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Finding the right dose of an anti epileptic medicine

Trilok was not surprised when his son was diagnosed with epilepsy, having experienced the disease second hand because his father was an epilepsy patient as well. When the doctor suggested that his son should undergo maintenance therapy with phenytoin, he was, however, skeptical, as his father had a bad experience with phenytoin. His father had frequently suffered from side effects like slurred speech and uncoordinated movements, and his quality of life was quite reduced because of these side effects.

When he brought this up with the doctor, the doctor informed him that phenytoin is a drug of choice for his son’s situation, but before they prescribe it, it is possible to check for phenytoin metabolism by a simple genetic test. Trilok readily agreed, and the test revealed that his son was a genetically poor metabolizer of CYP2C9 and is likely to experience increased phenytoin side effects because of this. With this insight, the doctor started the son on a reduced dose regimen of phenytoin, which has seemed successful till date in keeping the epilepsy under control, as well as keeping the side effects manageable.

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