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Phenytoin
From WikEM
(Redirected from Dilantin)
Contents
General
- Type: Anticonvulsants
- Dosage Forms: capsules 50, 100, 200, 300 125/5 mL IM/IV
- Common Trade Names: Dilantin, Phenytek
Adult Dosing
Status epilepticus
- Loading dose: 15-20mg/kg IV; if ineffective, can give 10mg/kg IV 20 min after first dose
- Maintenance dose: 100mg PO/IV q 6-8hrs
- Start 12 hours after loading dose
Seizure disorder
- 300-400mg/day divided into 2-3 doses/day (Max 400mg/dose)
- May give 4-7mg/kg/day divided into 2-3 doses/day
- Consider loading dose: 15-20mg/kg divided into 2-3 doses given 2-4 hrs apart
- Adjust dose on response and serum levels
- Available in extended or immediate release
Seizure prophylaxis (neurosurgery)
- Loading dose: 10-20mg/kg IV in 3 doses 2-4 hrs apart (max 400mg/dose)
- 4-6mg/kg/day IV divided into 2-3 doses/day
- Can give IM route, though IV prefered
- 100-200mg IM q 4 hrs x 1 week
- 150% PO dose by IM route if previously on medication
Pediatric Dosing
Status epilepticus
- Loading dose: 15-20mg/kg IV; if ineffective, can give 10mg/kg IV 20 min after first dose
- Max 1500mg/day
- Start maintenance 12 hrs after loading dose
Seizure disorder
All doses are divided into 2-3 doses/day; always start at 5mg/kg/day and titrate based on effect and serum levels
- <6 mo: 5-8mg/kg/day PO/IV
- 6mo-4 yrs: 8-10mg/kg/day PO/IV
- 4-7yrs: 7.5-9mg/kg/day PO/IV
- 7-10 yrs: 7-8mg/kg/day PO/IV
- 10-16 yrs: 6-7mg/kg/day PO/IV
- >16 yrs use adult dosing
- For immediate release. Extended release available for ages >7 at same dosages.
Special Populations
- Pregnancy Rating: D
- Lactation: Likely safe; limited information. Use caution.
- Renal Dosing
- Adult: No oral loading regimen
- Pediatric: No adjustment
- Hepatic Dosing
- Adult: No oral loading regimen
- Pediatric: Decrease dose, amount not defined
Contraindications
- Allergy to class/drug
- Sinus brady/SA block/2nd-3rd AV block
- Adams-Stokes syndrome
- Avoid abrupt withdrawl
- Caution:
- CV disease
- Hypotension
- Alcohol use
- HLA-B 1502 positive
- Renal impairment
- Hepatic impairment
- Porphyria
- Diabetes mellitus
- Thyroid disease
- Depression
- Elderly
Adverse Reactions
See phenytoin toxicity for overdose
Toxicity symptoms by phenytoin level^
Level | Sypmtoms |
>10 | Usually no symptoms |
10-20 | Occasional mild nystagmus |
20-30 | Nystagmus |
30-40 | Ataxia, slurred speech, Nausea/vomiting |
40-50 | Lethargy, confusion |
>50 | Coma, seizure (rare) |
^Provides a rough guide only; neither sensitive nor specific
Serious
- V-Fib (IV)
- Hypotension (IV)
- CV collapse (IV)
- AV conduction disturbance (IV)
- Hepatotoxicity
- Thrombocytopenia
- Leukopenia
- Agranulocytosis
- Pancytopenia
- Megaloblastic anemia
- Stevens-Johnson syndrome
- Toxic epidermal necrolysis
- Drug rash (with eosinophilia)
- Tissue necrosis (IV)
- Purple glove syndrome (IV)
- Anaphylaxis
- Lymphoma
- Lupus
- Osteomalacia
- Toxic delirium
- SI
- Periarteritis nodosa
- Withdrawal seizures with abrupt discontinuation
Common
- Nausea/vomiting
- Rash
- Nystagmus
- Ataxia
- Slurred speech
- Dizziness
- Confusion
- Paresthesia
- Blurred vision
- Somnolence
- Constipation
- headache
- Insomnia
- Gingival hyperplasia
- Tremor
- Lymphadenopathy
- Coarse facies
- Hyperglycemia
- Osteomalacia
- Phlebitis (IV)
- Peyronie disease
- Taste change
Pharmacology
- Half-life: 7-42 hrs
- Metabolism: liver; CYP450: 2C9 and 2C19
- Excretion: bile and urine
- Mechanism of Action: effects neuronal voltage-dependent NA and CA channels
See Also
References
- Epocrates
- Medscape