Seizure disorders:

Indications for DILANTIN SUSPENSION:

Tonic-clonic, psychomotor and neurosurgically induced seizures.

Adult:

1 teaspoonful 3 times daily; may increase to 5 teaspoonfuls daily if necessary.

Children:

Initially 5mg/kg per day in 2–3 equally divided doses. Increase weekly if needed. Usual maintenance: 4–8mg/kg per day; max 300mg daily.

Contraindications:

History of prior acute hepatotoxicity due to phenytoin. Concomitant delavirdine.

Warnings/Precautions:

Suicidal tendencies (monitor). Diabetes. Discontinue if acute hepatotoxicity occurs; do not restart. Adjust dose gradually. Discontinue and evaluate if first sign of rash occurs. Monitor serum levels when switching between sodium salt of phenytoin (caps) and free acid form (suspension, Infatabs). Angioedema. Underlying cardiac disease. Use proper dental hygiene. Hormonal contraception. Monitor bone mineral density with chronic use. Porphyria. Slow metabolizers. Renal and/or hepatic impairment. Hypoalbuminemia. Elderly. Debilitated. Pregnancy: avoid. Nursing mothers: not recommended.

Pharmacologic Class:

Hydantoin.

Interactions:

Potentiated by acute alcohol ingestion, amiodarone, antiepileptic agents (eg, ethosuximide, felbamate, oxcarbazepine, methsuximide, topiramate), azoles (eg, fluconazole, ketoconazole, itraconazole, miconazole, voriconazole), benzodiazepines (eg, chlordiazepoxide, diazepam), capecitabine, chloramphenicol, disulfiram, estrogens, fluorouracil, fluoxetine, fluvastatin, fluvoxamine, halothane, H2-blockers (eg, cimetidine), isoniazid, methylphenidate, omeprazole, phenothiazines, salicylates, sertraline, succinamides (eg, ethosuximide), sulfonamides, ticlopidine, tolbutamide, trazodone, warfarin. Antagonized by anticancer drugs (eg, bleomycin, carboplatin, cisplatin, doxorubicin, methotrexate), chronic alcohol ingestion, carbamazepine, diazepam, folic acid, fosamprenavir, nelfinavir, reserpine, rifampin, ritonavir, St. John’s wort, sucralfate, theophylline, vigabatrin. Antagonizes albendazole, HIV antivirals (eg, efavirenz, lopinavir/ritonavir, indinavir, nelfinavir, ritonavir, saquinavir), antiepileptic agents (eg, carbamazepine, felbamate, lamotrigine, topiramate, oxcarbazepine, quetiapine), atorvastatin, fluvastatin, simvastatin, chlorpropamide, clozapine, cyclosporine, digoxin, folic acid, methadone, mexiletine, nifedipine, nimodipine, nisoldipine, praziquantel, verapamil. Reduces efficacy of concomitant azoles, corticosteroids, doxycycline, estrogens, furosemide, irinotecan, oral contraceptives, paclitaxel, paroxetine, quinidine, rifampin, sertraline, teniposide, theophylline, vitamin D, warfarin. Concomitant fosamprenavir/ritonavir may potentiate amprenavir. Concomitant neuromuscular blockers (eg, pancuronium, vecuronium, rocuronium, cisatracurium); may need higher infusion rate. Variable effects with phenobarbital, valproic acid, sodium valproate. Absorption decreased by calcium, antacids.

Adverse Reactions:

Nystagmus, ataxia, slurred speech, decreased coordination, somnolence, mental confusion, headaches, dizziness, cerebellar atrophy, nausea, vomiting, constipation, gingival hyperplasia, osteomalacia, blood dyscrasias, lymphadenopathy, cardiac effects, hepatic disease, hyperglycemia, SLE, hypertrichosis, lab test abnormality; rare: rash (eg, SJS, TEN, AGEP, DRESS), multiorgan hypersensitivity (may be fatal).

Note:

To enroll in the North American Antiepileptic Drug Pregnancy Registry call (888) 233-2334.

Generic Availability:

YES

How Supplied:

Caps 30mg—100; 100mg—100, 1000; Tabs—100; Susp—8oz