Dilatin levels

[mooselips]

My husband diagnosed with Temperol Lobe Epilepsy with generalized seizures last October, had his 3rd seizure yesterday at 5:30a.m. while sleeping.  He has been on Dilantin 100mg. t.i.d. since Novemeber.  (Had his 1st seizure July 07, then Oct. 07.) He had a dilantin level in January WNL. (between 10 and 20)
We went to the ER yesterday his dilantin level was 3.3 and they gave him a loading dose of 500mg. PO of dilantin, and 500mg. IV Dilantin.  He is very regimented taking his Dilantin and does not miss doses.
And told him to take 400mgs. today.
I have a call in to our family Dr. and waiting for a return.
We were being seen by a Neurologist, but she abruptly cancelled my husbands January appt. and said she was leaving town for a month, and did not refer us to any other Dr. so we saw the family Dr. who is prescribing. I hesitate for my husband to return to her care. So we'll most likely look for another Neurologist. in the Northern Ohio area.

  He also bikes alot, and has put 300 miles on his bike since we have been here in Florida since Feb.1st

My question is concerning dosages pertaining to weight.  I have read on a website that dilantin is prescribed per mg. to kg.
The supposed correct dosage would be between 4 to 6 mgs. per Kilo.
Therefore if my husband weighs 190 pounds, he would be approx. 86 kilograms, and should take approx. 400 mgs. of Dilantin a day.  Any thoughts on that?

Also, could someone please explain hypermetabolism?

Sorry to be so rambling, but darn it's so scary to watch someone you love have a seizure.
I am a Nurse and believe me, when it's one of my own, I go into a semi-panic mode!

Thank you,


  

[mooselips]

He is currently taking:
Glimeperide 4mg. BID
Glucophage 850mg. 1 BID
liptor 10mg. 1 QD
Cozaar 50mg. 1 QD
Cymbalta 60mg. 1 HS
Toprol XL 25mg. 1 QD
and Asa 325mg. QD

An OCCASIONAL alcoholic beverage, like 1 beer, or a mixed drink twice a week.

I have already looked up drug interactions, and I don't think I see anything, although I could be wrong.
He will have a repeat Dilantin level next week, due to the half life of dilantin being 7 to 10 days.  By next Monday, he should be back within his 300mg. level range.

[bhups1]

Hi, is he on some other drugs too because other drugs might decrease the level of phenytoin by enhancing its metabolism via induction of enzymes and can lead to drug drug interction. “Drugs which may decrease phenytoin levels include: carbamazepine, chronic alcohol abuse, reserpine, and sucralfate. Moban® brand of molindone hydrochloride contains calcium ions which interfere with the absorption of phenytoin. Ingestion times of phenytoin and antacid preparations containing calcium should be staggered in patients with low serum phenytoin levels to prevent absorption problems”.  Taken from http://www.rxlist.com/cgi/generic/phenyt_od.htm

Our population is divided into 4 type of metabolizers ranging from rapid to slow metabolizers depending upon the speed of elimination of drug from body. Hence, every person react differently to same drug.