LYCOS RETRIEVER 
Phenytoin
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Phenytoin is a first-line agent for treating partial and generalized tonic-clonic (grand mal) seizures. It is ... one of the main agents used with patients who present with status epilepticus. Phenytoin drug levels need to be monitored with laboratory testing. The therapeutic concentration recommended is between 10-20mg/L. In addition, liver function testing and a complete blood count (CBC) need to be followed. Phenytoin has many interactions with other medications, and its own level can fluctuate when other drugs are taken.
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Phenytoin hypersensitivity syndrome (PHS) is a reaction which typically develops within 3 weeks to three months after initiation of treatment with phenytoin (1-5). It is characterized by fever, exanthems that range from acneiform to erythema multiforme major, lymphadenopathy, and eosinophilia (1-5). In addition, patients may develop hepatitis and acute renal failure. There is no age or sex predilection. However the black population appears to be at increased risk for developing this syndrome (5, 6 ). First order relatives of patients who have experienced this reaction have ... been reported to have an increased risk (5- 7 ).
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Phenytoin has complex effects on the immune system. Phenytoin suppresses cytotoxic activities of cells such as natural killer (NK) cells and cytotoxic T lymphocytes (CTL), but not lymphokine-activated killer (LAK) cells.[54] Phenytoin treatment preferentially induces a Th2-type response.[55] Phenytoin ... significantly depresses interferon augmentation of NK cell cytotoxicity in a dose-dependent manner.[56] Phenytoin suppresses the production of cortisol. Specifically, phenytoin induces the liver cytochrome P450 enzyme system and stimulates steroid clearance.[57] It can also induce adrenal suppression. These effects may partially explain the side effects of phenytoin, which are forms of immune dysfunction.
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Phenytoin has a volume of distribution of 0.6 L/kg and is extensively bound to plasma proteins (90%). Blood levels of phenytoin reflect only total serum concentration of the drug. Only the free unbound phenytoin has biological activity.
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Patients who have received no previous treatment may be started on one 100 mg Phenytoin (Extended Phenytoin Sodium Capsule) three times daily and the dosage then adjusted to suit individual requirements. For most adults, the satisfactory maintenance dosage will be one capsule three to four times a day. An increase up to two capsules three times a day may be made, if necessary.
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Each Dilantin— Extended Phenytoin Sodium Capsule, USP—contains 30 mg or 100 mg phenytoin sodium, USP. Also contains lactose, NF; confectioner's sugar, NF; talc, USP; and magnesium stearate, NF. The capsule shell and band contain colloidal silicon dioxide, NF; FD&C red No. 3; gelatin, NF; glyceryl monooleate; sodium lauryl sulfate, NF. The Dilantin 30-mg capsule shell and band ... contain citric acid, USP; FD&C blue No. 1; sodium benzoate, NF; titanium dioxide, USP. The Dilantin 100-mg capsule shell and band also contain FD&C yellow No. 6; purified water, USP; polyethylene glycol 200. Product in vivo performance is characterized by a slow and extended rate of absorption with peak blood concentrations expected in 4 to 12 hours as contrasted to Prompt Phenytoin Sodium Capsules, USP with a rapid rate of absorption with peak blood concentration expected in 1½ to 3 hours.
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Phenytoin