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The safety and warning information provided below outlines the crucial precautions and potential risks associated with the use of phenytoin (Dilantin). It is important to review these details carefully and discuss any concerns with your healthcare provider.

• Withdrawal Seizures: Abruptly discontinuing phenytoin (Dilantin) can lead to status epilepticus, a serious condition where seizures persist for more than 5 minutes or occur in rapid succession without recovery in between. Always consult your neurologist to create a safe withdrawal plan or when switching to another seizure medication.

• Suicidal Thoughts or Behaviors: Phenytoin (Dilantin), like many antiseizure medications, may increase the risk of suicidal thoughts or behaviors, sometimes as early as one week into treatment. If mood changes, worsened depression, or thoughts of self-harm occur, contact a healthcare professional immediately. Your prescriber will weigh the benefits and risks based on your situation.

• Serious Skin and Allergic Reactions: Rarely, phenytoin (Dilantin) can cause severe skin reactions such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). These reactions may appear within the first month of treatment. Discontinue use and seek medical attention if you experience a rash or other symptoms like fever, swollen lymph nodes, or organ-related issues. Do not use if allergic to phenytoin or similar medications, particularly if you have the HLA-B*1502 gene or are of Asian descent.

• Heart Problems: This medication can slow the heart rate and potentially cause cardiac arrest. Symptoms such as dizziness, fainting, or a very slow heartbeat require immediate medical attention, especially if there is a history of heart issues.

• Liver Problems: Phenytoin (Dilantin) may cause serious liver damage, including liver failure, which could occur independently or as part of an allergic response. Report symptoms like yellowing of the skin or eyes, fever, nausea, vomiting, or stomach pain to your prescriber.

• Low Blood Cell Count: Although rare, this medication can reduce the levels of essential blood cells, potentially leading to life-threatening conditions. Notify your prescriber if you experience unusual bruising, recurrent infections, or fatigue.

• Effects on Vitamin D and Bone Health: Long-term use might affect bone strength, increasing the risk of osteopenia, osteoporosis, or fractures by accelerating vitamin D breakdown. Discuss bone health management strategies with your prescriber if using phenytoin (Dilantin) long-term.

• Harm to Unborn Baby: Use during pregnancy can increase the risk of birth defects. Pregnant individuals or those planning pregnancy should weigh the risks and benefits with their prescriber and consider joining the North American Antiepileptic Drug (NAAED) Pregnancy Registry.

• High Blood Sugar Levels: Phenytoin (Dilantin) may elevate blood sugar levels, impacting diabetes management. Report any changes in blood sugar levels to your healthcare provider.

• High Phenytoin Levels: Excessive levels of phenytoin (Dilantin) can lead to confusion, delirium, or even permanent brain damage. If you notice mental changes, seek medical guidance to adjust your dosage. This risk is heightened in individuals with liver or kidney issues or low albumin levels.

Contraindications: Avoid using phenytoin (Dilantin) if you have allergies to it or similar medications, a history of liver damage due to its use, or are taking delavirdine, as these conditions may pose serious health risks. Always consult your healthcare provider under these circumstances.

Phenytoin can lead to several side effects, ranging from mild to severe. Common side effects include headaches, dizziness, drowsiness, nausea, vomiting, constipation, and trouble sleeping. These are generally mild, but if they persist or worsen, it's advisable to consult a healthcare professional. Additionally, some individuals may experience gum swelling and bleeding, which can be minimized by regular dental care, including brushing, flossing, and gum massages.

More serious side effects require immediate attention. These include slow heartbeat, unusual eye movements, loss of coordination, slurred speech, confusion, muscle twitching, double or blurred vision, tingling in hands or feet, and facial changes such as swollen lips or a butterfly-shaped rash. Other concerning symptoms are excessive hair growth, increased thirst or urination, unusual tiredness, bone or joint pain, and easily broken bones.

Phenytoin can also affect mental health, potentially leading to depression, suicidal thoughts or behavior, or other mood changes. If any sudden changes in mood or behavior occur, it's crucial to contact a healthcare provider immediately. Rarely, males may experience a painful or prolonged erection, which requires urgent medical attention.

In very rare cases, severe allergic reactions or liver problems can occur. Symptoms such as uncontrolled muscle movements, persistent nausea or vomiting, abdominal pain, yellowing of the skin or eyes, dark urine, or signs of an allergic reaction like fever, rash, swelling, and trouble breathing demand immediate medical help. While these side effects are rare, being aware and vigilant can help in managing them effectively. Always discuss any new or unusual symptoms with a healthcare provider.

Phenytoin, also known as Dilantin, has the potential to interact with various medications and supplements. It's important to inform your doctor and pharmacist about all the medications and supplements you are taking, whether they are prescribed, over-the-counter, vitamins, or herbal products.

Certain drugs can influence how phenytoin is removed from your body, potentially altering its effectiveness. Some of these medications include Amiodarone, azole antifungals like Itraconazole, macrolide antibiotics such as Erythromycin, estrogens, Isoniazid, rifamycins like Rifabutin, and St. John's wort.

Conversely, phenytoin can accelerate the elimination of other drugs from your body, impacting their efficacy. These include Atazanavir, some cancer treatments like Imatinib and irinotecan, cobicistat, corticosteroids such as Prednisone, doravirine, etravirine, felodipine, nisoldipine, Quetiapine, quinidine, rilpivirine, suvorexant, telithromycin, Theophylline, and Vitamin D.

Phenytoin may also reduce the effectiveness of hormonal birth control methods like pills, patches, or rings, increasing the risk of pregnancy. It’s crucial to discuss with your healthcare provider whether you need to use additional birth control methods. Notify your doctor if you experience any spotting or breakthrough bleeding, as these might indicate reduced effectiveness of your birth control.

Additionally, phenytoin can interfere with certain laboratory tests, potentially leading to incorrect results. Ensure that all healthcare personnel are aware that you are using this medication.