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This medication includes crucial safety information about its potential risks and necessary precautions. It is essential to review these warnings and consult your healthcare provider if you have any questions or concerns.

• Withdrawal Seizures: Abruptly discontinuing phenytoin (Dilantin) can result in a serious condition known as status epilepticus, characterized by prolonged or repeated seizures without recovery. To avoid this, discuss any changes with your neurologist, who can guide you in safely tapering off the medication or transitioning to another treatment.

• Suicidal Thoughts or Behavior: There is an increased risk of suicidal thoughts or behavior when taking phenytoin (Dilantin), which can begin as early as one week after starting treatment and persist throughout its use. If you or someone you know experiences mood changes, worsening depression, or thoughts of self-harm, seek immediate advice from a healthcare professional. Your prescriber will weigh these risks against the benefits based on your specific condition.

• Severe Skin and Allergic Reactions: Rare but serious skin reactions, such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), may occur, especially during the first month of treatment. Discontinue use and seek medical help if you develop a rash, swollen lymph nodes, fever, facial swelling, blisters, or skin peeling. Avoid this medication if you have had an allergic reaction to it or similar drugs like carbamazepine. Be vigilant for symptoms affecting major organs, such as jaundice, nausea, vomiting, or loss of appetite, and inform your prescriber immediately.

• Heart Problems: Phenytoin (Dilantin) can cause a slowed heart rate or cardiac arrest. If you experience dizziness, fainting, or an unusually slow heartbeat, contact your healthcare provider without delay. Those with a history of heart problems should be particularly cautious.

• Liver Issues: This medication may lead to serious liver damage or, in rare cases, liver failure, either independently or as part of an allergic reaction. Report any signs of liver issues, such as jaundice, fever, nausea, vomiting, or abdominal pain, to your prescriber.

• Reduced Blood Cell Count: In rare instances, phenytoin (Dilantin) can lower your blood cell counts, potentially leading to life-threatening conditions. Notify your healthcare provider if you experience unusual bruising, infections, swollen lymph nodes, or fatigue.

• Effects on Vitamin D and Bone Health: Long-term use of phenytoin (Dilantin) may weaken bones, increasing the risk of osteopenia, osteoporosis, or fractures due to accelerated breakdown of vitamin D. Your prescriber may conduct tests to assess bone health and recommend preventive measures.

• Risk to Unborn Babies: Phenytoin (Dilantin) poses potential harm to unborn babies, increasing the risk of birth defects. If you are pregnant or planning pregnancy, discuss the medication's risks and benefits with your prescriber. Pregnant individuals using this medication can consider enrolling in the North American Antiepileptic Drug (NAAED) Pregnancy Registry.

• Elevated Blood Sugar Levels: This medication can elevate blood sugar levels by impacting insulin release, complicating diabetes management. Consult your prescriber if you notice changes in your blood sugar readings.

• Excessive Phenytoin Levels: High levels of phenytoin can lead to mental disturbances, including confusion, delirium, or encephalopathy, and in rare cases, permanent brain damage. Contact your healthcare provider if these symptoms occur, as dose adjustments may be necessary.

Contraindications:

• Do not use phenytoin (Dilantin) if you have allergies to it or similar medications.
• Avoid if you have a history of liver damage from phenytoin (Dilantin).
• Do not take it concurrently with delavirdine, as this combination can pose significant health risks.

Always consult with your healthcare provider if you have any specific health conditions or are taking other medications.

Common side effects:

• headache
• nausea
• vomiting
• constipation
• dizziness
• a feeling of spinning
• drowsiness
• trouble sleeping
• nervousness
• swelling and bleeding of the gums

Less common but important to monitor:

• slow heartbeat
• unusual eye movements
• loss of coordination
• trouble speaking
• confusion
• muscle twitching
• double or blurred vision
• tingling in the hands or feet
• facial changes such as swollen lips or a butterfly-shaped rash
• excessive hair growth
• increased thirst or urination
• unusual tiredness
• bone or joint pain
• easily broken bones
• metallic taste
• depression or suicidal thoughts

Serious side effects:

• painful or prolonged erection in males, lasting four or more hours
• serious allergic reactions
• fever
• swollen lymph nodes
• rash
• itching or swelling (particularly of the face, tongue, or throat)
• severe dizziness
• trouble breathing
• serious skin reactions
• signs of liver issues, such as persistent nausea, vomiting, abdominal pain, yellowing of the skin or eyes, and dark urine

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
• Tenofovir Alafenamide

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

• Abemaciclib
• Amiodarone
• Apixaban
• Aprepitant
• Aripiprazole
• Avapritinib
• Axitinib
• Carbamazepine
• Ceritinib
• Clarithromycin
• Cobimetinib
• Crizotinib
• Dasatinib
• Dexamethasone
• Etravirine
• Everolimus
• Fluvastatin
• Gefitinib
• Halothane
• Ibrutinib
• Imatinib
• Irinotecan
• Isoniazid
• Itraconazole
• Ketoconazole
• Lapatinib
• Ledipasvir
• Lopinavir
• Macrolide Antibiotics
• Nifedipine
• Osimertinib
• Palbociclib
• Panobinostat
• Posaconazole
• Quetiapine
• Rifampin
• Rifamycins
• Rivaroxaban
• Saquinavir
• Selpercatinib
• Simvastatin
• St John's Wort
• Tacrolimus
• Theophylline
• Valproic Acid
• Voriconazole

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

• Acetaminophen
• Acyclovir
• Betamethasone
• Bexarotene
• Cimetidine
• Ciprofloxacin
• Colesevelam
• Corticosteroids
• Doxycycline
• Fluconazole
• Fluoxetine
• Ginkgo
• Levofloxacin
• Nelfinavir
• Nisoldipine
• Orlistat
• Paroxetine
• Phenprocoumon
• Prednisone
• Risperidone
• Rufinamide
• Sertraline
• Simvastatin
• Sulthiame
• Topiramate
• Verapamil