Phenytoin

Phenytoin Brand Names- Dilantin | Phenytek

What is Phenytoin

Phenytoin is an oral and parenteral hydantoin anticonvulsant first synthesized in 1908. Although it has been used in many diverse conditions, its only approved use is as an anticonvulsant, specifically, for the prophylactic management of tonic-clonic (grand mal) seizures and partial seizures with complex symptomatology (psychomotor seizures).

It may be used alone or with phenobarbital or other anticonvulsants. Phenytoin may also be used to prevent seizures occurring during surgery but is not used for pure absence (petit mal) seizures.

Phenytoin has been used for many other conditions including treatment of neuropathic pain syndromes including diabetic neuropathy, although it is variably effective.

Indications

1. diabetic neuropathy
2. digoxin toxicity
3. eclampsia
4. head trauma
5. partial seizures
6. seizure prophylaxis
7. status epilepticus
8. subarachnoid hemorrhage
9. tonic-clonic seizures

Side Effects

1. abdominal pain
2. acute generalized exanthematous pustulosis (AGEP)
3. agranulocytosis
4. amblyopia
5. anaphylactoid reactions
6. angioedema
7. aplastic anemia
8. asterixis
9. asthenia
10. ataxia
11. AV block
12. bone fractures
13. bradycardia
14. bullous rash
15. cardiac arrest
16. cataracts
17. cerebral edema
18. cholestasis
19. choreoathetosis
20. coma
21. confusion
22. constipation
23. depression
24. diabetic ketoacidosis
25. dizziness
26. drowsiness
27. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
28. dysarthria
29. dysgeusia
30. dyskinesia
31. dystonic reaction
32. elevated hepatic enzymes
33. eosinophilia
34. erythema multiforme
35. exfoliative dermatitis
36. folate deficiency
37. gingival hyperplasia
38. glomerulonephritis
39. headache
40. hemolytic anemia
41. hepatic failure
42. hepatic necrosis
43. hepatitis
44. hepatomegaly
45. hirsutism
46. hyperglycemia
47. hypertrichosis
48. hypocalcemia
49. hypophosphatemia
50. hyporeflexia
51. hypotension
52. hypothyroidism
53. impotence (erectile dysfunction)
54. infusion-related reactions
55. injection site reaction
56. insomnia
57. interstitial nephritis
58. jaundice
59. leukopenia
60. libido decrease
61. lupus-like symptoms
62. lymphadenopathy
63. macrocytosis
64. maculopapular rash
65. megaloblastic anemia
66. metallic taste
67. nausea
68. nephrolithiasis
69. nephrotic syndrome
70. neutropenia
71. new primary malignancy
72. nystagmus
73. osteomalacia
74. osteopenia
75. osteoporosis
76. pancytopenia
77. paresthesias
78. peripheral neuropathy
79. peripheral vasodilation
80. porphyria
81. priapism
82. purpura
83. renal failure (unspecified)
84. respiratory depression
85. scarlatiniform exanthema
86. seizures
87. skin hyperpigmentation
88. skin necrosis
89. Stevens-Johnson syndrome
90. suicidal ideation
91. teratogenesis
92. thrombocytopenia
93. tinnitus
94. toxic epidermal necrolysis
95. tremor
96. vasculitis
97. ventricular fibrillation
98. ventricular tachycardia
99. vertigo
100. vitamin D deficiency
101. vomiting

Monitoring Parameters

• CBC
• ECG
• EEG
• LFTs
• neurologic function
• serum albumin
• serum phenytoin concentrations

Contraindications

• abrupt discontinuation
• Adams-Stokes syndrome
• agranulocytosis
• alcoholism
• Asian patients
• AV block
• barbiturate hypersensitivity
• bone fractures
• bone marrow suppression
• bradycardia
• breast-feeding
• bundle-branch block
• carbamazepine hypersensitivity
• cardiac arrhythmias
• cardiac disease
• contraception requirements
• coronary artery disease
• dental disease
• depression
• diabetes mellitus
• driving or operating machinery
• encephalopathy
• ethanol ingestion
• ethanol intoxication
• extravasation
• geriatric
• heart failure
• hematological disease
• hepatic disease
• hepatotoxicity
• Hodgkin lymphoma
• hydantoin hypersensitivity
• hypoalbuminemia
• hypoglycemia
• hyponatremia
• hypotension
• hypothyroidism
• infusion-related reactions
• intramuscular administration
• intravenous administration
• jaundice
• lymphoma
• myasthenia gravis
• neonates
• obstetric delivery
• osteomalacia
• osteoporosis
• petit mal (absence) seizures
• porphyria
• pregnancy
• psychosis
• radiation therapy
• renal disease
• renal failure
• renal impairment
• reproductive risk
• serious rash
• succinimide hypersensitivity
• suicidal ideation
• thyroid disease
• vitamin K deficiency

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• Sucralfate
• Sufentanil
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Sulfinpyrazone
• Sulfonylureas
• Sunitinib
• Suvorexant
• Tacrolimus
• Tadalafil
• Tamoxifen
• Tasimelteon
• Tazemetostat
• Teduglutide
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Temazepam
• Temsirolimus
• Teniposide
• Tenofovir Alafenamide
• Terbinafine
• Tetracaine
• Tezacaftor; Ivacaftor
• Thalidomide
• Theophylline, Aminophylline
• Thiazolidinediones
• Thiopental
• Thiotepa
• Thiothixene
• Thyroid hormones
• Tiagabine
• Ticagrelor
• Ticlopidine
• Tinidazole
• Tipranavir
• Tizanidine
• Tocilizumab
• Tofacitinib
• Tolvaptan
• Topiramate
• Toremifene
• Torsemide
• Trabectedin
• Tramadol
• Trandolapril; Verapamil
• Tranylcypromine
• Trazodone
• Tretinoin, ATRA
• Triamcinolone
• Triazolam
• Triclabendazole
• Tricyclic antidepressants
• Trimethoprim
• Trimetrexate
• Trimipramine
• Triprolidine
• Tubocurarine
• Tucatinib
• Ubrogepant
• Ulipristal
• Upadacitinib
• Valacyclovir
• Valbenazine
• Valdecoxib
• Valproic Acid, Divalproex Sodium
• Vandetanib
• Vecuronium
• Vemurafenib
• Venetoclax
• Verapamil
• Vigabatrin
• Vilazodone
• Vincristine
• Vincristine Liposomal
• Vorapaxar
• Voriconazole
• Vortioxetine
• Voxelotor
• Warfarin
• Zafirlukast
• Zalcitabine, ddC
• Zaleplon
• Zanubrutinib
• Zidovudine, ZDV
• Ziprasidone
• Zolpidem
• Zonisamide