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Below are important safety warnings and precautions for the use of phenytoin (Dilantin). It is crucial to review this information and discuss any concerns with your healthcare provider.

• Withdrawal Seizures: Abruptly stopping phenytoin (Dilantin) can cause withdrawal seizures, a condition known as status epilepticus. This may occur when a seizure lasts over 5 minutes or when multiple seizures happen without full recovery in between. Always consult your neurologist before discontinuing to plan a safe tapering schedule or transition to another seizure medication.

• Suicidal Thoughts or Behavior: Phenytoin (Dilantin), like other antiseizure drugs, may increase the risk of suicidal thoughts or behaviors. These risks can appear as early as one week after starting treatment. If you or anyone you know experiences mood changes, worsening depression, or self-harm thoughts, seek immediate medical advice. Your healthcare provider will evaluate the benefits and risks of continuing this medication.

• Serious Skin and Allergic Reactions: Rare but severe skin reactions, such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), may occur. These reactions typically manifest within the first month of treatment. Discontinue use immediately if a rash develops and consult your prescriber. Seek urgent medical attention for symptoms like rash, fever, facial swelling, or skin peeling. DRESS can affect vital organs; report symptoms like jaundice, nausea, or reduced appetite to your healthcare provider. Risks include being of Asian descent, carrying the HLA-B*1502 gene, or having allergies to similar medications.

• Heart Problems: Phenytoin (Dilantin) may reduce heart rate and, in rare cases, lead to cardiac arrest. Symptoms such as dizziness, fainting, or a slow heartbeat require immediate medical attention. Those with a history of heart issues are at increased risk.

• Liver Problems: This medication can lead to severe liver damage or failure, alone or as part of an allergic reaction. Symptoms like jaundice, fever, nausea, or stomach pain should be reported to your prescriber immediately.

• Lower Blood Cell Count: Infrequently, phenytoin (Dilantin) can decrease levels of vital blood cells, leading to conditions that may become life-threatening. Notify your healthcare provider if you experience unusual bruising, infections, or persistent fatigue.

• Effects on Vitamin D and Bone Health: Long-term use can weaken bones, increasing the risk of osteopenia, osteoporosis, or fractures due to accelerated breakdown of vitamin D. Discuss bone health maintenance and possible testing with your healthcare provider.

• Harm to Unborn Baby: Phenytoin (Dilantin) may pose risks to an unborn child, potentially causing birth defects such as cleft lip or heart issues. Pregnant individuals or those planning to conceive should discuss potential risks and benefits with their prescriber. Participation in the North American Antiepileptic Drug (NAAED) Pregnancy Registry is encouraged.

• High Blood Sugar Levels: For individuals with diabetes, phenytoin (Dilantin) may complicate blood sugar management. Monitor your levels and consult with your healthcare provider if any changes occur.

• High Phenytoin Levels: Excessive levels can lead to confusion, delirium, or even permanent brain damage. If you experience mental changes, contact your prescriber promptly. Blood levels may need to be evaluated, and the dosage adjusted accordingly. Risks include high doses, liver or kidney issues, low albumin levels, or slow drug metabolism.

Contraindications: Avoid using phenytoin (Dilantin) if you have:

• A known allergy to phenytoin or similar medications.
• A history of liver damage from phenytoin.
• Concurrent use of delavirdine.

Always consult your healthcare provider regarding these warnings and any conditions that might contraindicate the use of phenytoin (Dilantin).

Common side effects:

• Unpredictable eye movements
• Trouble with coordination
• Slurred speech
• Sleepiness
• Confusion

Less common but important to monitor:

• Dizziness
• Trouble sleeping
• Muscle twitching
• Tremors
• Headaches
• Swollen gums
• Excess hair growth
• Metallic taste

Serious side effects:

• Suicidal thoughts or behaviors
• Severe skin and allergic reactions
• Heart problems
• Liver issues
• Low blood cell counts

Phenytoin Sodium, commonly prescribed for seizure control, can interact with various medications and substances, potentially affecting its effectiveness and safety. Understanding these interactions is crucial for optimal treatment outcomes.

Medications That May Increase Phenytoin Levels:

Certain drugs can elevate phenytoin concentrations in the blood, increasing the risk of side effects. These include:

• Antiepileptic Drugs: Ethosuximide, Felbamate, Oxcarbazepine, Methsuximide, and Topiramate.

• Antifungal Agents: Fluconazole, Ketoconazole, Itraconazole, Miconazole, and Voriconazole.

• Antidepressants: Fluoxetine, Fluvoxamine, and Sertraline.

• Gastric Acid Reducers: Cimetidine and Omeprazole.

• Other Medications: Amiodarone, Chloramphenicol, Disulfiram, Isoniazid, Methylphenidate, phenothiazines, salicylates, ticlopidine, Tolbutamide, Trazodone, and Warfarin.

Medications That May Decrease Phenytoin Levels:

Other substances can lower phenytoin levels, potentially reducing its effectiveness. These include:

• Antiepileptic Drugs: Carbamazepine and Vigabatrin.

• Antiviral Agents: Fosamprenavir, nelfinavir, and Ritonavir.

• Other Substances: Chronic alcohol use, Diazepam, Folic Acid, Rifampin, St. John's wort, and Theophylline.

Medications Affected by Phenytoin:

Phenytoin can also influence the effectiveness of other drugs by altering their metabolism. Notably:

• Anticoagulants: Warfarin's effects may be increased or decreased when taken with phenytoin, necessitating careful monitoring.

• Oral Contraceptives: Phenytoin may reduce the effectiveness of birth control pills, increasing the risk of unintended pregnancy.

• Corticosteroids: The efficacy of corticosteroids may be diminished when used concurrently with phenytoin.

Alcohol Interaction:

Alcohol consumption can unpredictably affect phenytoin levels. Acute alcohol intake may increase phenytoin concentrations, while chronic alcohol use can decrease them, potentially leading to loss of seizure control or increased side effects.

Food and Supplement Interactions:

• Antacids and Enteral Feedings: Antacids containing calcium, magnesium, or aluminum, as well as enteral (tube) feedings, can interfere with phenytoin absorption. It's advisable to separate the administration of phenytoin and these substances by at least two hours.

• Folic Acid: While folic acid is essential, high doses may decrease phenytoin levels, potentially reducing its effectiveness.

Recommendations:

To manage these interactions:

• Inform Healthcare Providers: Always disclose all medications, supplements, and herbal products you are taking to your doctor or pharmacist.

• Monitor Levels: Regular blood tests may be necessary to ensure phenytoin levels remain within the therapeutic range.

• Avoid Alcohol: Limit or avoid alcohol consumption to prevent unpredictable changes in phenytoin levels.

• Timing of Medications: If taking antacids or receiving enteral feedings, schedule them at least two hours apart from phenytoin doses to ensure proper absorption.

By being aware of these interactions and working closely with healthcare providers, patients can help ensure the safe and effective use of phenytoin sodium in their treatment regimen.