CLINICAL DILEMMAS How to Minimize Interaction Between Phenytoin and Enteral Feedings: Two Approaches

The drug-nutrient interaction between phenytoin and enteral feedings that results in decreased phenytoin bioavailability was first reported in 1982 by Bauer. ~ The nature of the interaction has under-gone considerable research; however, the exact mechanism of the interaction has not been found. Several factors may be involved in this complex phenomenon, including gastrointestinal transit time, the nitrogen source of the feeding, calcium content of the feeding, pH of the feeding, dosage form of phenytoin, and dilution of phenytoin suspension before administration.2 2 Phenytoin is a frequently prescribed medication at our institution; the suspension dosage form ac-counts for approximately 30 % to 40 % of tota