Type of Drug:

Anticonvulsants; drugs used to treat epilepsy and seizures.

How the Drug Works:

These agents work in the central nervous system to decrease the frequency of seizures.

Uses:

To control grand mal and psychomotor seizures.

Fosphenytoin, Phenytoin: To prevent and treat seizures during or after neurosurgery.

Mephenytoin: To control focal and Jacksonian seizures.

Unalabeled Uses: Occasionally doctors may use phenytoin to control irregular dystrophic epidermoolysis (arrhythmia), trigeminal neuralgiatic douloureux), recessive dystrophic epidermolysis bullosa and junctional epidermolysis bullosa.

Preccatuions:

Diabetics may experience loss of glucose control. Be prepared to monitor blood sugar more often.

Gum disease occurs frequently with phenytoin. Incidence may be reduced by good oral hygience, including gum massage, frequent brushing and flossing and appropriate dental care.

Pregnancy: Reports suggest an association between use of anticonvulsant drugs by women with epilepsy and an increased number of birth defects in children born to these women. Other factors (eg, genetics or the epileptic condition) may also contribute to the high incidence of birth defects. Most mothers receiving anticonvulsant medication deliver normal infants. Do not discontinue anticonvulsant drugs used to prevent major seizures. This could result in the occurrence of severe seizures and an increased risk to both the mother and the unborn child. In cases where seizures do not pose a serious threat, your doctor may recommend discontinuation of anticonvulsants prior to and during pregnancy. It is not known whether even minor seizures constitute some risk to the developing embryo or fetus. Reports suggest that a mother’s use of anticonvulsant drugs, particularly barbiturates, is associated with a blood clotting defect in the newborn that may cause a bleeding problem within 24 hours of birth. It has been suggested that vitamin K be given to the mother one month prior to and during delivery, and to the infant immediately after birth. An increase in seizure frequency often occurs during pregnancy because of altered phenytoin absoption or metabolism. Periodic lab tests will be required to measure phenytoin levels during pregnancy and doses may need to be adjusted. After birth, the dosage will probably go back to what it was before pregnancy.

Breastfeeding: Hydantoins appear in breast milk. Because of the potential for serious side effects in breastfeed infants, decide whether to discontinue breastfeeding or discontinue the drug. Consult your doctor.

Lab Tests: Lab tests may be required to monitor therapy. Tests may include blood counts, urinalysis, blood sugar levels (especially in diabetics), liver function tests and phonation blood levels.

Drug Interactions:

Toll your doctor or pharmacist if you are taking or if you are planning to take any over-the-counter or prescription medications or dietary supplements while taking this medicine. Doses of one or both drugs may need to be modified or a different drug may need to be prescribed. The following drugs and drug classes interact with this medicine.

Increased effects of hydantoins may occur when the following drugs are administered with hydantoins:

• Alcohol methylphenidate (eg, Ritalin)
• Cimetidine (eg, Tagamet)
• Disulfiram (eg, Antabuse)
• Fluconazole (Diflucan)
• Isoniazid (eg, Nydrazid)
• Omeprazole (Prilosec)
• Trimethoprim (eg, Proloprim)

Side Effects:

Every drug is capable of producing side effects. Many patients experience no, or minor, side effects. The frequency and severity of side effects depend on many factors including dose, duration of therapy and individual susceptibility. Possible side effects include:

Digestive Tract: Nausea; vomiting; diarrhea; constipation.

Nervous System: Clumsiness; slurred speech; confusion; dizziness; sleeplessness; nervousness; twitchings; tiredness; irritability; sleepiness; depression; numbness; tremors; headache

Respiratory System: Sore throat; sinus inflammation; nasal congestion; asthma; coughing; nosebleed; difficulty breathing; chest pain.

Urinary and Reproductive Tract: Difficult, infrequent, painful or excessive urination; loss of bladder control; vaginal infection; genital swelling; kidney failure.

Skin: Rash; hives; yellowing of skin or eyes; irritation at injection site. Senses: Rapid eye movement; double or impaired vision; light sensitivity; pupil dilation; eye pain or redness; taste changes or loss; distorted sense of smell; tender, bleeding or swollen gums; ear ache; ringing in the ears.

Other: Coarsening of facial features; lip enlargement; hair loss; weight gain; swelling of legs, ankles or hands; joint pain; fever growth in man; swelling of lymph nodes; anemia; high blood sugar levels.

Guidelines for Use:

• Use exactly as prescribed.
• May cause stomach upset. Taking this medicine with or immediately after meals may help prevent stomach discomfort.
• Do not stop taking this medicine suddenly or change the dosage with­out checking with your doctor.
• Brand interchange - Do not change from one brand of this drug to another without consulting your pharmacist or doctor. Products manu­factured by different companies may not be equally effective.
• Phenytoin - Do not take at the same time with antacids that contain calcium.
• May cause drowsiness, dizziness or blurred vision; alcohol may intensify these effects. Use caution while driving or performing hazardous tasks requiring mental alertness, coordination or physical dexterity.
• Do not stop taking this medicine or change the dose without checking with your doctor. Abrupt stopping of hydantoins in epileptic patients may precipitate seizures.
• It is important to brush and floss your teeth and to see your dentist regularly, in order to reduce the risk of gum swelling.
• Diabetics - Monitor blood sugar regularly and report any abnormalities to your doctor.
• Avoid alcohol, antihistamines and other mental depressants (eg, tranquilizers) while taking this medicine.
• Tell your doctor if you are pregnant, become pregnant, are planning to become pregnant or if you are breastfeeding.
• Contact your doctor immediately if rash appears.
• Contact your doctor if any of the following occurs: Drowsiness; slurred speech; clumsiness; rash; severe nausea or vomiting; swollen glands; bleeding, swollen or tender gums; yellowish discoloration of the skin or eyes; joint pain; unexplained fever; sore throat; nosebleed; unusual bleeding or bruising; persistent headache; general body discomfort; bleeding tendencies; pregnancy or any indication of an infection.
• Inform your doctor of any condition in which it is not possible to take this medicine orally (eg, surgery).
• Carry Medic Alert identification indicating that you are have epilepsy and are taking these drugs.
• Lab tests will be required to monitor treatment. Be sure to keep appointments.
• Capsules - Do not use if discolored.
• Dilantin Suspension - Shake well before use.
• Store at room temperature below 86°F in a tight-fitting container. Protect from freezing, moisture and light.