S-mephenytoin 4-hydroxylase is inherited as an autosomal-recessive trait in Japanese families.

The 4-hydroxylation of S-mephenytoin exhibits polymorphism in both whites and Japanese such that the populations can be divided into extensive and poor metabolizers. To determine whether genetic constitution is a primary determinant in the expression of such metabolism, four extended Japanese families containing 13 sets of parent/offspring relationships were phenotyped for their mephenytoin 4-hydroxylation activity using the 8-hour urinary ratio of unchanged R- and S-mephenytoin as the trait measurement. The incidence of the poor metabolizer phenotype in these families was 2.2 times greater than that in an unrelated Japanese population. In three families in which both parents were poor metabolizers of mephenytoin, all six children also exhibited the poor metabolizer trait. The phenotype distribution for each family studied was consistent with the hypothesis that mephenytoin 4-hydroxylation activity is under diallelic, monogenic control, with the poor metabolizer phenotype being the autosomal recessive homozygous genotype and the extensive metabolizer phenotype including both the autosomal dominant and heterozygous genotypes.