LYCOS RETRIEVER 
Phenytoin: Patients
built 618 days ago
Phenytoin is one of the most widely prescribed anticonvulsants. It is ... used occasionally as a myocardial anti-arrhythmic. Phenytoin levels are measured to ensure appropriate therapeutic levels are maintained. Due to a narrow therapeutic index, plus wide individual variability in the rate of phenytoin metabolism and clearance, therapeutic drug monitoring is essential during treatment with phenytoin. Insufficient levels may lead to inadequate symptom management, while excess levels can lead to dangerous toxicity. Patients of the BC Cancer Agency may be receiving phenytoin therapy for a variety of symptoms.
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Phenytoin is useful in generalized tonic-clonic, complex partial, and simple partial seizures and frequently is chosen for initial therapy, particularly in adults. Because of phenytoin's potential adverse reactions (hirsutism, gingival hyperplasia, coarsening of facial features), other antiepileptic drugs are often prescribed for infants and young children. Phenytoin is commonly given with phenobarbital, primidone, carbamazepine, or valproate when monotherapy fails. It is ineffective in absence, myoclonic, and atonic seizures and is not recommended for the treatment of infantile spasms, Lennox-Gastaut syndrome, and epileptic syndromes in older children and adolescents when absence seizures or myoclonus is present. Intravenous phenytoin sodium is effective for status epilepticus and can be used as the initial drug to manage recurrent seizures if they are widely spaced. This drug ... may prevent seizures initially in high-risk patients with head trauma.
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Phenytoin may produce changes in the normal makeup of the blood, including high blood sugar levels and anemia. It may trigger disorders of the lymphatic system and cause liver damage. If the liver is not able to properly break down phenytoin, it can produce toxic effects, even at small doses. Doctors typically assess kidney and liver function prior to ordering it. The tests are repeated at regular intervals. Patients should notify the doctor promptly of any side effects. If a skin rash develops, the doctor will instruct the patient how to taper off and stop the drug.
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Phenytoin's metabolism may be affected by other drugs. Drugs that can reduce the amount of phenytoin in the body include rifampin and phenobarbital. Drugs that increase phenytoin concentrations include amiodarone, chloramphenicol, cimetidine, disulfiram, fluconazole, fluoxetine, isoniazid (INH), omeprazole, and paroxetine. Thus, measuring levels of phenytoin in the blood may be necessary when patients begin or discontinue other medications.
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Phenytoin was tried in the treatment of gluteal abscesses secondary to intramuscular injection by Lodha et al. [16]. The control patients were treated with eusol (15 %) and urea solution (4 %). The same degree of reduction in wound area was achieved in the phenytoin group at 10 days and in the control group at day 20.
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Phenytoin increases the clearance of busulfan by 15% or more, possibly due to the induction of glutathione-S-transferase. Since the pharmacokinetics of BUSULFEX were studied in patients treated with phenytoin, the clearance of BUSULFEX at the recommended dose may be lower and exposure (AUC) higher in patients not treated with phenytoin. Because busulfan is eliminated from the body via conjugation with glutathione, use of acetaminophen prior to (<72 hours) or concurrent with BUSULFEX may result in reduced busulfan clearance based upon the known property of acetaminophen to decrease glutathione levels in the blood and tissues.
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