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You may experience some mild side effects such as headache, nausea, vomiting, constipation, dizziness, a feeling of spinning, drowsiness, trouble sleeping, or nervousness. These are generally manageable but should be discussed with a healthcare professional if they persist or worsen. Phenytoin can also cause gum swelling and bleeding; maintaining good oral hygiene and regular dental check-ups can help reduce these effects.

While many individuals do not encounter serious issues, it's crucial to be aware of more significant side effects. Seek medical attention if you notice a slow heartbeat, unusual eye movements, loss of coordination, difficulty speaking, confusion, muscle twitching, or vision problems. Other concerning symptoms include tingling in the hands or feet, facial changes, excessive hair growth, increased thirst or urination, unusual fatigue, bone pain, or easily broken bones.

Some people may experience mental health changes, including depression or suicidal thoughts. It's important to alert your healthcare provider if you or those around you observe sudden mood shifts or behaviors. In rare cases, males might experience a painful or prolonged erection; immediate medical attention is necessary to prevent lasting complications.

Serious conditions such as uncontrolled muscle movements, liver problems, or easy bruising or bleeding require prompt medical help. Although rare, severe allergic reactions can occur, with symptoms like fever, swollen lymph nodes, rash, severe dizziness, or breathing difficulties. If you experience these, seek emergency medical care. Always stay informed and consult with your healthcare provider if you have concerns beyond these listed side effects.

Certain medications may interact with this drug, including Colesevelam, Orlistat, and Sucralfate. Additionally, some drugs can impact how phenytoin is cleared from your body, affecting its effectiveness. These include Amiodarone, azapropazone, azole antifungals (e.g., Itraconazole), macrolide antibiotics (e.g., Erythromycin), estrogens, Isoniazid, rifamycins (e.g., Rifabutin), and St. John's wort. Phenytoin can also increase the elimination of other medications, altering their effectiveness. Affected drugs include Atazanavir, certain cancer medications (e.g., Imatinib, irinotecan), cobicistat, corticosteroids (e.g., Prednisone), doravirine, Etravirine, felodipine, nisoldipine, rilpivirine, Quetiapine, quinidine, suvorexant, telithromycin, Theophylline, and Vitamin D.

This medication may reduce the effectiveness of hormonal birth control methods such as pills, patches, or rings, which could lead to pregnancy. It's important to talk to your doctor or pharmacist about using reliable backup contraception while taking this medication. Inform your doctor if you experience new spotting or breakthrough bleeding, as these could indicate your birth control isn't working effectively.

Additionally, this drug might interfere with certain lab tests, leading to inaccurate results. Ensure that all your healthcare providers and lab technicians are aware that you are taking this medication.