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  • Title: Severe phenytoin toxicity in a CYP2C9*3*3 homozygous mutant from India.
    Author: Ramasamy K, Narayan SK, Chanolean S, Chandrasekaran A.
    Journal: Neurol India; 2007; 55(4):408-9. PubMed ID: 18040121.
    Abstract:
    The authors report an Indian adult female patient with a history of generalized tonic clonic seizures who developed severe features of phenytoin (DPH) toxicity on therapeutic dosage of this antiepileptic drug. Administration of 300 mg/day of DPH in this patient resulted in toxic symptoms associated with an excessive serum DPH concentration of 33 microg/ml. The PCR-RFLP analysis revealed a homozygosity involving CYP2C9*3*3. This mutation results in a marked decrease in the enzymatic activity (CYP2C9) and leads to a decreased clearance of the drug which can lead to severe acute and chronic toxicity. On switching the antiepileptic therapy from DPH to sodium valproate, there was reversal of both.
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