Phenytoin Monitoring in Nursing Home Patients-Reply

Arch Intern Med. 1990;150(9):1971-1974. doi:10.1001/archinte.1990.00390200145034.
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In Reply.—We would like to reassure Drs Courtney and Falbe that it is not the policy of our nursing home to measure serum phenytoin concentrations at least monthly in every patient. The large number of the measurements was the result of an ongoing larger study looking at drug-drug interactions in nursing home patients. The indications for measuring serum phenytoin levels have been elegantly discussed by Troupin, 1 and we had commented on those in our "Comment" section. Whether these indications are applicable to frail nursing home patients cannot be dogmatically stated. This was precisely the question we wanted to address, since previous studies are done in younger patients.2,3

The lack of clinically apparent toxicity is not surprising considering the difficulty in recognizing phenytoin toxicity in a patient population with a high prevalence of neurologic deficits and alterations in mental status.4 Availability of serum levels of phenytoin may


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