Which patient statement requires re-education about phenytoin?

• A. I take this medication with a full glass of milk at breakfast.
• B. I know it is important to have my drug levels checked regularly.
• C. I will report a skin rash immediately to my doctor.
• D. This medication can lower my body's ability to clot and fight infection.

Answer: (A)

Phenytoin absorption can be significantly reduced by calcium-containing products. Milk supplies calcium, and when phenytoin is taken with a full glass of milk, calcium in the gut can bind the drug and form insoluble complexes. That lowers how much phenytoin gets into the bloodstream, which can drop drug levels below the therapeutic range and compromise seizure control. Because of this, the statement about taking phenytoin with a large amount of milk indicates a misunderstanding and needs re-education. The other points reflect appropriate management: regular drug-level monitoring helps maintain a stable therapeutic range, reporting a skin rash promptly is important due to potential serious reactions, and awareness of potential effects on clotting or immune function is part of comprehensive counseling, though the milk interaction is the specific teaching point here.