LYCOS RETRIEVER 
Phenytoin
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Phenytoin should not be taken by patients who are allergic to this drug. People with slow heart rates, certain other heart conditions, or a flaking, open skin condition ... should not take it. Phenytoin may be used cautiously for patients with asthma, allergies, limited kidney or liver function, heart disease, and blood disorders. It also should be used with caution in those with alcoholism, diabetes mellitus, lupus, poor thyroid function, or porphyria, a rare metabolic disorder. Pregnant women should discuss the risks and benefits of this medication with the doctor. It has been associated with birth defects and possibly cancer in children born to women taking the drug; one study done in 2003 suggests that phenytoin interferes with the normal development of the baby's blood circulation. Expectant mothers who are taking it to prevent seizures should not abruptly stop the drug.
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Phenytoin (Dilantin®) [W]as first used in the late 1930s. It has become one of the more commonly used agents and often is considered the first-line drug to treat seizures. It is thought to work by suppressing electrical activity in brain nerve cells. It can be given orally or intravenously (IV), and a newer form of the drug, fosphenytoin (Cerebryx®) can be injected into muscle. The oral form has the benefit of once-a-day dosing.
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Phenytoin crosses the placenta. Congenital malformations (including a pattern of malformations termed the “fetal hydantoin syndrome” or “fetal anticonvulsant syndrome”) have been reported in infants. Isolated cases of malignancies (including neuroblastoma) and coagulation defects in the neonate following delivery have ... been reported. Epilepsy itself, the number of medications, genetic factors, or a combination of these probably influence the teratogenicity of anticonvulsant therapy. Total plasma concentrations of phenytoin are decreased by 56% in the mother during pregnancy; unbound plasma (free) concentrations are decreased by 31%. Because protein binding is decreased, monitoring of unbound plasma concentrations is recommended.
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Phenytoin comes as a capsule, extended-release (long-acting) capsule, chewable tablet, and liquid to take by mouth. It usually is taken two or three times a day. However, the extended-release capsules may be taken only once a day, usually at bedtime. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take phenytoin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
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Phenytoin induced mutations in Salmonella typhimurium in the presence of a metabolic activation system in one study. No mutagenic effect was observed in Drosophila or in mammalian cells in vitro in the absence of an exogenous metabolic system. Aneuploidy was induced in one study in primary mouse embryonic fibroblasts in vitro. Cell transformation was induced in Syrian hamster embryo. A single study showed increased clone sizes of murine macrophages in a host-mediated assay. Phenytoin inhibited gap-junctional intercellular communication.
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Phenytoin has been investigated as a treatment for more than 100 diseases. A Medline search in November of 2002 showed that 12,860 articles concerning it have been published since 1966. In dermatology, phenytoin has been investigated to treat ulcers, epidermolysis bullosa, and inflammatory conditions. Numerous allergic, and proliferative, idiosyncratic cutaneous side effects have been reported with its use.[1] This review summarizes its uses, mechanisms, and cutaneous side effects.
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Phenytoin