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Multiple Episodes of Phenytoin Toxicity in an Elderly Patient

Objective: To describe a case involving multiple episodes of phenytoin toxicity leading to hospitalization over a period of 13 months in an elderly man and to review the risk factors contributing to drug toxicity in this individual. Case Summary: A 70-year-old African-American man presented four times with phenytoin toxicity manifested as ataxia and bilateral nystagmus, leading to multiple hospitalizations over 13 months. Each time the phenytoin concentration was dangerously high, and each time the symptoms of toxicity resolved without serious consequences when phenytoin therapy was temporarily stopped. Each toxicity episode was characterized by a variety of risk factors. Discussion: The risk factors contributing to the drug toxicity in this elderly individual are discussed. Conclusions: This case illustrates that age is not an independent risk factor for adverse drug reactions and that appropriate and comprehensive geriatric pharmaceutical care approaches are necessary to prevent and/or reduce the incidence of these reactions.