Serum phenytoin levels can be raised by amiodarone, markedly so in some individuals (4-fold rise reported). Amiodarone serum levels are reduced by phenytoin.
A 25 to 30% reduction in the phenytoin dose has been recommended for those taking 2 to 4 mg/kg daily, but it should be remembered that small alterations in phenytoin dose may result in a large change in phenytoin levels, as phenytoin kinetics are non-linear. The clinical significance of the effects on amiodarone are unclear.
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