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Phenytoin

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A commonly used antiepilepsy medication (Dilantin™).

Phenytoin, formerly known as diphenylhydantoin, is perhaps the most commonly used major anticonvulsant agent.

Liver safety of Phenytoin

It is a rare but well known cause of acute idiosyncratic drug induced liver disease that can be severe and even fatal.

Mechanism of action of Phenytoin

Phenytoin (fen' i toyn) is a hydantoin derivative that has potent anti-seizure activity that is believed to be based upon stablization of neuronal membranes caused by an increase in the efflux and decrease in the influx of sodium ions across GABA regulated sodium channels.  A similar action in cardiac muscle may account for its activity against ventricular arrhythmias. 

FDA approval information for Phenytoin

Phenytoin was first approved for use in the United States in 1946, and currently more than 3 million prescriptions are filled yearly. 

Clinical use of Phenytoin

Current indications for phenytoin are treatment and prevention of generalized tonic-clonic (grand mal) seizures and complex partial seizures and management of status epilepticus.  It is now rarely used to suppress ventricular arrhythmias in patients unresponsive to lidocaine. 

Dosage and administration for Phenytoin

Phenytoin is available generically in oral and parenteral formulations.  Oral forms include tablets and capsules of 100 to 300 mg, including extended release formations for once daily dosing. 

Brand name for Phenytoin

Commercial names include Dilantin.  Chewable tablets and oral suspensions are available for pediatric use. 

Dosage and administration for Phenytoin

The recommended dose of phenytoin for chronic use is 100 mg three times daily.  Common side effects include dizziness, ataxia, nausea, gum hyperplasia and rash (which can occur in 10% of patients).  Phenytoin has major effects on metabolism of other medications, and patients should be provided specific advice about other medications that can be used during long term phenytoin therapy.

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