{"CYP2C9 and HLA-B*15:02 genotype can affect a patient's response to phenytoin. Based on the genotype result, this patient is predicted to be a CYP2C9 Intermediate Metabolizer and is at increased risk for developing phenytoin-induced toxicities. For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 genotype does not appear to have been ordered for this patient. Use of an alternative antiepileptic may be recommended. Please consult a clinical pharmacist for more information"}