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The following safety information is crucial for anyone using this medication. Please review these warnings carefully and consult your healthcare provider if you have any questions or concerns.

• Risk of Withdrawal Seizures: Do not abruptly stop taking phenytoin (Dilantin), as it may lead to a severe condition called status epilepticus, characterized by prolonged or repeated seizures. Consult your neurologist to develop a safe plan for gradually reducing or switching your medication.

• Suicidal Thoughts or Behavior: Phenytoin (Dilantin) may increase the risk of suicidal thoughts or behavior shortly after starting treatment and throughout its use. If you notice mood changes, worsening depression, or thoughts of self-harm, contact a healthcare professional immediately. Your prescriber will weigh the medication's risks and benefits based on your condition.

• Serious Skin and Allergic Reactions: Phenytoin (Dilantin) may rarely cause severe skin reactions like toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). If a rash develops, discontinue use and seek medical advice unless your prescriber determines it's unrelated. Avoid use if you have previously had allergic reactions to phenytoin (Dilantin) or similar drugs such as carbamazepine. Seek medical help for symptoms like rash, swollen lymph nodes, fever, facial swelling, blisters, or skin peeling. DRESS can also affect vital organs, so inform your prescriber if you experience yellowing skin or eyes, nausea, vomiting, or loss of appetite.

• Heart Problems: This medication can slow heart rate or cause cardiac arrest. If you notice dizziness, fainting, or an unusually slow heartbeat, contact your doctor immediately, especially if you have a history of heart issues.

• Liver Problems: Phenytoin (Dilantin) can cause serious liver damage or even liver failure, either independently or as part of an allergic reaction (DRESS). Notify your doctor if you experience symptoms such as jaundice, fever, nausea, vomiting, or stomach pain.

• Lower Blood Cell Count: Although rare, phenytoin (Dilantin) can decrease white blood cells, platelets, and red blood cells, leading to potentially life-threatening conditions. Inform your doctor if you notice unusual bruising, frequent infections, or persistent fatigue.

• Effects on Vitamin D and Bone Health: Long-term use of phenytoin (Dilantin) might lead to weakened bones, increasing the risk of osteopenia, osteoporosis, or fractures by accelerating vitamin D breakdown. Your prescriber might monitor your bone health and suggest preventive measures.

• Risk to Unborn Babies: Phenytoin (Dilantin) can harm an unborn baby, increasing the risk of birth defects. Pregnant individuals or those planning to become pregnant should discuss potential risks with their prescriber. If pregnant, consider joining the North American Antiepileptic Drug (NAAED) Pregnancy Registry to contribute to safety research.

• High Blood Sugar Levels: This medication may elevate blood sugar levels, complicating diabetes management. Notify your prescriber if you notice changes when monitoring your blood sugar.

• High Phenytoin Levels: Excessive levels of phenytoin (Dilantin) can cause confusion, delirium, or brain damage affecting coordination. If you experience mental changes, contact your doctor, who may adjust your dosage.

Contraindications: Do not use phenytoin (Dilantin) if you are allergic to it or similar medications, have a history of liver damage from it, or are taking delavirdine. Always consult your healthcare provider if these conditions apply to you.

Common side effects:

• Dizziness
• Sleepiness
• Trouble sleeping
• Headaches
• Swelling and bleeding of the gums

Less common but important to monitor:

• Metallic taste
• Muscle twitching
• Excessive hair growth

Serious side effects:

• Unusual or sudden changes in mood (e.g., depression, suicidal thoughts)
• Coordination issues (e.g., unpredictable eye movements, slurred speech, confusion)
• Heart-related symptoms (e.g., slow heartbeat, chest pain, fainting)
• Signs of liver problems (e.g., severe stomach pain, yellowing of the skin or eyes, dark urine)
• Low blood cell counts (e.g., easy bruising, frequent infections, swollen lymph nodes)
• Painful or prolonged erection lasting more than four hours
• Serious allergic reactions (e.g., rash, fever, swollen lymph nodes, itching, severe dizziness, trouble breathing)

Interactions with high risk of serious adverse effects and should be avoided:

• 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
• TenofovirAlafenamide

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Amiodarone
• Apixaban
• Itraconazole

Interactions with low risk that usually do not require a change in therapy:

• Acetaminophen
• Atorvastatin