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When taking Phenytoin, you may experience some common side effects such as headache, nausea, vomiting, constipation, dizziness, and drowsiness. These are usually mild and tend to improve as your body adjusts to the medication. Ensuring regular dental hygiene can help manage the potential gum swelling and bleeding associated with Phenytoin use. It's advisable to brush and floss regularly and visit your dentist for routine check-ups.

There are, however, more serious side effects that require immediate medical attention. These include slow heartbeat, unusual eye movements, loss of coordination, confusion, muscle twitching, or changes in vision. Some individuals may notice excessive thirst or urination, tiredness, or bone pain. It's crucial to be alert to any significant mood changes, such as depression or suicidal thoughts, as these can also occur.

In rare cases, males might experience a prolonged erection lasting four or more hours, which needs urgent medical care. Signs of liver issues, like persistent nausea, abdominal pain, or yellowing of the skin, are also serious and warrant immediate attention. Though very rare, a severe allergic reaction might occur, marked by fever, swollen lymph nodes, or difficulty breathing. If you encounter any of these symptoms, seek medical help right away. Always communicate with your healthcare provider about any unusual effects you experience while on this medication.

Phenytoin may interact with several medications, including colesevelam, orlistat, and sucralfate. These interactions can influence how phenytoin functions. Certain drugs, such as amiodarone, azapropazone, azole antifungals (like itraconazole), macrolide antibiotics (such as erythromycin), estrogens, isoniazid, rifamycins (like rifabutin), and St. John's wort, can alter the elimination of phenytoin from your body, impacting its effectiveness.

Additionally, phenytoin can accelerate the clearance of other medications, potentially affecting their efficacy. Affected medications 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 such as pills, patches, or rings, which could result in pregnancy. It is advisable to consult with your doctor or pharmacist about using additional reliable birth control methods while on this medication. Report any new spotting or breakthrough bleeding to your doctor, as these might indicate that your birth control is not functioning properly.

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