Dilantin (Phenytoin)
Class and Category of Drug
Before you buy Dilantin (Phenytoin) online, read common information about the medication.
Chemical class: Hydantoin derivative
Therapeutic class: Anticonvulsant
Pregnancy category: C
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Drug Indications and Dosages
Before purchase Dilantin (Phenytoin) online , you must read how it works.
To treat tonic-clonic, simple, or complex partial seizures in patients who have had no prior treatment
Chewable Tablets, Oral Suspension (Phenytoin)
Adults and adolescents. Initial: 125 mg suspension or 100 to 125 mg tablet t.i.d., adjusted every 7 to 10 days as needed and tolerated.
Children. Initial: 5 mg/kg daily in divided doses b.i.d. or t.i.d., adjusted as needed and tolerated. Maintenance: 4 to 8 mg/kg daily in divided doses b.i.d. or t.i.d. Maximum: 300 mg daily.
Extended Capsules (Phenytoin Sodium ) Adults and adolescents. Initial: 100 mg t.i.d., adjusted every 7 to 10 days as needed and tolerated. Maintenance: Once seizures are controlled, adjusted dosage given daily if needed and tolerated.
Dosage Adjustment For hospitalized patients without hepatic or renal disease, oral loading dose of 400 mg followed in 2 hr by 300 mg and then in 2 more hr by another 300 mg for a total of 1 g. Children. Initial: 5 mg/kg daily in divided doses b.i.d. or t.i.d., adjusted as needed and tolerated. Maintenance: 4 to 8 mg/kg daily in divided doses b.i.d. or t.i.d. Maximum: 300 mg daily.
PROMPT Capsules (Phenytoin Sodium ) Adults and adolescents. 100 mg t.i.d., adjusted every 7 to 10 days as needed and tolerated.
Children. Initial: 5 mg/kg daily in divided doses b.i.d. or t.i.d., adjusted as needed and tolerated. Maintenance: 4 to 8 mg/kg daily in divided doses b.i.d. or t.i.d. Maximum: 300 mg daily.
To treat status epilepticus
Intravenous Injection (Phenytoin Sodium )
Adults and adolescents. Initial: 15 to 20 mg/kg by slow push in 50 ml sodium chloride injection at no more than 50 mg/ min. Maintenance: Beginning within 12 to 24 hr of initial dose, 5 mg/kg daily P.O. in divided doses b.i.d. to q.i.d., or 100 mg intravenous every 6 to 8 hr.
Children. 15 to 20 mg/kg at no more than 1 mg/kg/min. Maximum: 50 mg/min.
Dosage Adjustment For elderly or very ill patients and those with CV or hepatic disease, dosage reduced to 25 mg/min, as prescribed, or possibly as low as 5 to 10 mg/ min to reduce the risk of adverse reactions.
To prevent or treat seizures during neurosurgery
Intravenous Injection (Phenytoin Sodium )
Adults. 100 to 200 mg every 4 hr at no more than 50 mg/min during or immediately after neurosurgery.
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Incompatibilities
Don't mix phenytoin in same syringe with any other drugs or with any intravenous solutions other than sodium chloride for injection because precipitate will form.
Contraindications of Drug
Read contraindications if you want cheap Dilantin (Phenytoin) online.
Adams-Stokes syndrome, hypersensitivity to phenytoin or its components, sinoatrial block, second- or third-degree heart block, sinus bradycardia
Generic Drug Interactions
Drugs
acetaminophen: Possibly hepatotoxicity, decreased acetaminophen effects activated charcoal, antacids, calcium salts, enteral feedings, sucralfate: Decreased absorption of oral phenytoin
allopurinol, benzodiazepines, chloramphenicol, cimetidine, disulfiram, fluconazole, isoniazid, itraconazole, methylphenidate, metronidazole, miconazole, omeprazole, phenacemide, ranitidine, sulfonamides, trazodone, trimethoprim: Decreased metabolism and increased effects of phenytoin
amiodarone, ticlopidine: Possibly increased blood phenytoin level
antifungals (azole): Increased blood phenytoin level, decreased blood antifungal level antineoplastics, nitrofurantoin, pyridoxine: Decreased phenytoin effects
barbiturates: Variable effects on blood phenytoin level
bupropion, clozapine, loxapine, MAO inhibitors, maprotiline, molindone, phenothiazines, pimozide, thioxanthenes, tricyclic antidepressants: Decreased seizure threshold, decreased anticonvulsant effects calcium channel blockers: Increased metabolism and decreased effects of these drugs, possibly increased blood phenytoin level
carbamazepine: Decreased blood level and effects of carbamazepine, possibly phenytoin toxicity
carbonic anhydrase inhibitors: Increased risk of osteopenia from phenytoin chlordiazepoxide, diazepam: Possibly increased blood phenytoin level, decreased effects of these drugs
clonazepam: Possibly decreased blood level and effects of clonazepam, possibly phenytoin toxicity
corticosteroids, cyclosporine, dicumarol, digoxin, disopyramide, doxycycline, estrogens, furosemide, lamotrigine, levodopa, methadone, metyrapone, mexiletine, oral contraceptives, quinidine, sirolimus, tacrolimus, theophylline: Increased metabolism and decreased effects of these drugs
dopamine: Increased risk of severe hypotension and bradycardia (with intravenous phenytoin)
fluoxetine: Increased blood phenytoin level and risk of phenytoin toxicity
folk acid, leucovorin: Decreased blood phenytoin level, increased risk of seizures haloperidol: Decreased effects of haloperidol, decreased anticonvulsant effect of phenytoin
halothane anesthetics: Increased risk of hepatotoxicity and phenytoin toxicity ifosfamide: Decreased phenytoin effects, possibly increased toxicity
influenza virus vaccine: Possibly decreased phenytoin effects
insulin, oral antidiabetic drugs: Possibly hyperglycemia, increased blood phenytoin level (with tolbutamide)
levonorgestrel, mebendazole, streptozocin, sulfonylureas: Decreased effects of these drugs
lidocaine, propranolol (possibly other beta blockers): Increased cardiac depressant effects (with intravenous phenytoin), possibly decreased blood level and increased adverse effects of phenytoin
lithium: Increased risk of lithium toxicity, increased risk of neurologic symptoms with normal blood lithium level
meperidine: Increased metabolism and decreased effects of meperidine, possibly meperidine toxicity
methadone: Possibly increased metabolism of methadone and withdrawal symptoms neuromuscular blockers: Shorter duration of action and decreased effects of neuromuscular blockers
oral anticoagulants: Decreased metabolism and increased effects of phenytoin; early increase and then decrease in anticoagula-tion
paroxetine: Decreased bio availability of both drugs
phenylbutazone, salicylates: Increased phenytoin effects, possibly phenytoin toxicity primidone: Increased primidone effects, possibly primidone toxicity rifampin: Increased hepatic metabolism of phenytoin
valproic acid: Possibly decreased phenytoin metabolism, resulting in increased phenytoin effects; possibly decreased blood valproic acid level
vitamin D: Possibly decreased vitamin D effects, resulting in rickets or osteomalacia (with long-term use of phenytoin)
Activities
alcohol use: Additive CNS depression, increased phenytoin clearance
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Drugs Adverse Reactions
Central Nervous System: Ataxia, confusion, depression, dizziness, drowsiness, excitement, fever, headache, involuntary motor activity, lethargy, nervousness, peripheral neuropathy, restlessness, slurred speech, suicidal ideation, tremor, weakness
Cardiovascular: Cardiac arrest, hypotension, vasculitis
Eyes, Ears, Nose, And Throat: Amblyopia, conjunctivitis, diplopia, earache, epistaxis, eye pain, gingival hyper-plasia, hearing loss, loss of taste, nystagmus, pharyngitis, photophobia, rhinitis, sinusitis, taste perversion, tinnitus
Endocrine: Gynecomastia, hyperglycemia
Gastrointestinal: Abdominal pain, anorexia, constipation, diarrhea, epigastric pain, hepatic dysfunction, hepatic necrosis, hepatitis, nausea, vomiting
Genitourinary: Glycosuria, priapism, renal failure
Hematologic: Acute intermittent porphyria (exacerbation), agranulocytosis, anemia, eosinophilia, leukopenia, pancytopenia, thrombocytopenia
Musculoskeletal: Arthralgia, arthropathy, bone fractures, muscle twitching, osteomalacia, polymyosi-tis
Respiratory: Apnea, asthma, bronchitis, cough, dyspnea, hypoxia, increased sputum production, pneumonia, pneumothorax, pulmonary fibrosis
Skin: Exfoliative dermatitis, jaundice, maculopapular or morbilliform rash, purpuric dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, unusual hair growth, urticaria
Other: Facial feature enlargement, injection site pain, lupus-like symptoms, lymphadenopathy, polyarteritis, weight gain or loss
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Nursing Considerations for Generic Drugs
WARNING Patients of Asian ancestry who have the genetic allelic variant HLA-B 1502 develop serious and sometimes fatal dermatologic reactions ten times more often than people without this variant when given carbamazepine, another antiepileptic drug. Because early data suggest a similar effect with phenytoin, this drug shouldn't be used as a substitute for carbamazepine in these patients.
• Be aware that preferred administration routes for phenytoin are oral and intravenous injection. With intramuscular administration, phenytoin has a variable absorption rate.
• If patient has difficulty swallowing, open prompt (rapid-release) capsules and mix contents with food or fluid.
• Shake oral suspension before measuring dose, and use a calibrated measuring device.
• To minimize gastrointestinal distress, give phenytoin with or just after meals.
• Inspect intravenous form for particles and discoloration before administering.
WARNING Avoid rapid intravenous injection because it may cause cardiac arrest, CNS depression, or severe hypotension.
• To decrease vein irritation, follow intravenous injection with flush of sodium chloride for injection through same intravenous catheter.
• Continuously monitor electrocardiogram tracings and blood pressure when administering intravenous phenytoin.
• Frequently assess intravenous site for signs of extravasation because drug can cause tissue necrosis.
Instruct patient to avoid taking antacids or calcium products within 2 hours of phenytoin.
Urge patient to avoid alcohol during therapy.
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Phenytoin
Preparations
International Brand Drug Names
The information about drugs (tablets, pills, capsules, creams, solution, nasal spray, inhaler) around the world.
British Pharmacopoeia, 2008 edition: Phenytoin Capsules; Phenytoin Injection; Phenytoin Oral Suspension; Phenytoin Tablets;
The United States Pharmacopeia 31, 2008: Extended Phenytoin Sodium Capsules; Phenytoin Oral Suspension; Phenytoin Sodium Injection; Phenytoin Tablets; Prompt Phenytoin Sodium Capsules.
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