Diphenylhydantoin side effects and serum albumin levels

In a comprehensive drug monitoring program adverse reactions to diphenylhydantoin (DPH) were recorded in 11.4% of 88 patients with an admission serum albumin lower than 3.0 gm per 100 ml1'eceiving DPH and in 3.8% of 234 patients with a normal serum albumin receiving DPH. This difference was sustained after taking into account factors such as dosage, age, sex, primary diagnosis, and admission blood urea nitrogen. It is suggested that hypoalbuminemic patients have increased circulating levels of unbound DPH that increases the risk of toxicity to this drug.