Cardiovascular disease: Use with caution in patients with underlying cardiac disease; IV use is contraindicated in patients with sinus bradycardia, sinoatrial block, or second and third degree heart block. Sinhababu, S. P. Nux vomica 30 prepared with and without succession shows antialcoholic effect on toads and distinctive molecular association. Eosinophilia is often present. Because this disorder is variable in its expression, other organ systems not noted here may be involved. It is important to note that early manifestations of hypersensitivity, such as fever or lymphadenopathy, may be present even though rash is not evident. If such signs or symptoms are present, the patient should be evaluated immediately. Dilantin should be discontinued if an alternative etiology for the signs or symptoms cannot be established.
There is a relatively small margin between full therapeutic effect and minimally toxic doses of this drug. Use this medication regularly in order to get the most benefit from it. To help you remember, use it at the same times each day. It may take several weeks for the full benefits of this medication to be noticed. Do not stop taking this medication without consulting your doctor. What are the possible side effects of Dilantin?
Linagliptin: CYP3A4 Inducers Strong may decrease the serum concentration of Linagliptin. Management: Strongly consider using an alternative to any strong CYP3A4 inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness. Advise patients not to use capsules which are discolored. Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Disulfiram: May increase the serum concentration of Phenytoin. Management: Avoid concomitant use of disulfiram and phenytoin when possible. What does phenytoin sodium extended oral look like? Doxercalciferol: CYP3A4 Inducers Strong may increase serum concentrations of the active metabolites of Doxercalciferol.
Phenytoin is used to prevent and control seizures also called an anticonvulsant or antiepileptic drug. It works by reducing the spread of seizure activity in the brain. Phenytoin may cause swelling and bleeding of the gums. Massage your gums and brush and floss your teeth regularly to minimize this problem. See your dentist regularly. If you are receiving formula or supplements through a feeding tube, talk to your doctor about when you should take phenytoin. You will need to allow some time between receiving your feedings and taking phenytoin. Withdrawal: Anticonvulsants should not be discontinued abruptly because of the possibility of increasing seizure frequency; therapy should be withdrawn gradually to minimize the potential of increased seizure frequency, unless safety concerns require a more rapid withdrawal. Read the Patient Information Leaflet provided by your before you start using this product and each time you get a refill. The leaflet contains very important information on when to take your pills and what to if you miss a dose. If you have any questions, ask your doctor or pharmacist. Sonidegib: CYP3A4 Inducers Strong may decrease the serum concentration of Sonidegib. Diphenylhydantoin sodium salt, having a molecular weight of 274. Note: The list is not intended to be inclusive or comprehensive. Individual drug package inserts should be consulted. Phenytoin may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use phenytoin with caution.
Phenytoin may cause harm to the fetus. If you may become pregnant, discuss other possible treatment options with your doctor. If a decision is made to take phenytoin, use effective birth control while you are taking it. Talk with your doctor if you are planning to become pregnant, or if you have questions or concerns about this information. Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. 'Multum' is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. An increase in seizure frequency during pregnancy occurs in a high proportion of patients, because of altered phenytoin absorption or metabolism. Periodic measurement of serum phenytoin levels is particularly valuable in the management of a pregnant epileptic patient as a guide to an appropriate adjustment of dosage. However, postpartum restoration of the original dosage will probably be indicated. Cases of acute hepatotoxicity, including infrequent cases of acute hepatic failure, have been reported with Dilantin. Topiramate: May increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Topiramate. Phenytoin can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using phenytoin. NIFEdipine: May increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of NIFEdipine. Falsely high plasma phenytoin concentrations may occur when measured by immunoanalytical techniques eg, TD X, TD XFL X, Emit 2000. Phenytoin may produce falsely low results for serum concentrations of T 4, and dexamethasone or metyrapone tests. Phenytoin may cause increased serum levels of glucose, alkaline phosphatase, and gamma glutamyl transpeptidase GGT. Carcinogenesis: See for information on carcinogenesis. The presence of other medical problems may affect the use of phenytoin. Tell your doctor or dentist that you take phenytoin suspension before you receive any medical or dental care, emergency care, or surgery. Accordingly, at the first sign of acute toxicity, serum levels should be immediately checked. Dose reduction of phenytoin therapy is indicated if serum levels are excessive; if symptoms persist, termination is recommended. Hypersensitivity syndrome which may include, but is not limited to, symptoms such as arthralgias, eosinophilia, fever, liver dysfunction, lymphadenopathy, or rash systemic lupus erythematosus, periarteritis nodosa and immunoglobulin abnormalities. Patients who take phenytoin may be at increased risk of suicidal thoughts or actions. The risk may be greater in patients who have had suicidal thoughts or actions in the past. Watch patients who take phenytoin closely. Contact the doctor at once if new, worsened, or sudden symptoms such as depressed mood; anxious, restless, or irritable behavior; panic attacks; or any unusual change in mood or behavior occur. Contact the doctor right away if any signs of suicidal thoughts or actions occur. Avoid contact sports or other situations where bruising or injury could occur.
The lymph nodes filter lymph fluid as it flows through them, trapping bacteria, viruses, and other foreign substances, which are then destroyed by special white called lymphocytes. Stopping Dilantin suddenly can cause serious problems. Infant breast-feeding is not recommended for women taking this drug because phenytoin appears to be secreted in low concentrations in human milk. Cobicistat: Fosphenytoin-Phenytoin may decrease the serum concentration of Cobicistat. The adequacy of the respiratory and circulatory systems should be carefully observed and appropriate supportive measures employed. Hemodialysis can be considered since phenytoin is not completely bound to plasma proteins. Total exchange transfusion has been used in the treatment of severe intoxication in pediatric patients. Although the risk of cardiovascular toxicity increases with infusion rates above the recommended infusion rate, these events have also been reported at or below the recommended infusion rate. Delamanid: CYP3A4 Inducers Strong may decrease the serum concentration of Delamanid. If you or your child develop a skin rash, hives, or any allergic reaction to phenytoin, check with your doctor as soon as possible. Seizure control is very important during pregnancy. Do not start or stop taking this medicine without your doctor's advice if you are pregnant. Phenytoin may cause harm to an unborn baby, but having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant while taking this medicine. Craig S. Phenytoin poisoning. Neurocrit Care. 2005. Tadalafil: CYP3A4 Inducers Strong may decrease the serum concentration of Tadalafil. Management: Erectile dysfunction: monitor for decreased effectiveness - no standard dose adjustments recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer. CYP3A4 inducers. The Canadian product labeling does not recommend a dose adjustment with concurrent use of strong CYP3A4 inducers.
No specific recommendations are available for other oxcarbazepine formulations. American Antiepileptic Drug NAAED Pregnancy Registry if they become pregnant. Colesevelam: May decrease the serum concentration of Phenytoin. Management: Administer phenytoin at least 4 hours prior to colesevelam. Lymph nodes often swell in one location when a problem such as an injury, infection, or tumor develops in or near the lymph node. Which lymph nodes are swollen can help identify the problem. CAPSULES that was written for healthcare professionals. Boceprevir: Phenytoin may decrease the serum concentration of Boceprevir. Hypotension usually occurs when the drug is administered rapidly by the intravenous route. Dolutegravir: Fosphenytoin-Phenytoin may decrease the serum concentration of Dolutegravir. CAPSULE extended phenytoin sodium capsule, USP for oral administration contains 200 mg or 300 mg of phenytoin sodium, USP. Each capsule also contains the following inactive ingredients: colloidal silicon dioxide, hydroxyethyl cellulose, magnesium oxide, magnesium stearate, microcrystalline cellulose, povidone and sodium lauryl sulfate. Measure plasma phenytoin concentrations at the first sign of acute toxicity; dosage reduction is indicated if phenytoin concentrations are excessive; if symptoms persist, discontinue administration. Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. Phenytoin is not effective for absence petit mal seizures. If tonic-clonic grand mal and absence petit mal seizures are present, combined drug therapy is needed. Ibrutinib: CYP3A4 Inducers Strong may decrease the serum concentration of Ibrutinib. Methadone: Phenytoin may decrease the serum concentration of Methadone. USP, and from the sodium salt to the free acid form.
What other drugs will affect phenytoin Dilantin? Levomefolate: May decrease the serum concentration of Phenytoin. Wort, sucralfate, theophylline, and vigabatrin. CAPSULES exactly as prescribed. Cannabidiol: CYP3A4 Inducers Strong may decrease the serum concentration of Cannabidiol. Dienogest: CYP3A4 Inducers Strong may decrease the serum concentration of Dienogest. Management: Avoid use of dienogest for contraception when using medications that induce CYP3A4 and for at least 28 days after discontinuation of a CYP3A4 inducer. An alternative form of contraception should be used during this time. The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. When enteral feedings are stopped, phenytoin levels may rise significantly. In patients who can receive intermittent feedings, this drug should be administered at least 2 hours after a feeding and the next feeding should be delayed until at least 2 hours after the phenytoin dose. The IV formulation is recommended for patients who must receive continuous enteral feedings. Soft tissue irritation and inflammation has occurred at the site of injection with and without extravasation of intravenous phenytoin. Soft tissue irritation may vary from slight tenderness to extensive necrosis, sloughing, and in rare instances has led to amputation. Improper administration including subcutaneous or perivascular injection should be avoided to help prevent the possibility of the above. Teniposide: Phenytoin may decrease the serum concentration of Teniposide. Management: Consider alternatives to combined treatment with phenytoin and teniposide due to the potential for decreased teniposide concentrations. If the combination cannot be avoided, monitor teniposide response closely. DRESS see have been observed. Phenytoin is an antiepileptic drug which can be used in the treatment of epilepsy. The primary site of action appears to be the motor cortex where spread of seizure activity is inhibited. Possibly by promoting sodium efflux from neurons, phenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient. This includes the reduction of posttetanic potentiation at synapses. Loss of posttetanic potentiation prevents cortical seizure foci from detonating adjacent cortical areas. Phenytoin reduces the maximal activity of brain stem centers responsible for the tonic phase of tonic-clonic grand mal seizures. ABCB1 Inducers may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E MMAE component may be decreased. Temsirolimus: Phenytoin may decrease the serum concentration of Temsirolimus. Concentrations of the active metabolite, sirolimus, are also likely to be decreased and maybe to an even greater degree. Check with your doctor right away if you have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, vomiting, or yellow eyes or skin.
Inform patients of the availability of a Medication Guide, and instruct them to read the Medication Guide prior to taking this drug. Glands in the axillary lymph nodes may swell from an injury or infection to the arm or hand. Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Electrocardiogram and blood pressure should be monitored continuously. CAPSULES are a prescription medicine used to treat tonic-clonic grand mal complex partial psychomotor or temporal lobe seizures, and to prevent and treat seizures that happen during or after brain surgery. Benzodiazepines: May increase the serum concentration of Phenytoin. Short-term exposure to benzodiazepines may not present as much risk as chronic therapy. Exceptions: ALPRAZolam. Do not change brands or doseforms eg, tablets, suspension, injection of phenytoin without talking with your doctor. St. John's Wort, theophylline, and vigabatrin. However, the relative contributions of antiepileptic drugs and other factors associated with epilepsy to this increased risk are uncertain and in most cases it has not been possible to attribute specific developmental abnormalities to particular antiepileptic drugs. Postpartum Period. A potentially life-threatening bleeding disorder related to decreased levels of vitamin K-dependent clotting factors may occur in newborns exposed to phenytoin in utero. This drug-induced condition can be prevented with vitamin K administration to the mother before delivery and to the neonate after birth. Cannabis: May enhance the CNS depressant effect of CNS Depressants.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345. Apixaban: CYP3A4 Inducers Strong may decrease the serum concentration of Apixaban. Tell your doctor when you start any new drug, and discuss if you should use additional reliable birth control. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well. Phenytoin is a potent inducer of hepatic drug-metabolizing enzymes. Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Anaphylaxis has also been reported. Tacrolimus Systemic: Phenytoin may decrease the serum concentration of Tacrolimus Systemic. Tacrolimus Systemic may increase the serum concentration of Phenytoin. CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Vitamin D supplements may be necessary to prevent weakening of the bones osteomalacia. Discuss this with your doctor. Nintedanib: Combined Inducers of CYP3A4 and P-glycoprotein may decrease the serum concentration of Nintedanib. Shake well before each use. Be sure the medicine is completely mixed before you take a dose. Consult your doctor before breast-feeding. Maalox, Mylanta, Tums, others. Your doctor may tell you to allow some time to pass between taking the antacid and taking phenytoin.
Flunarizine: Phenytoin may decrease the serum concentration of Flunarizine. Methemoglobinemia Associated Agents. Combinations of these agents may increase the likelihood of significant methemoglobinemia. Apremilast: CYP3A4 Inducers Strong may decrease the serum concentration of Apremilast. The overall incidence of malformations for children of epileptic women treated with antiepileptic drugs including phenytoin during pregnancy is about 10%, or two- to three-fold that in the general population. Serum concentrations should be monitored in changing from the extended release to the regular release formulation of this drug, and from the sodium salt to the free acid form. Because there is approximately an 8% increase in drug content with the free acid form over that of the sodium salt, dosage adjustments and serum level monitoring may be necessary when switching from a product formulated with the free acid to a product formulated with the sodium salt and vice versa. CAPSULES with certain other medicines can cause side effects or affect how well they work. Do not start or stop other medicines without talking to your healthcare provider. Adams BD, Buckley NH, Kim JY, Tipps LB. Fosphenytoin may cause hemodynamically unstable bradydysrhythmias. J Emerg Med. 2006 Jan. Phenytoin can make birth control pills less effective. To prevent pregnancy while you are taking phenytoin, use a non-hormonal form of birth control such as a condom or diaphragm with spermicide. In most cases where interactions were seen, the effect is a decrease in phenytoin levels when the drugs are taken at the same time. When possible, phenytoin and these products should not be taken at the same time of day. The incidence of hepatocellular tumors were increased in male and female mice at the highest dose. No increases in tumor incidence were observed in rats. The highest doses tested in these studies were associated with peak plasma phenytoin levels below human therapeutic concentrations. Read the Guide provided by your before you start taking phenytoin and each time you get a refill. If you have any questions, ask your doctor or pharmacist. IM dose is increased by 50 percent over the previously established oral dose. To avoid drug cumulation due to absorption from the muscle depots, it is recommended that for the first week back on oral phenytoin, the dose be reduced to half of the original oral dose one third of the IM dose. Experience for periods greater than one week is lacking and blood level monitoring is recommended. For administration of phenytoin in patients who cannot take oral medication for periods greater than a week, gastric intubation may be considered. Gilbert S, Hatton J, Magnuson B. How to minimize interaction between phenytoin and enteral feedings: two approaches. Bazedoxifene: Phenytoin may decrease the serum concentration of Bazedoxifene. This may lead to loss of efficacy or, if bazedoxifene is combined with estrogen therapy, an increased risk of endometrial hyperplasia. The free acid form of phenytoin is used in Phenytoin Oral Suspension and Phenytoin Infatabs chewable tablets. DILANTIN phenytoin extended capsules and parenteral DILANTIN phenytoin are formulated with the sodium salt of phenytoin. Because there is approximately an 8% increase in drug content with the free acid form over that of the sodium salt, dosage adjustments and serum level monitoring may be necessary when switching from a product formulated with the free acid to a product formulated with the sodium salt and vice versa. It may harm an unborn baby. However, since untreated are a serious condition that can harm both a woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using this medication during pregnancy.
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Nappi JM. Warfarin and phenytoin interaction. Porphyria: May cause exacerbation of porphyria; use with caution in patients with porphyria. Phenytoin can make birth control pills less effective. Ask your doctor about using non hormonal birth control condom, diaphragm with spermicide to prevent pregnancy while taking phenytoin. Patients who have received no previous treatment may be started on one 100-mg Dilantin Extended Phenytoin Sodium Capsule three times daily and the dosage then adjusted to suit individual requirements. For most adults, the satisfactory maintenance dosage will be one capsule three to four times a day. An increase up to two capsules three times a day may be made, if necessary.
Note: The list is not intended to be inclusive or comprehensive. Initially, one gram of phenytoin capsules is divided into three doses 400 mg, 300 mg, 300 mg and administered at two-hour intervals. Normal maintenance dosage is then instituted 24 hours after the loading dose, with frequent serum level determinations. What happens if I miss a dose Dilantin?
Etoposide Phosphate: CYP3A4 Inducers Strong may decrease the serum concentration of Etoposide Phosphate. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide phosphate. If these combinations cannot be avoided, monitor patients closely for diminished etoposide phosphate response. Ticlopidine: May increase the serum concentration of Phenytoin. Do not stop taking Dilantin without first talking to your healthcare provider. Stopping Dilantin suddenly can cause serious problems.
Patients, their caregivers, and families should be counseled that antiepileptic drugs AEDs may increase the risk of suicidal thoughts and behavior and should be advised of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts or behavior. RxList is part of the WebMD Health Network. The opinions expressed in the WebMD User Reviews are solely those of the User, who may or may not have medical or scientific training, and do not represent the opinions of WebMD. These member reviews have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other purpose except for compliance with our Terms and Conditions.