Do not stop taking Dilantin without first talking to your healthcare provider. Stopping Dilantin suddenly can cause serious problems. 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. 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.
Minerals with ADEK, Folate, Iron: May decrease the serum concentration of Fosphenytoin-Phenytoin. Advise patients of the early toxic signs and symptoms of potential hematologic, dermatologic, hypersensitivity, or hepatic reactions. Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir: CYP2C8 Inducers Strong may decrease the serum concentration of Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir. Specifically, the serum concentrations of dasabuvir may decrease significantly.
Phenytoin is 100% bioavailable by the IV route. 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. Do not stop taking phenytoin without first checking with your doctor. Your doctor may want you or your child to gradually reduce the amount you are using before stopping completely. In most patients maintained at a steady dosage, stable phenytoin serum levels are achieved. There may be wide interpatient variability in phenytoin serum levels with equivalent dosages. Patients with unusually low levels may be noncompliant or hypermetabolizers of phenytoin. Unusually high levels result from liver disease, variant CYP2C9 and CYP2C19 alleles, or drug interactions which result in metabolic interference. The patient with large variations in phenytoin plasma levels, despite standard doses, presents a difficult clinical problem. Serum level determinations in such patients may be particularly helpful. As phenytoin is highly protein bound, free phenytoin levels may be altered in patients whose protein binding characteristics differ from normal.
Dilantin may cause fetal harm when administered to a pregnant woman. Continue to take phenytoin suspension even if you feel well. Do not miss any doses. Osteomalacia has been associated with phenytoin therapy and is considered to be due to phenytoin's interference with vitamin D metabolism. Ask your health care provider any questions you may have about how to use phenytoin suspension. Phenytoin is secreted in human milk. The developmental and health benefits of breastfeeding should be considered along with the mother's clinical need for Dilantin and any potential adverse effects on the breastfed infant from Dilantin or from the underlying maternal condition.
No information is available on the relationship of age to the effects of phenytoin in geriatric patients. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment in the dose for patients taking phenytoin. Do not drink alcohol while you take phenytoin without first talking to your healthcare provider. Drinking alcohol while taking phenytoin may change your blood levels of phenytoin which can cause serious problems. Note: The list is not intended to be inclusive or comprehensive. Individual drug package inserts should be consulted. There have also been reports of coarsening of facial features, systemic lupus erythematosus, periarteritis nodosa, and immunoglobulin abnormalities. Dolutegravir: Fosphenytoin-Phenytoin may decrease the serum concentration of Dolutegravir. 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. CarBAMazepine: May decrease the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of CarBAMazepine. CarBAMazepine may increase the serum concentration of Phenytoin. Possibly by competitive inhibition at sites of metabolism. There have also been reports of hypertrichosis. Maintenance dose: Base on ideal body weight if using weight-based regimens or use conventional daily doses with adjustments based upon therapeutic drug monitoring and clinical effectiveness. Softening of your bones osteopenia, osteoporosis, and osteomalacia. This can cause broken bones. Do NOT take more than the recommended dose or change your dose without checking with your doctor. Hardman JG, Limbird LL, Molinoff PB, eds. Goodman and Gillman's The Pharmacological Basis of Therapeutics, 9th ed. New York, NY: McGraw-Hill, 1996. Nausea, vomiting, constipation, toxic hepatitis, and liver damage.
Rufinamide: May increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of Rufinamide. Rolapitant: CYP3A4 Inducers Strong may decrease the serum concentration of Rolapitant. Management: Avoid rolapitant use in patients requiring chronic administration of strong CYP3A4 inducers. Monitor for reduced rolapitant response and the need for alternative or additional antiemetic therapy even with shorter-term use of such inducers. Phenytoin can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using phenytoin. Accordingly, at the first sign of acute toxicity, plasma levels are recommended. Using phenytoin with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use phenytoin, or give you special instructions about the use of food, alcohol, or tobacco. Use phenytoin suspension with caution in the ELDERLY; they may be more sensitive to its effects. If you become pregnant while taking phenytoin, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of phenytoin on the baby.
Patients should be encouraged to enroll in the North American Antiepileptic Drug NAAED Pregnancy Registry if they become pregnant. This registry is collecting information about the safety of antiepileptic drugs during pregnancy. Ribociclib: CYP3A4 Inducers Strong may decrease the serum concentration of Ribociclib. 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. Take phenytoin suspension by mouth with or without food. If stomach upset occurs, take with food to reduce stomach irritation. Bortezomib: CYP3A4 Inducers Strong may decrease the serum concentration of Bortezomib. Floxuridine: May increase the serum concentration of Phenytoin. You have nausea, or you are vomiting. 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. TEN, such as antiepileptic drug AED dose, compliance, concomitant medications, comorbidities, and the level of dermatologic monitoring have not been studied. Many drugs can interact with phenytoin. Below is just a partial list.
Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Nervous System: The most common adverse reactions encountered with phenytoin therapy are nervous system reactions and are usually dose-related. Reactions include nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion. Dizziness, vertigo, insomnia, transient nervousness, motor twitchings, paresthesias, and headaches have also been observed. There have also been rare reports of phenytoin-induced dyskinesias, including chorea, dystonia, tremor and asterixis, similar to those induced by phenothiazine and other neuroleptic drugs. Decreased serum concentrations of phenytoin may occur during pregnancy because of altered phenytoin pharmacokinetics. Periodic measurement of serum phenytoin concentrations should be performed during pregnancy, and the Dilantin dosage should be adjusted as necessary. Administration of phenytoin to pregnant animals resulted in teratogenicity increased incidences of fetal malformations and other developmental toxicity including embryofetal death, growth impairment, and behavioral abnormalities in multiple animal species at clinically relevant doses. This product can affect the results of certain lab tests. Make sure laboratory personnel and your doctors know you use this drug. Due to an increased fraction of unbound phenytoin in patients with renal disease, the interpretation of total phenytoin plasma concentrations should be made with caution. Unbound phenytoin concentrations may be more useful. Eosinophilia is often present. The presence of other medical problems may affect the use of phenytoin. Ritonavir: Phenytoin may decrease the serum concentration of Ritonavir. Ritonavir may decrease the serum concentration of Phenytoin.
TraZODone: Phenytoin may decrease the serum concentration of TraZODone. TraZODone may increase the serum concentration of Phenytoin. Using phenytoin while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away. 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. Dilantin administration is not possible. Data are more extensive with respect to phenytoin and phenobarbital, but these are also the most commonly prescribed antiepileptic drugs; less systematic or anecdotal reports suggest a possible similar association with the use of all known antiepileptic drugs. Brentuximab Vedotin: CYP3A4 Inducers Strong may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E MMAE component may be decreased. Do not use capsules which are discolored. Mefloquine: May diminish the therapeutic effect of Anticonvulsants. Mefloquine may decrease the serum concentration of Anticonvulsants. Management: Mefloquine is contraindicated for malaria prophylaxis in persons with a history of convulsions. Monitor anticonvulsant concentrations and treatment response closely with concurrent use. CYP2C19 Inhibitors Moderate: May decrease the metabolism of CYP2C19 Substrates. Rescriptor. Your doctor will probably tell you not to take phenytoin if you are taking this medication. Advise patients not to discontinue use of Dilantin without consulting with their healthcare provider. CYP3A4 inducers. The Canadian product labeling does not recommend a dose adjustment with concurrent use of strong CYP3A4 inducers. MetyraPONE: Phenytoin may decrease the serum concentration of MetyraPONE. Some drugs may cause hormonal to work less well by decreasing the amount of hormones in your body.
Your doctor may adjust your dose as needed. Similarly, if there is a history of hypersensitivity reactions to these structurally similar drugs in the patient or immediate family members, consider alternatives to Dilantin. Drugs that may either increase or decrease phenytoin serum levels, include: phenobarbital, sodium valproate, and valproic acid. Similarly, the effect of phenytoin on phenobarbital, valproic acid, and sodium valproate serum levels is unpredictable. This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use additional reliable birth control methods while using this medication. 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. 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. Serum drug levels should be monitored when changing from extended release to prompt release and from the sodium salt to the free acid suspension and chewable tablets forms.
Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Wolters Kluwer Health and Drugs. Do not share this medication with others. Etizolam: CYP3A4 Inducers Strong may decrease the serum concentration of Etizolam. Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Ask your health care provider any questions you may have about how to use phenytoin. Lymph node problems may occur while using phenytoin. Check with your doctor right away if you or your child have swollen, painful, or tender lymph glands in your neck, armpit, or groin. The lethal dose in children is not known. Azelastine Nasal: CNS Depressants may enhance the CNS depressant effect of Azelastine Nasal. The patient should be advised that, because these signs and symptoms may signal a serious reaction, they should report any occurrence immediately to a physician even if mild or when occurring after extended use. CAPSULES without first talking to a healthcare provider.
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Etoposide: CYP3A4 Inducers Strong may decrease the serum concentration of Etoposide. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide. If these combinations cannot be avoided, monitor patients closely for diminished etoposide response. When appropriate, counsel pregnant women and women of childbearing potential about alternative therapeutic options. Preserve in tight, light-resistant containers. Protect from moisture. Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.
NIFEdipine: May increase the serum concentration of Phenytoin. Phenytoin may decrease the serum concentration of NIFEdipine. Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Flunarizine: Phenytoin may decrease the serum concentration of Flunarizine.
Care should be taken when using immunoanalytical methods to measure serum phenytoin concentrations. 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. Faraji B, Yu PP. Serum phenytoin levels of patients on gastrostomy tube feeding. ABCB1 Inducers may decrease the serum concentration of VinCRIStine Liposomal. 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.
Phenytoin is an anti-epileptic drug, also called an anticonvulsant. It works by slowing down impulses in the brain that cause seizures. In some patients usually younger patients tenderness, swelling, or bleeding of the gums gingival hyperplasia may appear soon after phenytoin treatment is started. To help prevent this, brush and floss your teeth carefully and regularly and massage your gums. Also, see your dentist every 6 months to have your teeth cleaned. If you have any questions about how to take care of your teeth and gums, or if you notice any tenderness, swelling, or bleeding of your gums, check with your doctor or dentist.