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Dilantin, ER, Vomit: A(nother) Scattered Blog Post

The thing about phenytoin, as my epileptologist has explained to me before, is that while it can be extremely effective, it’s more finicky than newer medications since there’s a relatively narrow therapeutic range at which it should be present in one’s blood, and hitting that sweet spot can be a matter of trial and error. To make matters more complicated, phenytoin levels can fluctuate depending on other medications taken and additional factors, such as whether it’s sunny outside and who won the Oscar® for Actor in a Supporting Role this year (I kid, I kid …).

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Featured

  Dilantin – Hero or Horror?

Since it first came out, Dilantin has always had its fans and its detractors.

 Phenytoin Loading Dose Calculator

Loading doses of phenytoin (Dilantin) are used to rapidly attain therapeutic drug concentrations. These loading doses may be given on initiation of therapy, or in response to a subtherapeutic drug level in patients at high risk for seizure activity.

 Trick of the Trade: Rapid Oral Phenytoin Loading in the ED

Oral phenytoin loading can be achieved in a single dose, obviating the need for an IV while still achieving quick administration, adequate serum levels, and minimal side effects.

Articles of Interest

EM@3AM – Phenytoin Toxicity

Maintain a high index of suspicion for phenytoin toxicity in the elderly, critically ill, and in those with reduced hepatic function (decreased albumin level = increased free phenytoin)

A Comparison of Seizure Prophylaxis: Phenytoin Versus Levetiracetam

Phenytoin is the more traditional AED of the two as it has been medically used for a much longer time than levetiracetam. However, levetiracetam, the newer AED of the two, has fewer side effects than phenytoin and fewer drug-drug interactions. Although past studies have aimed to compare the efficacy of phenytoin versus levetiracetam, there is no clear consensus as to if there is a clinical advantage to one over the other.

An Acute Case of Phenytoin Toxicity in the Emergency Department

Phenytoin was discovered over 100 years ago and is one of the most well-studied anticonvulsants used in clinical practice. It is listed on the World Health Organization’s List of Essential Medicines, and is a rather affordable option for patients with seizure disorder. It is classified as a voltage gated sodium channel blocker, and may be used as an antiarrhythmic agent.

Dilantin vs Phenytoin What in the world???

I am overly concerned and would like answers. Why are there so many posts of people having to switch from name brand Dilantin to Phenytoin and having seizure. I have been seizure free on Dilantin and when my insurance company United Health Care decided they wanted to save money and change me to Phenytoin, I had a seizure.

Epilepsy Expert Discusses Dilantin: long term problems

This video is about problems with chronic Dilantin (phenytoin) use. Often these issues aren't covered when someone is on the medicine.

Phenytoin and Fosphenytoin

Today, it is FDA-approved for the management of generalized tonic clonic (grand mal) seizures, complex partial seizures, and for the prevention of seizures after head trauma and neurosurgery. Phenytoin also has multiple unlabeled indications including the management of trigeminal neuralgia, syndrome of inappropriate antidiuretic hormone (SIADH), torsade de pointes, and arrhythmias (as a Class IB antiarrhythmic).

Phenytoin: 80 years young, from epilepsy to breast cancer, a remarkable molecule with multiple modes of action

In 1908 phenytoin (5,5-diphenylhydantoin) was first synthesized as a barbiturate derivative in Germany by professor Heinrich Biltz (1865-1943) and subsequently resynthesized by an American chemist of the pharmaceutical company Parke-Davis in 1923 in Detroit.

Simplifying Phenytoin in the ED

Phenytoin can be a complex medication. There are different levels than can be ordered, adjustments based on albumin, various pharmacokinetic equations, and multiple formulations.

Resources

Dilantin

Proven to help treat tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures, and to prevent and treat seizures that happen during or after brain surgery.

Epilepsy Foundation

Phenytoin (FEN-ih-toe-in) is the generic name (non–brand name) of a widely used seizure medicine. Common brand names for this type of medicine include Dilantin, but it is also sold using the name phenytoin or phenytoin sodium.

StatPearls

Phenytoin is a hydantoin derivative, a first-generation anti-convulsant drug that is effective in the treatment of generalized tonic-clonic seizures, complex partial seizures, and status epilepticus without significantly impairing neurological function. Phenytoin works by blockade of voltage-dependent membrane sodium channels responsible for increasing the action potential.