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Original ArticleOpen Access
Correlation between Serum and Salivary Phenytoin Concentrations in Thai Epileptic Children
Liamsuwan S 
,
Jaiweerawattana U
,
Jaiweerawattana U Objective: To study the correlation between serum and salivary phenytoin concentration in Thai epileptic children.
Material and Method: Children aged 5 to 12 years with diagnosed epilepsy who received phenytoin monotherapy seen in the
neurological clinic at Queen Sirikit National Institute of Child Health were studied. The recruited patients were required to
have good compliance, normal albumin level, and no evidence of cancer, HIV infection, hepatic, renal and salivary glands
disease. Blood and saliva samples were collected and measured phenytoin level by fluorescence-polarization immunoassay
technique.
Results: Thirty patients, 19 males and 11 females, were studied. The average (mean + SD) age and weight were 8.24 + 2.09
years and 27.76 + 9.86 Kilograms. Both serum and salivary phenytoin levels correlated with phenytoin doses as exponential
type (R2 = 0.4188, 0.3682, respectively). Equations for describing serum and salivary phenytoin levels by phenytoin dose were
y = 0.7403e0.3952x and y = 0.1431e0.3072x respectively. Serum and salivary phenytoin levels were closely correlated as linear
type (R = 0.880, R2 = 0.967). The obtained equation of this relationship was y = 10.165x, where y = serum phenytoin level and
x = salivary phenytoin level. Adverse drug reactions were found in 5 patients (6.6%), horizontal nystagmus 2 cases, hirsutism
2 cases and gingival hyperplasia 1 case.
Conclusion: High correlation between serum and salivary phenytoin levels supported the use of saliva instead of blood for
phenytoin monitoring in Thai children which were difficult in blood collection and had psychological trauma. The obtained
equations in the present study could be applied for adjusting the dosage regimen and monitoring by using salivary phenytoin
level in clinical practice.
Keywords: Phenytoin, Salivary level, Thai children
Material and Method: Children aged 5 to 12 years with diagnosed epilepsy who received phenytoin monotherapy seen in the
neurological clinic at Queen Sirikit National Institute of Child Health were studied. The recruited patients were required to
have good compliance, normal albumin level, and no evidence of cancer, HIV infection, hepatic, renal and salivary glands
disease. Blood and saliva samples were collected and measured phenytoin level by fluorescence-polarization immunoassay
technique.
Results: Thirty patients, 19 males and 11 females, were studied. The average (mean + SD) age and weight were 8.24 + 2.09
years and 27.76 + 9.86 Kilograms. Both serum and salivary phenytoin levels correlated with phenytoin doses as exponential
type (R2 = 0.4188, 0.3682, respectively). Equations for describing serum and salivary phenytoin levels by phenytoin dose were
y = 0.7403e0.3952x and y = 0.1431e0.3072x respectively. Serum and salivary phenytoin levels were closely correlated as linear
type (R = 0.880, R2 = 0.967). The obtained equation of this relationship was y = 10.165x, where y = serum phenytoin level and
x = salivary phenytoin level. Adverse drug reactions were found in 5 patients (6.6%), horizontal nystagmus 2 cases, hirsutism
2 cases and gingival hyperplasia 1 case.
Conclusion: High correlation between serum and salivary phenytoin levels supported the use of saliva instead of blood for
phenytoin monitoring in Thai children which were difficult in blood collection and had psychological trauma. The obtained
equations in the present study could be applied for adjusting the dosage regimen and monitoring by using salivary phenytoin
level in clinical practice.
Keywords: Phenytoin, Salivary level, Thai children
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