phenytoin (Intravenous route)

FEN-i-toin

Commonly used brand name(s):

In the U.S.

• Dilantin

Available Dosage Forms:

• Kit
• Solution

Therapeutic Class: Anticonvulsant

Chemical Class: Hydantoin (class)

Uses For phenytoin

Phenytoin injection is used to control seizures (convulsions) in the treatment of epilepsy. It is also used to prevent and treat seizures that occur during brain surgery. phenytoin is an anticonvulsant that works in the brain tissue to stop seizures.

phenytoin is available only with your doctor's prescription.

Before Using phenytoin

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For phenytoin, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to phenytoin or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of phenytoin injection in children.

Geriatric

No information is available on the relationship of age to the effects of phenytoin injection in geriatric patients. However, elderly patients are more likely to have age-related liver, kidney, or heart problems, which may require an adjustment in the dose for patients receiving phenytoin injection.

Pregnancy

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medicines

Using phenytoin with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

• Ranolazine

Using phenytoin with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Apazone
• Beclamide
• Dasatinib
• Delavirdine
• Dronedarone
• Erlotinib
• Etravirine
• Imatinib
• Irinotecan
• Ixabepilone
• Lapatinib
• Lidocaine
• Lopinavir
• Maraviroc
• Nilotinib
• Posaconazole
• Romidepsin
• St John's Wort
• Sunitinib
• Tacrolimus
• Temsirolimus
• Tolvaptan
• Voriconazole

Using phenytoin with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Acetaminophen
• Acetazolamide
• Acyclovir
• Amiodarone
• Amitriptyline
• Amprenavir
• Aprepitant
• Atorvastatin
• Betamethasone
• Bexarotene
• Busulfan
• Capecitabine
• Carbamazepine
• Caspofungin
• Chloramphenicol
• Cimetidine
• Ciprofloxacin
• Cisplatin
• Clarithromycin
• Clobazam
• Clofazimine
• Clopidogrel
• Clozapine
• Colesevelam
• Cortisone
• Cyclosporine
• Dexamethasone
• Diazepam
• Dicumarol
• Digitoxin
• Diltiazem
• Disopyramide
• Disulfiram
• Doxepin
• Doxorubicin Hydrochloride
• Ethinyl Estradiol
• Ethosuximide
• Etonogestrel
• Everolimus
• Felbamate
• Fentanyl
• Fluconazole
• Fludrocortisone
• Fluorouracil
• Fluoxetine
• Fluvoxamine
• Folic Acid
• Fosamprenavir
• Gefitinib
• Ginkgo
• Ibuprofen
• Imipramine
• Isoniazid
• Itraconazole
• Levodopa
• Levomethadyl
• Levonorgestrel
• Levothyroxine
• Mestranol
• Methoxsalen
• Methsuximide
• Miconazole
• Midazolam
• Nafimidone
• Nelfinavir
• Nifedipine
• Nilutamide
• Nisoldipine
• Norelgestromin
• Norethindrone
• Norgestrel
• Oxcarbazepine
• Paclitaxel
• Pancuronium
• Paroxetine
• Phenprocoumon
• Piperine
• Praziquantel
• Prednisolone
• Prednisone
• Progabide
• Quetiapine
• Quinidine
• Remacemide
• Rifampin
• Rifapentine
• Risperidone
• Ritonavir
• Rufinamide
• Sabeluzole
• Saquinavir
• Sertraline
• Shankhapulshpi
• Simvastatin
• Sirolimus
• Sulfamethizole
• Sulfaphenazole
• Sulthiame
• Telithromycin
• Tenidap
• Theophylline
• Tiagabine
• Ticlopidine
• Ticrynafen
• Tirilazad
• Tizanidine
• Tolbutamide
• Topiramate
• Trazodone
• Triamcinolone
• Trimethoprim
• Tubocurarine
• Valproic Acid
• Vecuronium
• Verapamil
• Vigabatrin
• Viloxazine

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Using phenytoin with any of the following may cause an increased risk of certain side effects but may be unavoidable in some cases. If used together, your doctor may change the dose or how often you use phenytoin, or give you special instructions about the use of food, alcohol, or tobacco.

• Ethanol

Other Medical Problems

The presence of other medical problems may affect the use of phenytoin. Make sure you tell your doctor if you have any other medical problems, especially:

• Diabetes or
• Heart failure or
• Heart rhythm problems or
• Hypotension (low blood pressure) or
• Lymphadenopathy (lymph node problems)—Use with caution. May make these conditions worse.

• Heart block (e.g., Adams-Stokes syndrome, AV block, or sinoatrial block) or
• Sinus bradycardia (slow heartbeat)—Should not be used in patients with these conditions.

• Kidney disease or
• Liver disease—Use with caution. The effects may be increased because of slower removal from the body.

Proper Use of phenytoin

A nurse or other trained health professional will give you phenytoin in a hospital. phenytoin is given as a shot into one of your muscles or through a needle placed in one of your veins.

Your doctor will only give you a few doses of phenytoin until your condition improves. You will be switched to an oral medicine that works the same way. If you have any concerns about this, talk to your doctor.

Precautions While Using phenytoin

It is very important that your doctor check your progress closely while you are using phenytoin to see if it is working properly and to allow for a change in the dose. Blood tests may be needed to check for any unwanted effects.

Using phenytoin while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away. Do not breastfeed while you are using phenytoin.

Lymph node problems may occur while using phenytoin. Check with your doctor right away if you have swollen, painful, or tender lymph glands in your neck, armpit, or groin.

phenytoin may cause severe tenderness and pain at the site of the injection. Contact your doctor right away if you notice any of these side effects at the injection site: bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth.

Do not stop taking phenytoin without first checking with your doctor. Your doctor may want you to gradually reduce the amount you are using before stopping completely.

If you develop a skin rash, hives, or any allergic reaction to phenytoin, stop taking the medicine and check with your doctor as soon as possible.

phenytoin may affect blood sugar levels. If you notice a change in the results of your blood or urine sugar tests or if you have any questions, check with your doctor.

Liver problems may occur while you are using phenytoin. Stop using phenytoin and check with your doctor right away if you are having more than one of these symptoms: abdominal pain or tenderness; clay-colored stools; dark urine; decreased appetite; fever; headache; loss of appetite; nausea and vomiting; skin rash; swelling of the feet or lower legs; unusual tiredness or weakness; or yellow eyes or skin.

If you develop any unusual or strange thoughts and behavior while receiving phenytoin injection, be sure to discuss it with your doctor. Some changes that have occurred in people receiving phenytoin are like those seen in people who drink too much alcohol. Other changes might be confusion, worsening of depression, hallucinations (seeing, hearing, or feeling things that are not there), suicidal thoughts, and unusual excitement, nervousness, or irritability.

Avoid drinking alcohol while you are receiving phenytoin.

Before you have any medical tests, tell the medical doctor in charge that you are taking phenytoin. The results of some tests may be affected by phenytoin.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

phenytoin Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor or nurse immediately if any of the following side effects occur:

• Chest pain or discomfort
• cold, clammy, or pale skin
• decreased coordination
• difficulty with sleeping
• disorientation
• dizziness
• drowsiness to profound coma
• fainting
• fast, slow, or irregular heartbeat
• hallucination
• headache
• lightheadedness
• measles-like skin rash
• mood or other mental changes
• nausea
• nervousness
• pain in the shoulders, back, neck, or jaw
• shakiness and unsteady walk
• shortness of breath
• slow heart rate
• slurred speech
• sweating
• swelling of the feet and lower legs
• troubled breathing
• uncontrolled eye movements
• unsteadiness, trembling, or other problems with muscle control or coordination
• unusual tiredness or weakness

• Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
• blistering, crusting, irritation, itching, peeling, or reddening of the skin
• cracked, dry, or scaly skin
• inability to move the eyes
• increased blinking or spasms of the eyelid
• shakiness in the legs, arms, hands, or feet
• sticking out of the tongue
• trouble with breathing, speaking, or swallowing
• twitching, uncontrolled movements of the tongue, lips, face, neck, trunk, arms, or legs
• unusual facial expressions

• Abdominal or stomach pain
• bleeding gums
• blisters, hives, or itching
• bloating of the abdomen or stomach
• blood in the urine or stools
• bloody, black, or tarry stools
• blurred vision
• break in the skin, especially associated with blue-black discoloration, swelling, or drainage of fluid
• burning, numbness, tingling, or painful sensations
• chills
• cough or hoarseness
• dark urine
• diarrhea
• dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
• fainting spells
• fever with or without chills
• general feeling of discomfort or illness
• general feeling of tiredness or weakness
• hair loss
• high fever
• irritation in the mouth
• joint or muscle pain
• light-colored stools
• loss of appetite
• loss of heat from the body
• lower back or side pain
• muscle or joint pain
• painful or difficult urination
• pale skin
• pinpoint red spots on the skin
• red skin lesions, often with a purple center
• red, irritated eyes
• red, swollen skin
• redness and swelling of the gums
• skin rash
• sore throat
• soreness of the muscles
• sores, ulcers, or white spots on the lips or in the mouth
• sweating
• swollen glands
• swollen, painful, or tender lymph glands in the neck, armpit, or groin
• unexplained bleeding or bruising
• unsteadiness or awkwardness
• unusual bleeding or bruising
• weakness in the arms, hands, legs, or feet
• weight loss
• yellow eyes or skin

Get emergency help immediately if any of the following symptoms of overdose occur:

• Change in consciousness
• changes in patterns and rhythms of speech
• loss of consciousness
• pounding in the ears
• unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

• Sleeplessness
• unable to sleep

• Difficulty having a bowel movement (stool)
• enlarged lips
• increased hair growth on the forehead, back, arms, and legs
• pain of the penis on erection

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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