A 45 yo patient developed generalized seizures 7 months ago for which phenytoin (CYP2C9, 2C19, 3A4 substrate; CYP2C9, 2C19, 3A4 inducer) was initiated. Since then, seizures have been well controlled. The most recent steady-state plasma phenytoin concentration was 16 mcg/mL (normal: 10-20 mcg/mL). Recently, the patient developed atrial fibrillation and the cardiologist is considering initiating amiodarone (CYP3A4 substrate; CYP1A2, 2C9, 2D6, 3A4 inhibitor) to control the rhythm. 1. Are there any potential drug interactions between phenytoin and amiodarone? Explain. 2. What would be the overall therapeutic outcome?
[Expert Solution]: A 45 yo patient developed generalized…
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