Interaction of rabeprazole with phenytoin sodium: a prospective study

Background: Phenytoin Sodium, a commonly prescribed anti-epileptic, with narrow therapeutic index, may interact with Rabeprazole, a commonly used Proton Pump Inhibitor (PPI), as both are metabolized by CYP2C19, potentially impacting bioavailability, therapeutic outcomes, and patient safety. Methods: A total of 52 epileptic patients, previously stabilized on phenytoin, have now been prescribed Tab Rabeprazole for a minimum of 30 days and were included in the study after meeting the other inclusion criteria. On day-0, a blood sample was collected from these patients, and plasma phenytoin level was determined using High-Performance Liquid Chromatography (HPLC). Additionally, clinical evaluations and assessments of other routine laboratory parameters were conducted. The Follow-up evaluations was done on day-15 and day-30, replicating the procedures employed on day-0, including both clinical, laboratory assessments and plasma phenytoin level measurement using HPLC. All data was recorded in the case report form, and statistical analysis was done. Results: The mean Phenytoin level exhibited a non-significant increase, rising from 15.49 ?g/ml on day-0 to 15.57 ?g/ml on day-15 and further to 15.75 ?g/ml on day -0. Notably, there was no change in epilepsy outcomes concerning both seizure frequency and adverse effects. Additionally, there were no statistically significant changes observed in epilepsy control, SBP, DBP, and routine laboratory parameters, including haemoglobin, TLC, DLC, platelet count, serum albumin, serum globulin, serum bilirubin, SGOT, SGPT, serum urea, serum creatinine, and BSL (random). Conclusions: The co-administration of rabeprazole with Phenytoin resulted in a non-significant increase in Phenytoin levels, while maintaining stable control of epilepsy.

Knowledge, attitude, and practice of ‘P-drug concept’ among postgraduate residents and interns in a tertiary care teaching hospital in Maharashtra

Background: A P-drug is a clinician’s personal or preferred or priority choice drug. The study aims to evaluate the knowledge, awareness, and practice of P-drug, which helps postgraduates to prescribe medicines rationally. The objective of this study is to assess the knowledge, attitude, and practice of the P-drug concept among postgraduate students at a tertiary care teaching hospital. Methods: The study is a prospective, cross-sectional pre-validated questionnaire-based study conducted in the tertiary care teaching hospital. A total of 300 postgraduates, interns and consultants from Tertiary care teaching hospital from Maharashtra were enrolled and instructed to fill the questionnaire. These filled forms were collected, and data was analyzed. Results: Out of 300 members, 233 filled the questionnaire, and these forms are evaluated. About 49.7% among them are aware of P-drug, 43.4% are aware of P-treatment, 28.4% are not including fixed-dose combinations in their P-drug list, 42% are aware of the advantages of prescribing P-drug, and 48.4% felt that teaching programs are needed for preparing P-drug list. Conclusions: The P-drug concept is requisite for improving the quality of health care and practicing rational use of medicine. As only a few studies have been conducted on the P-drug idea in this institute, the institutional teaching review board should run teaching programs regarding the P-drug concept.