CORTICOSTEROIDS AND PHENYTOIN

The therapeutic effects of dexamethasone, methylprednisolone, prednisolone, prednisone (and probably other glucocorticoids) can be markedly reduced by phenytoin. Fludrocortisone may similarly be affected. One study suggested that dexamethasone may increase serum phenytoin levels, but another study and two case reports suggest that an important decrease can occur. The results of the dexametha- sone adrenal suppression test may prove to be unreliable in those taking phenytoin. Fosphenytoin, a prodrug of phenytoin, may interact similarly with these corticoster- oids.
The significance of the falls in corticosteroid levels will depend on the disease the corticosteroid is prescribed for. Monitor the outcome of concurrent use closely, especially in transplant patients, and increase the dose accordingly. Consider monitoring phenytoin levels if dexamethasone is given.
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