Phenytoin

AKA: Dilantin (extended action), Diphenylan (prompt acting), Diphenylhydantoin (DPH), Ditan (prompt acting), Ethotoin, Mephenytoin, Mesantoin, Peganone, Phenytex, PHT.

The most commonly prescribed drug for epilepsy, it has been the subject of at least 8000 papers. The exact mechanism by which it works is still not understood, but it is believed to influence the electromagnetic fields, polarizing the electrically charged elements of the cells.

Effects: Though it is mainly used as a treatment for epilepsy, it has a number of other various effects: it can normalize electrical activity in the cell membranes; it can stabilize behavior by suppressing obsessive thoughts, fear, anger, violent behavior, and passivity; it can supposedly improve intelligence, concentration, learning, long-term memory, comprehension, and speed of visual-motor coordination; it has some anti-aging effects, including restoring the homeostasis of the neuroendocrine system; in small doses, it increases the "good" form of cholesterol, called high density lipo-protein (HDL).

Precautions: It is not taken by anyone who is allergic to hydantoin anticonvulsants, has liver damage or impaired liver functioning, has had surgery within the last two months that has required general or spinal anesthesia, has diabetes, or a blood disorder. Those over 60 should realize that adverse reactions and side effects will occur more often and much more strongly than they do in younger individuals.

Common side effects include constipation; mild dizziness; drowsiness; gums that are bleeding, swollen, or tender; nausea; increased susceptibility to sunburn; and vomiting. Less common side effects include agitation, breast swelling, confusion, diarrhea, an increase in facial and body hair, hallucinations, headaches, insomnia, muscle twitches, rash, slurred speech, staggering, vision changes. Rare symptoms include abdominal pain, an increased chance of bleeding or bruising, fever, jaundice, and sore throat. Other symptoms cited by some sources include anemia, balding, chest pains, depression, mental confusion and learning disability, conjunctivitis, nervousness, numbness of the hands and feet, nystagmus, retention of water, sensitivity to bright lights, swollen glands, tiredness, irritability, and weight gain, though these also disappear as time goes on and dosage is reduced. A severe allergic reaction could be life-threatening, and could include such symptoms as fever, rash, swollen glands, and kidney failure. Use of phenytoin may even cause liver damage, including hepatitis. If stomach upset occurs, it should be taken with meals. Long-term effects may be weakened bones, gum overgrowth (though this occurs mainly in children and is rare in instances where the lower, cognitive-enhancing doses are taken; still, good oral hygiene is recommended), constant eye movements, liver damage, lymph gland enlargement, and numbness and tingling in the hands and feet.

An overdose can cause problems in maintaining balance, a drop in blood pressure, slow, shallow breathing, coma, drowsiness, spastic eye movements, decreased intelligence, slow reaction time, slurred speech, and staggering. There have been reports of insomnia, tremors and in some cases, liver toxicity in the first month or so of use. It is not habit-forming, but abrupt cessation could trigger severe epileptic seizures.

Phenytoin may deplete the body's stores of B-12, lead to a heightened need for thyroid hormone, interfere with the absorption of vitamin D and folic acid (supplements of calcium should be taken along with vitamin D and folic acid, though calcium will decrease the amount of Phenytoin the body absorbs from the small intestine).

The effects of Phenytoin can be increased when taken with alcohol (small amounts), Allopurinol, salicylate drugs such as aspirin, benzodiazopine tranquilizers and sedatives, Chlorphi-ramine, Cimetidine, Ibuprofen, Metro-nidazole, Miconazole, Molindone, Nizatidine, Omeprazole, Phenacemide, succinimide antiseizure medicines, tri-cyclic antidepressants, Trimethoprim, or Valproic Acid. The anticonvulsant effect can be enhanced when taken in combination with Amiodarone, Carba-mazepine, Chloramphenicol, Disul-firam, Fluconazole, Isoniazid, Methyl-phenidate, Nicardipine, Nimodipine, Oxyphenbutazone, Para-aminosalicylic acid (PAS), Phenothiazines, Phenylbutazone, Sulfa drugs, or Warfarin. The anticonvulsant effect is diminished when Phenytoin is taken with alcohol (habitual use), antacids, anticancer drugs, barbiturates, Carbamazepine, charcoal tablets, Diazoxide, Glutethimide, influenza virus vaccine, Loxapine, marijuana (with attendant drowsiness and unsteadiness), Nitrofurantoin, Paroxitine, Pyridoxine, Rifampin, Sucralfate, or Theophylline. When taken in combination with anticoagulants or Propafenone, the effects of both drugs are intensified, and when taken with Xanthines, the effects of both drugs are weakened. Phenytoin can amplify the effects of Estrogen, Griseofulvin, Methotrexate, Propranolol, Quinidine, sedatives, and Warfarin, and curtail the effects of Amiodarone, Carbamazepine, corticosteroids, cortisone drugs, Cyclosporine, Dicumarol, Digitalis preparations, Disopyramide, Doxycycline, Furosemide, Haloperidol, Hypoglycemics, Itraconazole, Methadone, Metyrapone, Mexiletine, oral contraceptives, potassium supplements, Probenecid, Quinidine, Sotalol, Theophylline drugs, and Valproic Acid. Phenytoin can interact unpredictably with Clonazepam, Dopamine, levodopa, Levonorgestrel, Mebendazole, Phenothiazine antipsychotic medicines, or oral antidiabetic medications.

The severity of side effects and adverse reactions increases when taken with Felbamate, there is an increased risk of toxicity when taken with Cimetidine, and an increased risk of liver toxicity when taken with Acetaminophen. The anticonvulsant dose may need to be adjusted when taken with tricyclic antidepressants; there may be a changed seizure pattern when taken with barbiturates; there is a greater chance of bone disease when taken with carbonic anhydrase inhibitors; there could be oversedation when taken with central nervous system depressants; the incidence of seizures increases when taken with cocaine or oral contraceptives; corticosteroid drugs could hide any Phenytoinsensitivity reactions; there could be an increase in drug levels in the blood when taken in combination with gold compounds; and Leucovorin could counteract the effects of phenytoin. When taken with Lithium, it can increase the toxicity of the latter drug; when taken with MAO inhibitors, it could result in an increased polythiazide effect; when taken with Meperidine, it can decrease the painrelieving effects of the latter while increasing its side effects; when taken with nitrates, it could result in an excessive drop in blood pressure; when taken with Omeprazole, there could be a delay in the excretion of phenytoin with a resultant excess remaining in the blood; when taken with Phenacemide, it could result in an increased risk of paranoia; and when taken with Valproic acid, it could result in seizures.

Dosage: Adult epileptics are generally given doses of 200 to 400 mg/day in two to four divided doses. About an eighth of that, or 25 to 50 mg/day are given for cognitive-enhancing effects, though some recommend as much as 100 mg/day in two to four divided doses.

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