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Patients with Renal or Hepatic Disease. Due to an increased fraction of unbound phenytoin in patients with renal or hepatic disease, or in those with hypoalbuminemia, . Item Code (Source) NDC:0069-5471: Route of Administration: INTRAVENOUS, INTRAMUSCULAR: DEA Schedule : Active Ingredient/Active Moiety: Ingredient Name Basis of Strength Strength; FOSPHENYTOIN SODIUM (UNII: 7VLR55452Z) (PHENYTOIN - UNII:6158TKW0C5)

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Referral Form Page 1 of 2 Sunshine Coast Community Hospice Ltd PO Box 5603, Maroochydore BC Q 4558 Ph: 07 5479 0881 – 07 5471 1793 . State Post Code Telephone Mobile Marital Status Married Widowed Single Divorced/Separated Partner Primary Language Reason for Referral Palliative Care Symptom Management . Date Progression of Disease and Investigations/treatments Specialist & Hospital Past Medical & Psychiatric History