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Dilantin (Phenytoin) is an anticonvulsant. It works by stabilizing the threshold in the brain that controls excessive excitability caused by overstimulation.

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Uses

Phenytoin (FEN-ih-toe-in) are used for treating certain types of convulsions and seizures. They may also be used for other conditions as determined by your doctor. Although it has been used in many conditions, Phenytoin's only approved use is as an anti-seizure medication (anticonvulsant), especially to prevent tonic-clonic (grand mal) seizures and complex partial seizures (psychomotor seizures). Phenytoin acts on the brain and nervous system in the treatment of epilepsy. Phenytoin may also be used to prevent and treat seizures occurring during and after neurosurgery (surgery of the brain and spinal cord).

How to take

Phenytoin comes as a capsule to take by mouth. It usually is taken two or three times a day. Take Phenytoin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor. Do not open, crush, or chew capsules; swallow them whole. Continue to take Phenytoin even if you feel well. Do not stop taking Phenytoin without talking to your doctor, especially if you have taken large doses for a long time. Abruptly stopping the drug can cause seizures.

Side effects

Dizziness, drowsiness, difficulty focusing (vision), unsteady gate, tiredness, abnormal involuntary movements, nausea, vomiting, constipation, decreased coordination, involuntary eye movement, mental confusion, slurred speech, abdominal pain, loss of appetite, redness, irritation, bleeding, and swelling of the gums, insomnia, difficulty swallowing, constipation, stomach pain, loss of taste and appetite, muscle twitching, nervousness, headache, and increased hair growth. Tell your doctor if any of these symptoms are severe or do not go away. Call your doctor immediately if you experience any of the following symptoms: Difficulty coordinating movements, skin rash, easy bruising, tiny purple-colored skin spots, bloody nose, slurred speech, unusual bleeding, yellowing of the skin or eyes, dark urine, swollen glands, fever, sore throat. Rashes can occur in between 1 in 20 and 1 in 10 persons; some may be severe. Additionally, darkening coloration of the skin may develop (more commonly in women). Various lymph node reactions have been reported with Phenytoin therapy. Lymph nodes may swell up, sometimes painfully. Phenytoin causes serum glucose to rise. Thus, blood sugar should be monitored closely when Phenytoin is administered to patients with diabetes. Hyperglycemia (high blood sugar) may occur in people taking Phenytoin, which blocks the release of insulin. Phenytoin can potentially injure the liver although this is an uncommon occurrence. Phenytoin can cause the platelet or white blood cell counts to drop, increasing the risk of bleeding or infection, respectively. Phenytoin also can cause anemia. Because it interferes with vitamin D metabolism, Phenytoin can cause weakening of the bones (osteomalacia). Phenytoin can cause sexual dysfunction including decreased libido, impotence, and priapism (painful, prolonged erections). An overdose of Phenytoin can be fatal. If you suspect an overdose, seek medical attention immediately. Symptoms of Phenytoin overdose may include: Coma, difficulty in pronouncing words correctly, involuntary eye movement, lack of muscle coordination, low blood pressure, nausea, sluggishness, slurred speech, tremors, vomiting.

Precaution

If you have ever had an allergic reaction to or are sensitive to Phenytoin or similar epilepsy medications such as Peganone or Mesantoin, do not take Phenytoin. Make sure your doctor is aware of any drug reactions you have experienced. Tell your doctor if you develop a skin rash. If the rash is scale-like, characterized by reddish or purplish spots, or consists of (fluid-filled) blisters, your doctor may stop Phenytoin and prescribe an alternative treatment. If the rash is more like measles, your doctor may have you stop taking Phenytoin until the rash is completely gone. Because Phenytoin is processed by the liver, people with impaired liver function, older adults, and those who are seriously ill may show early signs of drug poisoning. Practicing good dental hygiene minimizes the development of gingival hyperplasia (excessive formation of the gums over the teeth) and its complications. Avoid drinking alcoholic beverages while taking Phenytoin. Phenytoin is secreted into breast milk. Nursing is not recommended for persons taking Phenytoin.

Drug interactions

It is especially important to check with your doctor before combining Phenytoin with the following: Alcohol, Amiodarone (Cordarone), Antacids containing calcium, Blood-thinning drugs such as Coumadin, Chloramphenicol (Chloromycetin), Chlordiazepoxide (Librium) Cimetidine (Tagamet), Diazepam (Valium), Dicumarol, Digitoxin (Crystodigin), Disulfiram (Antabuse), Doxycycline (Vibramycin), Estrogens such as Premarin, Ethosuximide (Zarontin), Felbamate (Felbatol), Fluoxetine (Prozac), Furosemide (Lasix), Isoniazid (Nydrazid), Major tranquilizers such as Mellaril and Thorazine, Methylphenidate (Ritalin) Molindone hydrochloride (Moban), Oral contraceptives, Paroxetine (Paxil), Phenobarbital, Quinidine (Quinidex), Reserpine (Diupres), Rifampin (Rifadin), Salicylates such as aspirin, Seizure medications such as Depakene, Depakote, Tegretol, and Zarontin, Steroid drugs such as prednisone (Deltasone), Sucralfate (Carafate), Sulfa drugs such as Gantrisin, Theophylline (Theo-Dur, others), Ticlopidine (Ticlid), Tolbutamide (Orinase), Trazodone (Desyrel), Ulcer medications such as Tagamet and Zantac. Phenytoin's metabolism may be affected by other drugs. Drugs that can reduce the amount of Phenytoin in the body include Rifampin and Phenobarbital. Drugs that increase Phenytoin concentrations include Amiodarone, Chloramphenicol, Cimetidine, Disulfiram, Fluconazole, Fluoxetine, Isoniazid (INH), Omeprazole, and Paroxetine. Thus, measuring levels of Phenytoin in the blood may be necessary when patients begin or discontinue other medications. Tricyclic antidepressants (such as Elavil, Norpramin, and others) may cause seizures in susceptible people, making a dosage adjustment of Phenytoin necessary. Abnormal softening of the bones may occur in people taking Phenytoin because of Phenytoin's interference with vitamin D metabolism. The oral absorption of Phenytoin can be reduced by any of the following: antacids containing magnesium, calcium carbonate, or aluminum; calcium salts; or enteral feeding products (tube feedings). Separating the administration of Phenytoin and enteral feeding products, antacids, or calcium salts by at least 2 hours will help avoid this interaction.

Missed dose

If you take one dose a day, take the dose you missed as soon as you remember. If you do not remember until the next day, skip the missed dose and go back to your regular schedule. Do not take 2 doses at once. If you take more than 1 dose a day, take the missed dose as soon as possible. If it is within 4 hours of your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once. If you forget to take your medication 2 or more days in a row, check with your doctor.

Storage

Tablets and capsules should be kept at room temperature, 15-30° C (59-86° F).