title: Reduced phenytoin levels in an epileptic patient following Roux-En-Y gastric bypass for obesity.
abstract: Despite widespread uptake of bariatric procedures for severe obesity, changes in pharmacodynamics after surgery are poorly understood. We report an epileptic patient who had a seizure following gastric bypass, although he had been asymptomatic for 30 years and without any change in his treatment. Phenytoin levels were undetectable despite a high dose. Drugs with a narrow therapeutic range such as phenytoin should be prescribed with caution after bariatric surgery.
authors.affiliation: Department of Bariatric Surgery, Musgrove Park Hospital, Taunton TA15DA, UK.
authors.forename: Dimitrios J
authors.initials: DJ
authors.lastname: Pournaras
authors.forename: David
authors.initials: D
authors.lastname: Footitt
authors.forename: David
authors.initials: D
authors.lastname: Mahon
authors.forename: Richard
authors.initials: R
authors.lastname: Welbourn
mesh_terms: D000927:Anticonvulsants / Q000097:blood / Q000627:therapeutic use; D015992:Body Mass Index; D004827:Epilepsy / Q000097:blood*; D015390:Gastric Bypass; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery; D010672:Phenytoin / Q000097:blood* / Q000627:therapeutic use; D011184:Postoperative Period; D014227:Triazines / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D010672:Phenytoin; D000077213:Lamotrigine