BUSULFAN AND PHENYTOIN

Phenytoin increases the clearance of busulfan and reduces its AUC by about 20%. Subtherapeutic levels of phenytoin may occur in the presence of busulfan.
The changes in busulfan clearance are relatively small, but nevertheless it has been suggested that phenytoin should be avoided in patients taking busulfan. Note that the US manufacturer of parenteral busulfan gives a dose assuming that phenytoin will also be given, and notes that if other antiepileptics are used instead, the busulfan plasma levels may be increased and monitoring is recommended. If both drugs are given monitor closely to ensure that busulfan remains effective, and that phenytoin levels remain therapeutic.
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