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SORAfenib: CYP3A4 Inducers Strong may decrease the serum concentration of SORAfenib. Glands in the axillary lymph nodes may swell from an injury or infection to the arm or hand. Patients who have received no previous treatment may be started on one 100-mg Dilantin Extended Phenytoin Sodium Capsule three times daily and the dosage then adjusted to suit individual requirements. For most adults, the satisfactory maintenance dosage will be one capsule three to four times a day. An increase up to two capsules three times a day may be made, if necessary. Tenofovir Alafenamide: Fosphenytoin-Phenytoin may decrease the serum concentration of Tenofovir Alafenamide.

Elderly: Use with caution in the elderly

Keep all regular medical and laboratory appointments. Loop Diuretics: Phenytoin may diminish the diuretic effect of Loop Diuretics. Venetoclax: CYP3A4 Inducers Strong may decrease the serum concentration of Venetoclax.

Side effects of phenytoin

CAPSULES may harm your unborn baby. Tell your doctor right away if you or your child develop a fever, rash, swollen, painful, or tender lymph glands in the neck, armpit, or groin, unusual bleeding or bruising, or yellow eyes or skin after taking phenytoin. These may be symptoms of a serious and life-threatening condition called Drug Reaction with Eosinophilia and Systemic Symptoms DRESS. What does phenytoin sodium extended oral look like?

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Johnston, G. A. The specificity of strychnine as a glycine antagonist in the mammalian spinal cord. Phenytoin is extensively bound to serum plasma proteins and is prone to competitive displacement. Phenytoin is metabolized by hepatic cytochrome P450 enzymes CYP2C9 and CYP2C19, and is particularly susceptible to inhibitory drug interactions because it is subject to saturable metabolism. Inhibition of metabolism may produce significant increases in circulating phenytoin concentrations and enhance the risk of drug toxicity. Phenytoin is a potent inducer of hepatic drug-metabolizing enzymes. Serum level determinations for phenytoin are especially helpful when possible drug interactions are suspected.



Common side effects of phenytoin

The increased risk of suicidal thoughts or behavior with AEDs was observed as early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed. Because most trials included in the analysis did not extend beyond 24 weeks, the risk of suicidal thoughts or behavior beyond 24 weeks could not be assessed. Anyone considering prescribing phenytoin sodium or any other AED must balance the risk of suicidal thoughts or behavior with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior. Should suicidal thoughts and behavior emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the illness being treated. What should I avoid while taking Dilantin? Use phenytoin suspension with caution in the ELDERLY; they may be more sensitive to its effects. The addition or withdrawal of phenytoin during concomitant therapy with these agents may require adjustment of the dose of these agents to achieve optimal clinical outcome. Dilantin can be given diluted with normal saline.



How should i store phenytoin

Paliperidone: Inducers of CYP3A4 Strong and P-glycoprotein may decrease the serum concentration of Paliperidone. Management: Avoid using the 3-month extended-release injectable suspension Invega Trinza with inducers of both CYP3A4 and P-glycoprotein during the 3-month dosing interval if possible. If combination is necessary, consider using extended-release tablets. Check your blood or urine glucose level frequently, as directed by your doctor. Promptly report any abnormal results as directed. Enzalutamide: CYP3A4 Inducers Strong may decrease the serum concentration of Enzalutamide. Management: Consider using an alternative agent that has no or minimal CYP3A4 induction potential when possible. If this combination cannot be avoided, increase the dose of enzalutamide from 160 mg daily to 240 mg daily. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your or local waste disposal company. USP are formulated with the sodium salt of phenytoin. Store at room temperature between 59-86 degrees F 15-30 degrees C away from light and moisture. not store in the bathroom. Keep all medicines away from children and pets. Cabozantinib: CYP3A4 Inducers Strong may decrease the serum concentration of Cabozantinib. Management: Avoid use of strong CYP3A4 inducers with cabozantinib if possible. If combined, cabozantinib dose adjustments are recommended and vary based on the cabozantinib product used and the indication for use. See monograph for details. This may not be a complete list of all interactions that may occur. Ask your health care provider if phenytoin suspension may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine. CAPSULES and each time you get a refill. There may be new information. Palbociclib: CYP3A4 Inducers Strong may decrease the serum concentration of Palbociclib.



List of phenytoin side effects

There were four suicides in drug-treated patients in the trials and none in placebo-treated patients, but the number is too small to allow any conclusion about drug effect on suicide. Dolutegravir: Fosphenytoin-Phenytoin may decrease the serum concentration of Dolutegravir. Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. CAPSULES, call your healthcare provider or local Poison Control Center right away. CYP3A4 Substrates: CYP3A4 Inducers Strong may increase the metabolism of CYP3A4 Substrates. Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Exceptions: Buprenorphine; Etizolam; HYDROcodone; Zolpidem. What are the possible side effects of Dilantin? It also makes vaginal fluid thicker to help prevent from reaching an egg fertilization and changes the lining of the uterus womb to prevent attachment of a fertilized egg. If a fertilized egg does not attach to the uterus, it passes out of the body.



Prescribing information for phenytoin

Many other prescription and nonprescription medicines eg, used for allergic reactions, asthma or other breathing problems, blood thinning, diabetes, infections, inflammation, aches and pains, attention deficit hyperactivity disorder, alcoholism, cancer, high blood pressure, indigestion, irregular heartbeat or other heart problems, hepatitis C, high blood iron levels, high cholesterol, HIV, birth control, hormone replacement, immune system suppression, mental or mood problems, pain, sleep, seizures, stomach or bowel problems multivitamin products, and herbal or dietary supplements eg, herbal teas, coenzyme Q10, garlic, ginseng, ginkgo, St. John's wort may interact with phenytoin. What should I discuss with my healthcare provider before taking phenytoin Dilantin? Delamanid: CYP3A4 Inducers Strong may decrease the serum concentration of Delamanid. Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin. ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. PREGNANCY and BREAST-FEEDING: Phenytoin suspension may cause harm to the fetus. If you think you may be pregnant, contact your doctor right away. You will need to discuss the benefits and risks of taking phenytoin suspension while you are pregnant. You and your doctor will need to decide if you will continue to take phenytoin suspension while you are pregnant. Phenytoin suspension is found in breast milk. Do not breast-feed while taking phenytoin suspension. Hydrocortisone Systemic: CYP3A4 Inducers Strong may decrease the serum concentration of Hydrocortisone Systemic. Benzodiazepines: May increase the serum concentration of Phenytoin. Short-term exposure to benzodiazepines may not present as much risk as chronic therapy. Exceptions: ALPRAZolam. Most important. A change in your diet, medicine, or dosage is likely to be necessary. Promptly consult your doctor or pharmacist. Dose is based on body weight and must be determined by your doctor. At first, 5 milligrams mg per kilogram kg of body weight given in two or three divided doses per day. The doctor may adjust the dose as needed. You should not use phenytoin if you also take delavirdine Rescriptor or if you are allergic to phenytoin, ethotoin Peganone fosphenytoin Cerebyx or mephenytoin Mesantoin. Use this medication regularly in order to get the most benefit from it. It is important to take all doses on time to keep the amount of medicine in your body at a constant level. Remember to use it at the same times each day. Dosage is based on your medical condition and response to therapy. Suspension: Shake well prior to use; measure and administer dose using a calibrated oral dosing syringe or other accurate dose-measuring device. Absorption is impaired when phenytoin suspension is given concurrently to patients who are receiving continuous nasogastric feedings. A method to resolve this interaction is to divide the daily dose of phenytoin and withhold the administration of nutritional supplements for 1 to 2 hours before and after each phenytoin dose. The manufacturer recommends not to administer concomitantly with an enteral feeding preparation. Death is due to respiratory and depression.



Reviews for phenytoin

Most of the drug is excreted in the bile as inactive metabolites which are then reabsorbed from the intestinal tract and excreted in the urine. Urinary excretion of phenytoin and its metabolites occurs partly with glomerular filtration but more importantly by tubular secretion. Because phenytoin is hydroxylated in the liver by an enzyme system which is saturable at high plasma levels, small incremental doses may increase the half-life and produce very substantial increases in serum levels, when these are in the upper range. The steady-state level may be disproportionately increased, with resultant intoxication, from an increase in dosage of 10% or more. To be sure this medication is helping your condition, your blood may need to be tested often. You may also need a blood test when switching from one form of phenytoin to another. Visit your doctor regularly. Tadalafil: CYP3A4 Inducers Strong may decrease the serum concentration of Tadalafil. Management: Erectile dysfunction: monitor for decreased effectiveness - no standard dose adjustments recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer. The risk of suicidal thoughts or behavior was generally consistent among drugs in the data analyzed. The finding of increased risk with AEDs of varying mechanisms of action and across a range of indications suggests that the risk applies to all AEDs used for any indication. The risk did not vary substantially by age 5 to 100 years in the clinical trials analyzed. Swallow the capsules whole. Do not use the capsules if discolored. Brexpiprazole: CYP3A4 Inducers Strong may decrease the serum concentration of Brexpiprazole. Management: If brexpiprazole is used together with a strong CYP3A4 inducer, the brexpiprazole dose should gradually be doubled over the course of 1 to 2 weeks. Do not take these products at the same time as your phenytoin dose. Separate liquid nutritional products at least 1 hour before and 1 hour after your phenytoin dose, or as directed by your doctor. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate safety, effectiveness, or appropriateness for any given patient. Drugs.



Protect from light and moisture

Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first. The drop is caused by slower absorption, as compared to oral administration, due to the poor water solubility of phenytoin. Intravenous administration is the preferred route for producing rapid therapeutic serum levels. Phenytoin is extensively bound to plasma proteins and is prone to competitive displacement. Phenytoin is metabolized by hepatic cytochrome P450 enzymes CYP2C9 and CYP2C19, and is particularly susceptible to inhibitory drug interactions because it is subject to saturable metabolism. Inhibition of metabolism may produce significant increases in circulating phenytoin concentrations and enhance the risk of drug toxicity. Monitoring of phenytoin serum levels is recommended when a drug interaction is suspected. Phenytoin can cause overgrowth of your gums. Brushing and flossing your teeth and seeing a dentist regularly while taking phenytoin can help prevent this from happening. Your doctor will start you on a low dose of phenytoin and gradually increase your dose, not more often than once every 7 to 10 days. Ezogabine: Fosphenytoin-Phenytoin may decrease the serum concentration of Ezogabine. Management: Consider increasing the ezogabine dose when adding phenytoin. Patients using this combination should be monitored closely for evidence of adequate ezogabine therapy.



Important information

What are the ingredients in Dilantin Capsules? Phenytoin should be used with caution in patients with hypotension and severe myocardial insufficiency. Exemestane: CYP3A4 Inducers Strong may decrease the serum concentration of Exemestane. Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Drugs which may decrease phenytoin levels include: carbamazepine, chronic alcohol abuse, reserpine, and sucralfate. You may experience an increased chance for bleeding, including bleeding from your gums, nosebleeds, unusual bruising, or dark stools, or an increased chance for clotting. Craig S. Phenytoin poisoning. Neurocrit Care. 2005. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing. Flibanserin: CYP3A4 Inducers Strong may decrease the serum concentration of Flibanserin. Guidry JR, Eastwood TF, Curry SC. Phenytoin absorption in volunteers receiving selected enteral feedings. Advise patients of the early toxic signs and symptoms of potential hematologic, dermatologic, hypersensitivity, or hepatic reactions. Temsirolimus: Phenytoin may decrease the serum concentration of Temsirolimus. Concentrations of the active metabolite, sirolimus, are also likely to be decreased and maybe to an even greater degree. Phenytoin suspension may cause dizziness or drowsiness. These effects may be worse if you take it with alcohol or certain medicines. Use phenytoin suspension with caution. Dasabuvir: CYP3A4 Inducers Strong may decrease the serum concentration of Dasabuvir. Some medical conditions may interact with phenytoin. Dabrafenib: CYP3A4 Inducers Strong may decrease the serum concentration of Dabrafenib.



Highlights for phenytoin

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements. Phenytoin Sodium Injection should be injected slowly and directly into a large vein through a large-gauge needle or intravenous catheter. Each injection of intravenous phenytoin should be followed by an injection of sterile saline through the same needle or catheter to avoid local venous irritation due to alkalinity of the solution. Continuous infusion should be avoided; the addition of Phenytoin Sodium Injection to intravenous infusion fluids is not recommended because of the likelihood of precipitation. Ingestion times of phenytoin and antacid preparations containing calcium should be staggered in patients with low serum phenytoin levels to prevent absorption problems. CYP2C9 Inhibitors Moderate: May decrease the metabolism of CYP2C9 Substrates. Benperidol: CYP3A4 Inducers Strong may decrease the serum concentration of Benperidol.



How should i take phenytoin

CAPSULES can help prevent this. Busulfan: Phenytoin may decrease the serum concentration of Busulfan. Dosage adjustments and closer serum monitoring may be necessary when switching dosage forms. With recommended dosage, a period of seven to ten days may be required to achieve steady-state blood levels with phenytoin and changes in dosage increase or decrease should not be carried out at intervals shorter than seven to ten days. Kennedy MC, Wade DN. The effect of food on the absorption of phenytoin. Inactive ingredients: lactose monohydrate, confectioner's sugar, talc, and magnesium stearate. The capsule body contains titanium dioxide and gelatin. Vinflunine: CYP3A4 Inducers Strong may decrease the serum concentration of Vinflunine. Tell your doctor if this medicine does not seem to work as well in treating your condition. F. Use only clear solutions free of precipitate and haziness; slightly yellow solutions may be used. Precipitation may occur if solution is refrigerated and may dissolve at room temperature. Discard any unused product. Hematopoietic complications, some fatal, have occasionally been reported in association with administration of phenytoin. These have included thrombocytopenia, leukopenia, granulocytopenia, agranulocytosis, and pancytopenia with or without bone marrow suppression. Neonatal coagulation defects reversible with vitamin K administration have been reported postpartum. This drug-induced condition can be prevented with vitamin K administration to the mother before delivery and to the neonate after birth. Use phenytoin with caution in the ELDERLY; they may be more sensitive to its effects. The overall incidence of malformations for children of epileptic women treated with antiepileptic drugs, including phenytoin, during pregnancy is about 10%, or two- to three-fold that in the general population.



Phenytoin dosage

Do not drink alcohol while you take Dilantin without first talking to your healthcare provider. Drinking alcohol while taking Dilantin may change your blood levels of Dilantin which can cause serious problems. Be especially watchful for these symptoms when a new antidepressant is started or when the dose is changed. This medication may decrease milk production. ID listed above. Thank you. Wear a medical alert tag or carry an ID card stating that you take phenytoin. Any medical care provider who treats you should know that you are taking a seizure medication. This information is generalized and not intended as specific medical advice. Doxofylline: Fosphenytoin-Phenytoin may decrease the serum concentration of Doxofylline. Phenytoin may cause swelling and bleeding of the gums. Massage your gums and brush and floss your teeth regularly to minimize this problem. See your dentist regularly. The risk increases if you are also taking other drugs that increase serotonin, so tell your doctor or pharmacist of all the drugs you take see section. Decreased serum concentrations of phenytoin may occur during pregnancy because of altered phenytoin pharmacokinetics. Periodic measurement of serum phenytoin concentrations should be performed during pregnancy, and the Dilantin dosage should be adjusted as necessary. The IV formulation of this drug can be substituted, short-term, for the oral formulation, but only when oral administration is not possible. Proper dental care is important while you are taking phenytoin. Brush and floss your teeth and visit the dentist regularly.



Do not use capsules which are discolored

What other drugs will affect phenytoin Dilantin? CAPSULES. If you would like more information, talk with your healthcare provider. Have had liver problems from taking phenytoin. Cases of acute hepatotoxicity, including infrequent cases of acute hepatic failure, have been reported with phenytoin. These events may be part of the spectrum of DRESS or may occur in isolation. Other common manifestations include jaundice, hepatomegaly, elevated serum transaminase levels, leukocytosis, and eosinophilia. The clinical course of acute phenytoin hepatotoxicity ranges from prompt recovery to fatal outcomes. In these patients with acute hepatotoxicity, phenytoin should be immediately discontinued and not readministered. Do not stop taking phenytoin without first talking to your healthcare provider. Adams BD, Buckley NH, Kim JY, Tipps LB. Fosphenytoin may cause hemodynamically unstable bradydysrhythmias. J Emerg Med. 2006 Jan. Antacids may affect absorption of phenytoin. The induction potency of St. John's wort may vary widely based on preparation. Because of its effect on ventricular automaticity, phenytoin is contraindicated in sinus bradycardia, sino-atrial block, second-and third-degree A-V block, and patients with Adams-Stokes syndrome. Stiripentol: May decrease the serum concentration of Phenytoin. CAPSULES can slow your thinking and motor skills. Stopping Dilantin suddenly can cause serious problems. Avoid drinking alcohol while you are taking phenytoin. Phenytoin metabolism is slightly decreased in elderly patients. If you have any questions about phenytoin suspension, please talk with your doctor, pharmacist, or other health care provider. Teniposide: Phenytoin may decrease the serum concentration of Teniposide. Management: Consider alternatives to combined treatment with phenytoin and teniposide due to the potential for decreased teniposide concentrations. If the combination cannot be avoided, monitor teniposide response closely. Valbenazine: CYP3A4 Inducers Strong may decrease the serum concentration of Valbenazine.



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General information about phenytoin


Phenytoin adult dosage

Appropriate use: Not indicated for the treatment of absence seizures or seizures due to hypoglycemia or other metabolic causes. Patients stabilized on a daily oral regimen of phenytoin experience a drop in peak blood levels to 50 to 60 percent of stable levels if crossed over to an equal dose administered intramuscularly. However, the intramuscular depot of poorly soluble material is eventually absorbed, as determined by urinary excretion of 5-p-hydroxyphenyl-5-phenylhydantoin HPPH the principal metabolite, as well as the total amount of drug eventually appearing in the blood. Phenytoin Sodium Injection is formulated with the sodium salt of phenytoin. Because there is approximately an 8% increase in drug content with the free acid form over that of the sodium salt, dosage adjustments and serum level monitoring may be necessary when switching from a product formulated with the sodium salt and vice versa.

Keep container tightly closed

Individual drug package inserts should be consulted. FDA pregnancy category D. Phenytoin may cause harm to an unborn baby, but having a seizure during pregnancy could harm both the mother and the baby. Phenytoin is an antiepileptic drug which can be useful in the treatment of epilepsy. The primary site of action appears to be the motor cortex where spread of seizure activity is inhibited. Possibly by promoting sodium efflux from neurons, phenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient. This includes the reduction of post tetanic potentiation at synapses. Loss of post tetanic potentiation prevents cortical seizure foci from detonating adjacent cortical areas. Phenytoin reduces the maximal activity of brain stem centers responsible for the tonic phase of tonic-clonic grand mal seizures.

What other drugs will affect phenytoin

Red No. 40 Aluminum Lake, propylene glycol and shellac glaze. CAPSULES exactly as prescribed. The intramuscular route is not recommended for the treatment of status epilepticus since blood levels of phenytoin in the therapeutic range cannot be readily achieved with doses and methods of administration ordinarily employed. ABCB1 Inducers may decrease the serum concentration of DOXOrubicin Conventional. Management: Seek alternatives to P-glycoprotein inducers in patients treated with doxorubicin whenever possible. Propylene glycol: Some dosage forms may contain propylene glycol; large amounts are potentially toxic and have been associated hyperosmolality, lactic acidosis, seizures and respiratory depression; use caution AAP 1997; Zar 2007.

Before taking phenytoin

Diphenylhydantoin sodium salt, having a molecular weight of 274. Administration of phenytoin to pregnant rats, rabbits, and mice during organogenesis resulted in embryofetal death, fetal malformations, and decreased fetal growth. With recommended dosages, a period of seven to ten days may be required to achieve phenytoin steady-state blood levels, and changes in dosage increase or decrease should not be carried out at intervals shorter than seven to ten days.

Serum concentration may be difficult to interpret in renal failure. Monitoring of free unbound concentrations or adjustment to allow interpretation is recommended. There are marked variations among individuals with respect to phenytoin plasma levels where toxicity may occur. Valproate Products: May decrease the protein binding of Fosphenytoin-Phenytoin. This appears to lead to an initial increase in the percentage of unbound free phenytoin and to a decrease in total phenytoin concentrations. Whether concentrations of free phenytoin are increased is unclear. With long-term concurrent use, total phenytoin concentrations may increase. Fosphenytoin-Phenytoin may decrease the serum concentration of Valproate Products.

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