Phenytoin, one of the older anticonvulsant drugs in the market, has an FDA Warning, multiple drug interactions, and oral side effects dentists should be aware of. Build your knowledge by reading on:
Generic Name: Phenytoin
Brand Name(s): Dilantin Infatabs, Dilantin, Phenytek
Pronunciation: FEN i toyn
About this drug:
Phenytoin is used for the treatment of tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures.
It is also used in the prevention and treatment of seizures occurring during or following neurosurgery.
Dentistry-related tidbits:
Phenytoin may cause xerostomia. Consider prescribing a fluoride supplement if the patient has a high rate of caries and increasing the frequency of dental exams.
Phenytoin may cause gingival overgrowth and taste changes. Advise the patient to brush and floss teeth regularly.
Patients should avoid drinking Alcohol when taking Phenytoin as this combination may increase the levels of Phenytoin and the risk of liver problems, respiratory and CNS depression, and diminished psychomotor function. Drinking Alcohol daily may also decrease Phenytoin levels and increase risk of seizures.
Narcotics, benzodiazepines, muscle relaxants, anticonvulsants, and other sedating medications in combination with Phenytoin may increase the risk of respiratory, CNS depression, or psychomotor function.
Monitor heart rate when administering Articaine, Bupivacaine, Lidocaine, Mepivacaine, or Ropivacaine to a patient taking Phenytoin, as the combination may increase the risk of bradycardia and methemoglobinemia.
The analgesic/antipyretic Acetaminophen in combination with Phenytoin may increase Acetaminophen toxicity. Limit Acetaminophen dose to less than 2000 mg/day to decrease risk of liver problems.
The NSAIDs Celecoxib and Diclofenac in combination with Phenytoin may increase NSAID levels and increase the risk of GI and other serious bleeding. Before prescribing any medication, use the Rx Check tool to prevent potential drug interactions or adverse effects.
Fun facts:
Phenytoin blocks the voltage-dependent sodium channels which decreases the neurons' firing rate.
This medication’s FDA Warning informs the risk of hypotension and cardiac arrhythmias is increased when IV infusion rate exceeds 50 mg/min in adults or 1-3 mg/kg/min (or 50 mg/min, whichever is slower) in pediatric patients.
Phenytoin is listed on the World Health Organization’s List of Essential Medicines.
Patients taking birth control pills must use a backup non-hormonal method of birth control as Phenytoin may decrease the contraceptive efficacy.
Combining Marijuana with Phenytoin may increase Phenytoin levels and toxicity and may increase the risk of CNS depression and diminished psychomotor function.
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