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Dilantin

Anticonvulsants, Surgery Dilantin (Generic) Generic drugs, marketed without brand names, contain the exact same active ingredients used in their brand-name counterparts, but cost significantly less. The drugs are required to meet US Food and Drug Administration (FDA) standards for safety, purity and effectiveness.
Dilantin

Tonic-clonic seizures, sometimes known as grand mal seizures, and partial seizures can both be treated with generic Dilantin. It is also used to treat and prevent seizures that may develop during or after surgical procedures involving the brain or nervous system.

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Generic Dilantin: A Comprehensive Overview

Introduction

Generic Dilantin, known generically as phenytoin, is a widely used anticonvulsant medication primarily prescribed to manage and prevent seizures in individuals with epilepsy. It is also used in the treatment of certain types of neuralgia and as a prophylactic agent in neurosurgical procedures. Phenytoin has been a cornerstone in the management of epilepsy for decades, offering effective seizure control for many patients. This article delves into the various aspects of generic Dilantin, including its mechanism of action, therapeutic uses, pharmacokinetics, side effects, contraindications, and important considerations for patients and healthcare providers.

Mechanism of Action

Phenytoin exerts its anticonvulsant effects primarily by stabilizing neuronal membranes and reducing the spread of seizure activity in the brain. It achieves this by inhibiting voltage-gated sodium channels, which are crucial for the generation and propagation of action potentials in neurons. By prolonging the inactivation state of these channels, phenytoin prevents the repetitive firing of neurons that is characteristic of seizure activity. This mechanism is particularly effective in controlling partial seizures and generalized tonic-clonic seizures.

In addition to its effects on sodium channels, phenytoin also influences calcium channels and enhances the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter. These additional actions contribute to its overall anticonvulsant efficacy.

Therapeutic Uses

  1. Epilepsy: Phenytoin is primarily used for the management of various types of epilepsy, including:

    • Partial Seizures: Seizures that originate in a specific area of the brain.

    • Generalized Tonic-Clonic Seizures: Seizures characterized by loss of consciousness and violent muscle contractions.

    • Status Epilepticus: A life-threatening condition where seizures occur in rapid succession without recovery in between. Phenytoin is often used as a second-line treatment after benzodiazepines.

  2. Neuralgia: Phenytoin is sometimes used to manage trigeminal neuralgia, a condition characterized by severe facial pain due to irritation of the trigeminal nerve.

  3. Neurosurgical Prophylaxis: Phenytoin may be administered prophylactically to prevent seizures in patients undergoing neurosurgical procedures.

Pharmacokinetics

Phenytoin exhibits complex pharmacokinetics that require careful monitoring to ensure therapeutic efficacy and avoid toxicity.

  1. Absorption: Phenytoin is absorbed slowly and variably from the gastrointestinal tract. The rate and extent of absorption can be influenced by factors such as food, formulation, and gastrointestinal motility.

  2. Distribution: Phenytoin is highly protein-bound, primarily to albumin. Only the unbound (free) fraction is pharmacologically active. Conditions that alter protein binding, such as hypoalbuminemia or the presence of other protein-bound drugs, can significantly affect phenytoin's activity.

  3. Metabolism: Phenytoin is metabolized primarily in the liver by the cytochrome P450 enzyme system, particularly CYP2C9 and CYP2C19. Its metabolism follows zero-order kinetics at therapeutic doses, meaning that a constant amount of the drug is metabolized per unit of time, rather than a constant fraction. This makes phenytoin particularly susceptible to dose-dependent toxicity.

  4. Excretion: The metabolites of phenytoin are excreted primarily in the urine. A small amount of unchanged drug is also excreted in the urine.

Dosage and Administration

The dosage of phenytoin must be individualized based on the patient's clinical response and serum drug levels. It is available in various formulations, including oral capsules, chewable tablets, and injectable solutions.

  1. Oral Administration: The typical starting dose for adults is 100 mg three times daily, with adjustments made based on serum levels and clinical response. The maintenance dose usually ranges from 300 to 400 mg per day.

  2. Intravenous Administration: For status epilepticus, phenytoin is administered intravenously at a dose of 15-20 mg/kg, infused at a rate not exceeding 50 mg/min to avoid cardiovascular complications.

  3. Therapeutic Drug Monitoring: Regular monitoring of serum phenytoin levels is essential to ensure therapeutic efficacy and avoid toxicity. The therapeutic range is generally 10-20 mcg/mL.

Side Effects

Phenytoin is associated with a range of side effects, some of which can be serious. Common side effects include:

  1. Central Nervous System: Dizziness, drowsiness, headache, and nystagmus.

  2. Gastrointestinal: Nausea, vomiting, and constipation.

  3. Dermatological: Skin rash, which can sometimes progress to more severe reactions such as Stevens-Johnson syndrome or toxic epidermal necrolysis.

  4. Hematological: Megaloblastic anemia, leukopenia, and thrombocytopenia.

  5. Hepatic: Elevated liver enzymes and, rarely, hepatitis.

  6. Endocrine: Hyperglycemia and altered thyroid function tests.

  7. Other: Gingival hyperplasia, coarsening of facial features, and hirsutism with long-term use.

Contraindications and Precautions

Phenytoin is contraindicated in patients with a known hypersensitivity to the drug or its components. It should be used with caution in patients with:

  1. Hepatic Impairment: Phenytoin metabolism may be reduced, increasing the risk of toxicity.

  2. Renal Impairment: Altered protein binding and excretion may affect drug levels.

  3. Cardiovascular Disease: Rapid intravenous administration can cause hypotension and arrhythmias.

  4. Pregnancy: Phenytoin is a known teratogen and can cause fetal hydantoin syndrome, characterized by craniofacial abnormalities, developmental delays, and other congenital defects.

Drug Interactions

Phenytoin is involved in numerous drug interactions due to its effects on hepatic enzymes and protein binding. Notable interactions include:

  1. Enzyme Inducers: Drugs such as rifampin and carbamazepine can increase phenytoin metabolism, reducing its efficacy.

  2. Enzyme Inhibitors: Drugs such as fluconazole and cimetidine can inhibit phenytoin metabolism, increasing the risk of toxicity.

  3. Protein-Bound Drugs: Drugs such as warfarin and valproic acid can displace phenytoin from protein binding sites, increasing the free fraction and potential for toxicity.

  4. Oral Contraceptives: Phenytoin can reduce the efficacy of hormonal contraceptives, increasing the risk of unintended pregnancy.

Patient Counseling and Education

Patients prescribed phenytoin should be counseled on the following:

  1. Adherence: Emphasize the importance of taking the medication exactly as prescribed to maintain therapeutic levels and prevent seizures.

  2. Monitoring: Regular blood tests are necessary to monitor serum phenytoin levels and liver function.

  3. Side Effects: Educate patients about potential side effects and the importance of reporting any unusual symptoms to their healthcare provider.

  4. Drug Interactions: Inform patients about the potential for drug interactions and the need to consult their healthcare provider before starting any new medications or supplements.

  5. Pregnancy and Breastfeeding: Advise women of childbearing age about the risks of phenytoin during pregnancy and the need for effective contraception. Discuss the risks and benefits of phenytoin use during breastfeeding.

Conclusion

Generic Dilantin (phenytoin) remains a vital medication in the management of epilepsy and other seizure disorders. Its well-established efficacy, coupled with its complex pharmacokinetics and potential for serious side effects, necessitates careful patient selection, dosing, and monitoring. Healthcare providers must be vigilant in managing drug interactions and educating patients to ensure safe and effective use. Despite the advent of newer anticonvulsants, phenytoin continues to play a crucial role in the therapeutic arsenal against epilepsy, offering hope and improved quality of life for many patients.

Phenytoin tablet What kind of medication is this? PHENYTOIN is a medication that can be used to manage seizures in patients who suffer from certain kinds of epilepsy. In addition, it can be used to prevent seizures before, during, or after medical procedures. Before I start using this medication, what should I discuss with my primary care physician? People have a right to know if you suffer from any of the following conditions: an alcohol misuse issue blood disorders or illness diabetes issues with the heart renal disease illness of the liver patients with porphyria who are undergoing radiation treatment suicidal ideation, suicidal planning, or suicidal behavior; a past attempt at suicide made by you or a member of your family illness of the thyroid a response that is unexpected or allergic to phenytoin, as well as other drugs, foods, colors, or preservatives breastfeeding women who are either pregnant or attempting to conceive a child What is the correct way to take this medication? This medication should be taken orally with a full glass of water. You may either chew it or swallow it whole. Always make sure to follow the instructions on the label of your medicine. If this medication causes stomach distress, it should be taken with meals. Always remember to space out your dosages evenly. Do not take your medication more frequently than recommended by the label. It is important not to stop taking this medication all of a sudden because doing so raises the chance of having seizures. Your physician will instruct you on the appropriate dosage for the medication. Should your physician decide that it is appropriate for you to stop taking the medication, the dosage will be reduced gradually over a period of time in order to prevent any unwanted effects. Have a discussion with your child's physician about the possibility of giving them this medication. There are some circumstances in which this medication may be administered, but there are also certain warnings associated with its use. In the event that you believe you may have taken an excessive amount of this medication, you should immediately contact a poison control center or an emergency facility. PLEASE TAKE NOTE That no one else should use this medication. It is important that others not use this medication. What should I do if I forget a dose? If you forget to take a dosage, you should take it as soon as you remember it. Take only that dose if it is getting close to the time for your next scheduled dose. Do not take duplicate or additional dosages. What other substances could react with this medication? It is not safe to use this medication with any of the following substances: delavirdine Moreover, the following substances might potentially interact with this medication: alcohol aspirin and drugs that are similar to aspirin medications containing barbiturates that are used to treat seizures or induce sleep calcium supplements carbamazepine medications such as chloramphenicol, chlordiazepoxide, cimetidine, and any number of others are available to treat stomach ulcers and heartburn. corticosteroid hormones such as prednisone or cortisone diazepam disulfiram doxycycline enteral feedings (liquid nutritional drinks or tube feeding liquids) ethosuximide female hormones, including those used in birth control tablets and other forms of contraception furosemide medications for mental disorders such as depression, anxiety, and other mood issues such as halothane and isoniazid Medications used to regulate the beat of the heart methsuximide methylphenidate molindone phenylbutazone reserpine rifampin, rifabutin, or rifapentine sucralfate sulfonamides like Azulfidine or Bactrim theophylline methylphenidate molindone phenylbutazone reserpine theophylline methylphenidate molindone pheny ticlopidine tolbutamide valproic acid vitamin D warfarin Inform your doctor or other health care provider about any additional medications you're taking, including over-the-counter or herbal remedies, even if they weren't prescribed to you. If you are a regular user of drinks that include caffeine or alcohol, if you smoke, or if you use illicit substances, you should also let your prescriber or another health care provider about this. This might have an impact on how well your medication works. Before you stop taking any of your medications or before you start taking any new ones, check in with your doctor or other healthcare provider. What side effects should I be on the lookout for while I'm taking this medication? You should schedule frequent checkups with your primary care physician or another qualified medical expert. This medication requires close observation and supervision. Regular blood tests may be scheduled for you by your physician or another qualified medical expert. Put on a medical identification necklace or bracelet, and carry a card with information about your condition, as well as the name of your treatment and the appropriate dose times. You should not switch brands of this medication or the dose form that you take without first seeing your physician or another qualified medical expert. You may become tired or dizzy. Do not operate a motor vehicle, operate heavy machinery, or engage in any activity that requires mental attention until you have determined how this medication affects you. Take it easy when getting up, especially if you are an older patient who needs medical attention. This lowers the likelihood of experiencing periods of lightheadedness or fainting. Consuming alcohol while taking this medication can make the side effects worse. Steer clear of alcoholic beverages. When you are using this medication, the effectiveness of birth control tablets may be compromised. Have a conversation with your primary care provider about the possibility of utilizing additional birth control methods. This medication may cause gum tissues to develop in an abnormal manner. Make sure you have frequent dental checkups. In the event that you require dental work as well as while you are caring for your teeth on a daily basis, complications may develop. When you brush or floss your teeth, you should take precautions to protect your teeth and gums from injury. Antacids should not be used at the same time as this medication is being taken. You should wait at least two to three hours before or after taking an antacid or medicine for diarrhea if you are taking phenytoin. This is because phenytoin can cause stomach distress and may interact with other medications. It is possible that taking this medication can raise the likelihood that you will think about or attempt suicide. When you are taking this medication, pay close attention to how your body is reacting to it. Your mental health should be monitored closely, and you should contact a specialist as soon as you notice any change in your mood or any suicidal or death thoughts. What potential negative reactions may I have to this medication? If you experience any of the following side effects, please contact your prescriber or a health care professional as soon as possible: Symptoms of an allergic response might include a rash, itching, or hives on the skin; swelling of the face, lips, or tongue; and breathing difficulties. alterations in one's vision discomfort or tightness in the chest confusion urine that is dark yellow or brown rapid or irregular heartbeats a high temperature, sore throat, and headache. a lack of control over the seizures insufficient command over the body's motions or trouble walking a rash that includes redness, blistering, peeling, or loosening of the skin; unusual bleeding or bruising; tiny red patches on the skin; vomiting; deterioration in mental state, thoughts or deeds of self-harm or death, yellowing of the eyes or skin Adverse effects that, in most cases, do not require immediate medical treatment but should be reported to your prescriber or another qualified medical practitioner if they persist or become bothersome include the following: sleep disturbances caused by constipation unnaturally rapid hair growth anywhere on the body or face nausea It's conceivable that this list doesn't cover all of the potential negative consequences. Where exactly may I store my medication? Be sure that youngsters can't get their hands on it. Keep at a temperature below 30 degrees Celsius, which is room temperature (86 degrees F). Guard against exposure to light and moisture. After the expiration date, any medicine that has been used but not finished should be thrown away.

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