病棟活動の質的向上への試み（第３報） 癌化学療法施行時における血中および脳脊髄液中のフェニトインとフェノバルビタールの濃度変化

Abstract

A clinical pharmacy servise was performed by the pharmacist using therapeutic drug monitoring (TDM) of phenytoin (PH) and phenobarbital (PB) for a patient with gliobrastoma during cancer chemotherapy. The cancer chemotherapeutic regimen with intraarterial or intravenous infusion was performed six times, which included a short-interval chemotherapy (from the first treatment to the third one with 1 day interval) and a long-interbal chemotherapy (from the fourth treatment to the sixth one with about 2-month interval), to the patient chronically administered with PH and PB.In each chemotherapy, total and free concentrations of PH and PB in plasma or CSF did not change. In the short-interval chemotherapy, total and free, concentrations of PH and PB in plasma or CSF decreased sharply. The free concentrations of PH and PB in plasma or CSF were equal. On the other hand, the total and free concentrations of PH and PB in plasma or CSF increased gradually in the long-interval chemotherapy. Especially, the total concentration of PH in CSF at the sixth treatment increased to 3 times larger than that at the first treatment. Total protein CSF increased from 122.7 mg/ml to 760.0mg/ml. The bound concentrations of PH in CSF correlated with the total protein in CSF, but the free concentrations of PH and PB in plasma and CSF did not change. The monitoring of PH and PB during the cancer chemotherapy was necessary to minimized the seizure for decreased level of anticonvulsant.