Abstract
Five patients with phenytoin (DPH) induced subnormal serum l. casei folate activity were treated for a period of 5 months with 20 mg of folic acid daily in order to investigate the effect of this treatment on the quantitative 24‐hours output of 5‐(p‐hydroxyphenyl)‐ 5 phenyl‐hydantoin (HPPH) and on the serum phenytoin levels. During the period of folic acid treatment an average decrease of 12 % in the mean HPPH output was found, and four out of the five patients showed a corresponding fall in the serum phenytoin levels. In each patient a large variation in the 24‐hours output of HPPH was found, and at least seven consecutive 24‐hours urine samples during each of two given periods are necessary in order to demonstrate any change in the HPPH output. It is suggested that treatment with massive doses of folic acid alters the metabolism of phenytoin towards an unknown metabolic route.
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