Also, I appreciate the opportunity to peruse your web page on kinetics. It seems interesting and I'm looking forward to spending some time with it. In regards to a recent question on phenytoin adjustments for uremic patients, I had left a response regarding a assay error but not included the references. During this time, we were also changing our assay from HPLC to the Abbott TDx assay for phenytoin. Thus, the free level via TDx is also in error, and results should be used with caution in Uremic patients.
Free levels are expensive, and hard to trust in uremia.
Just another example of how things change in medicine just when we thought we had it all worked out. William Dager, Pharm. Most physicians are either unaware or unconcerned because what they don't know won't hurt them. It is about the only way you can prove to a physician that the patient is pharmacologically toxic despite lack of clinical toxicity.