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.

Anticonvulsants

Generic Name / Brand Name Liver Toxicity Score Approval Year Major Indications
Brivaracetam / Briviact E 2016 Partial seizures
Carbamazepine / Tegretol A 1968 Partial, mixed and generalized seizures, trigeminal neuralgia
Clobazam / Onfi E 2011 Seizures assocated with Lennox-Gastaut syndrome
Clonazepam / Klonopin D 1975 Absence and myoclonic seizures, anxiety and panic disorders
Clorazepate / Tranxene E 1972 Partial seizures, anxiety disorders, and alcohol withdrawal
Diazepam / Valium E 1963 Convulsions, anxiety disorders, muscle spasms
Eslicarbazepine / Aptiom D 2013 Partial seizures
Ethosuximide / Zarontin E 1960 Absence seizures
Ezogabine / Potiga E 2011 Partial seizures
Felbamate / Febatol B 1993 Refractory or severe epilepsy
Fosphenytoin / Cerebyx A 1996 Tonic-clonic seizures, status epilepticus
Gabapentin / Neurontin C 1993 Partial seizures, post-herpetic neuralgia
Lacosamide / Vimpat D 2008 Partial seizures
Lamotrigine / Lamictal B 1994 Partial and generalized tonic-clonic seizures, bipolar disorder
Levetiracetam / Keppra C 1999 Partial, generalized tonic-clonic, and myoclonic seizures
Methsuximide / Celontin E 1957 Absence seizures
Oxcarbazepine / Trileptal D 2000 Partial seziures
Perampanel / Fycompa E 2012 Partial and generalized tonic-clonic seizures
Phenobarbital / Luminal A 1916 Partial and generalized seizures, anxiety, and irritable bowel syndrome
Phenytoin / Dilantin A 1938 Generalized tonic-clonic and partial onset seizures, status epilepticus
Pregabalin / Lyrica C 2004 Partial seizures, fibromyalgia, and neuropathic pain
Primidone / Mysoline E 1954 Partial and generalized tonic-clonic seizures
Rufinamide / Banzel E 2008 Seizures associated with Lennox-Gastaut syndrome
Tiagabine / Gabitril E 1997 Partial seizures
Topiramate / Topamax C 1996 Partial and generalized tonic-clonic seizures, migraine headaches
Valproate / Depakene A 1978 Absence and complex partial seizures
Vigabatrin / Sabril D 2009 Refractory, complex partial seizures, and infantile spasms
Zonisamide / Zonegran D 2000 Partial seizures

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