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The following safety information outlines critical warnings and precautions associated with the use of phenytoin (Dilantin). It is essential to review these details carefully and discuss any concerns with your healthcare provider.

• Withdrawal Seizures: Abruptly stopping phenytoin (Dilantin) can trigger a severe condition known as status epilepticus, characterized by prolonged seizures or repeated seizures without recovery in between. Always consult your neurologist to plan a gradual dose reduction or transition to another medication safely.

• Suicidal Thoughts or Behavior: Phenytoin (Dilantin), like many antiseizure drugs, may increase the risk of suicidal ideation or behavior, potentially starting as soon as one week after beginning treatment. If you observe mood changes, worsening depression, or thoughts of self-harm, seek immediate medical advice.

• Serious Skin and Allergic Reactions: Rare but severe skin reactions, including toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), can occur, typically within the first month of treatment. Discontinue use and consult your prescriber if a rash develops, especially if accompanied by other symptoms like swollen lymph nodes or fever. Avoid this medication if you have had previous allergic reactions to phenytoin or similar drugs.

• Heart Problems: Phenytoin (Dilantin) may cause a decrease in heart rate or cardiac arrest. Contact your healthcare provider promptly if you experience dizziness, fainting, or an unusually slow heartbeat.

• Liver Problems: This medication can lead to serious liver damage, including failure, on its own or as part of an allergic reaction. Symptoms like jaundice, fever, nausea, vomiting, or abdominal pain should be reported to your prescriber immediately.

• Lower Blood Cell Count: Though uncommon, phenytoin (Dilantin) may reduce the levels of critical blood cells, potentially leading to severe conditions. Report any unusual bruising, frequent infections, or fatigue to your healthcare provider.

• Effects on Vitamin D and Bone Health: Long-term use can weaken bones by accelerating vitamin D breakdown, increasing the risk of osteopenia, osteoporosis, or fractures. Discuss bone health management strategies with your prescriber.

• Pregnancy Risks: Phenytoin (Dilantin) can harm an unborn child, increasing the risk of birth defects. If you are pregnant or planning to become pregnant, discuss the potential risks and benefits with your prescriber. Consider joining the North American Antiepileptic Drug (NAAED) Pregnancy Registry for safety research.

• High Blood Sugar Levels: This medication may elevate blood sugar, complicating diabetes management. Monitor your blood sugar levels closely and report any significant changes to your prescriber.

• High Phenytoin Levels: Elevated levels may lead to confusion, delirium, or even permanent brain damage. Contact your prescriber if you notice any mental changes, as dose adjustments may be necessary.

Contraindications

Avoid phenytoin (Dilantin) if you have:

• A known allergy to phenytoin or similar medications.
• A history of liver damage due to phenytoin.
• Concurrent use of delavirdine, as it may cause severe health issues.

Always consult with your healthcare provider before starting or stopping phenytoin (Dilantin) to ensure it is safe for your condition.

When taking this medication, some individuals may experience common side effects. These can include headaches, nausea, vomiting, constipation, dizziness, a feeling of spinning, drowsiness, trouble sleeping, and nervousness. These effects are generally mild, but if they persist or worsen, it is important to consult a healthcare provider. Additionally, some people may notice swollen gums, which can be managed with regular dental hygiene and visits to the dentist.

More serious side effects require prompt attention. These include slow heartbeat, unusual eye movements, loss of coordination, slurred speech, confusion, muscle twitching, double or blurred vision, tingling of the hands or feet, facial changes such as swollen lips or a butterfly-shaped rash, excessive hair growth, increased thirst or urination, unusual tiredness, and bone or joint pain. There is also a risk of mental health changes, including depression, suicidal thoughts, or behavior.

Rare but severe side effects demand immediate medical care. These include uncontrolled muscle movements, signs of liver problems such as persistent nausea, vomiting, stomach pain, yellowing of the skin or eyes, and dark urine. Allergic reactions like rash, itching, swelling, especially of the face, tongue, or throat, severe dizziness, and trouble breathing also need urgent attention. In males, a painful or prolonged erection lasting four or more hours is a critical condition and requires stopping the medication and seeking medical help immediately to prevent permanent issues.

This is not an exhaustive list of side effects. If you notice other symptoms or have any concerns, contact your healthcare provider for advice.

Phenytoin, commonly known as Dilantin, has the potential to interact with various medications and supplements. It’s crucial to inform your doctor and pharmacist about all the medicines and supplements you are currently taking, including those that are prescribed, over-the-counter, vitamins, and herbal supplements.

Drug Interactions

Medicines Not Recommended with Phenytoin: Combining phenytoin with certain drugs may not be advised. Your doctor might choose to avoid using phenytoin with these medications or may adjust other medications you are taking. These include: artemether, Atazanavir, boceprevir, cabotegravir, cobicistat, daclatasvir, Darunavir, dasabuvir, delamanid, delavirdine, doravirine, elbasvir, elvitegravir, fostemsavir, grazoprevir, isavuconazonium, lorlatinib, Lurasidone, Maraviroc, ombitasvir, paritaprevir, piperaquine, Praziquantel, ranolazine, rilpivirine, Ritonavir, telaprevir, and tenofovir alafenamide.

Medicines Usually Not Recommended but May Be Necessary: In some cases, using phenytoin with certain drugs might be unavoidable. If these medications are prescribed together, your doctor may alter the dose or frequency of one or both. Such drugs include: abemaciclib, abiraterone acetate, acalabrutinib, afatinib, alfentanil, Amiodarone, apixaban, apremilast, azole antifungals (like Itraconazole), and many others including St. John's wort.

Medicines with Increased Side Effect Risks: Using phenytoin with certain medications may heighten the risk of side effects. However, this combination might be the optimal treatment for your condition. Your doctor might adjust dosages if both are needed. Examples include: Acetaminophen, Acetazolamide, Acyclovir, Amitriptyline, Atorvastatin, betamethasone, carboplatin, Chloramphenicol, Cimetidine, Ciprofloxacin, and many other drugs.

Phenytoin can also speed up the elimination of some medications from your body, which might affect their efficacy. These include atazanavir, certain cancer treatments (like Imatinib, irinotecan), corticosteroids (such as Prednisone), Quetiapine, Theophylline, and Vitamin D, among others.

Additional Considerations

Phenytoin might reduce the effectiveness of hormonal contraceptives (such as pills, patches, or rings), potentially leading to pregnancy. Consult your doctor or pharmacist regarding the use of additional reliable birth control methods. Notify your physician if you experience new spotting or breakthrough bleeding, as these could indicate reduced effectiveness of your birth control.

Moreover, phenytoin can interfere with certain laboratory tests, potentially leading to inaccurate results. Make sure all healthcare providers and lab personnel are aware that you are using this medication.