas
authors.forename: J C
authors.initials: JC
authors.lastname: Cloyd
authors.forename: E J
authors.initials: EJ
authors.lastname: Randinitis
authors.forename: J
authors.initials: J
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D000927:Anticonvulsants / Q000097:blood* / Q000493:pharmacokinetics; D019540:Area Under Curve; D002214:Capsules; D002626:Chemistry, Pharmaceutical; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D004041:Dietary Fats / Q000493:pharmacokinetics*; D005260:Female; D018565:Food-Drug Interactions / Q000502:physiology*; D006801:Humans; D007408:Intestinal Absorption / Q000502:physiology; D008297:Male; D008875:Middle Aged; D010672:Phenytoin / Q000097:blood* / Q000493:pharmacokinetics; D013810:Therapeutic Equivalency
chemical_list: D000927:Anticonvulsants; D002214:Capsules; D003692:Delayed-Action Preparations; D004041:Dietary Fats; D010672:Phenytoin