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Phenytoin may cause some common side effects, including headache, nausea, vomiting, constipation, dizziness, a sensation of spinning, drowsiness, sleep disturbances, or nervousness. These effects are usually mild, but if they persist or worsen, it is important to contact your healthcare provider.

Gum swelling and bleeding can also occur, so regular dental hygiene like brushing, flossing, and massaging your gums is recommended, along with regular dental check-ups. While serious side effects are uncommon, you should be aware of symptoms such as a slow heartbeat, unusual eye movements, loss of coordination, speech difficulties, confusion, muscle twitching, vision problems, tingling sensations, facial changes, excessive hair growth, increased thirst or urination, fatigue, and bone or joint pain. These require prompt medical attention.

A small number of people taking anticonvulsants might experience mood changes, including depression or suicidal thoughts. It’s crucial to contact your doctor if you or those around you notice any sudden mood or behavior changes. In rare instances, males may experience a prolonged, painful erection lasting over four hours, necessitating immediate medical help to prevent long-term issues.

Seek urgent medical care for severe side effects such as uncontrolled muscle movements, liver problems (e.g., persistent nausea or vomiting, abdominal pain, jaundice, dark urine), or easy bruising and bleeding. Though very rare, a serious allergic reaction may occur, characterized by fever, swollen lymph nodes, rash, itching or swelling of the face, tongue, or throat, severe dizziness, or difficulty breathing. Contact a healthcare professional immediately if such symptoms arise. Always inform your doctor of any side effects not listed here.

Certain medications could interact with this drug, including Colesevelam, Orlistat, and Sucralfate. Additionally, some drugs can influence how your body processes phenytoin, potentially altering its effectiveness. These include Amiodarone, azapropazone, azole antifungals (like Itraconazole), macrolide antibiotics (such as Erythromycin), estrogens, Isoniazid, rifamycins (for example, Rifabutin), and St. John's wort, among others.

Phenytoin may also accelerate the elimination of other medications from your body, which could impact their effectiveness. Affected drugs include Atazanavir, certain cancer treatments (such as Imatinib, irinotecan), cobicistat, corticosteroids (like Prednisone), doravirine, Etravirine, felodipine, nisoldipine, Quetiapine, quinidine, rilpivirine, suvorexant, telithromycin, Theophylline, Vitamin D, and others.

Moreover, this medication might reduce the effectiveness of hormonal birth control methods like pills, patches, or rings, which could lead to pregnancy. It's important to discuss with your doctor or pharmacist whether you should use additional backup birth control while taking this medication. Also, inform your doctor if you experience any unusual spotting or breakthrough bleeding, as these might indicate reduced birth control effectiveness.

Finally, this drug might interfere with certain lab tests, potentially leading to inaccurate results. Make sure to inform lab personnel and all your healthcare providers that you are using this medication.