LYCOS RETRIEVER 
Phenytoin: Drugs
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Phenytoin metabolism is dose dependent. Elimination follows first-order kinetics (fixed percentage of drug metabolized during a per unit time) at the low drug concentrations and zero-order kinetics (fixed amount of drug metabolized per unit time) at higher drug concentrations. This change in kinetics reflects the saturation of metabolic pathways. Thus, very small increments in dosage may result in adverse effects.
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Phenytoin sodium is an antiepileptic drug. Phenytoin sodium is related to the barbiturates in chemical structure, but has a five-membered ring. The chemical name is sodium 5,5-diphenyl-2, 4-imidazolidinedione, having the following structural formula:
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Phenytoin causes a hypersensitivity syndrome that manifests with fever, rash, and lymphadenopathy.[100] Its incidence is one in 1,000-10,000 exposures. It is ... seen with other aromatic antiepileptic drugs: carbamazepine, phenobarbital, and primidone, with frequent cross-sensitivity.[101] Hypersensitivity syndrome usually occurs 2-8 weeks after initiation of therapy. In one case, hypersensitivity syndrome stimulated the reactivation of human herpesvirus 6.[102] A report notes reactivation of cytomegalovirus.[103]
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Phenytoin should be discontinued if a skin rash appears (see WARNINGS regarding drug discontinuation). If the rash is exfoliative, purpuric, or bullous or if lupus erythematosus, Stevens-Johnson syndrome, or toxic epidermal necrolysis is suspected, use of this drug should not be resumed and alternative therapy should be considered. (See ADVERSE REACTIONS.) If the rash is of a milder type (measles-like or scarlatiniform), therapy may be resumed after the rash has completely disappeared. If the rash recurs upon reinstitution of therapy, further phenytoin medication is contraindicated.
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Phenytoin has been associated with drug induced gingival enlargement in the oral cavity. Plasma concentrations needed to induce gingival lesions has not been clearly defined. Effects consist of the following: bleeding upon probing, increased gingival exudate, pronounced gingival inflammatory response to plaque levels, associated in some instances with bone loss but without tooth detachment.
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Phenytoin is one of the most widely-prescribed drugs used to treat epilepsy. The anti-convulsant is associated with a drug hypersensitivity reaction resulting in the need for drug monitoring. Skin rashes often appear at the onset of adverse drug reactions.
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