Dilantin: Proven Seizure Control with Phenytoin Therapy
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Synonyms
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Dilantin (phenytoin) is an established anticonvulsant medication widely prescribed for the management and prevention of tonic-clonic (grand mal) and complex partial (psychomotor) seizures. As a hydantoin derivative, it exerts its therapeutic effect by stabilizing neuronal membranes and reducing seizure spread through motor cortex areas. With decades of clinical use and extensive research supporting its efficacy, Dilantin remains a cornerstone in epilepsy treatment protocols, offering reliable seizure control for appropriate patient populations under careful medical supervision.
Features
- Contains phenytoin sodium as the active pharmaceutical ingredient
- Available in multiple formulations: extended-release capsules (30 mg and 100 mg), prompt-release tablets (50 mg), and parenteral solution (50 mg/mL)
- Designed for once-daily or divided dosing depending on formulation and patient needs
- Exhibits nonlinear pharmacokinetics with dose-dependent absorption and metabolism
- Manufactured under strict quality control standards ensuring consistent potency
- Features specialized extended-release delivery system for stable plasma concentrations
Benefits
- Provides effective prevention and reduction of seizure frequency in epilepsy patients
- Offers flexible dosing options to accommodate individual therapeutic needs
- Maintains therapeutic drug levels with appropriate dosing regimen adherence
- Supported by extensive clinical experience and long-term safety data
- Enables improved quality of life through reduced seizure occurrence
- May be used as monotherapy or adjunctive treatment based on clinical indication
Common use
Dilantin is primarily indicated for the control of generalized tonic-clonic (grand mal) seizures and complex partial (psychomotor, temporal lobe) seizures. It may also be prescribed for the prevention and treatment of seizures occurring during or following neurosurgery. In specific cases, healthcare providers may utilize Dilantin off-label for certain cardiac arrhythmias, particularly those unresponsive to standard antiarrhythmic agents, though this application requires careful risk-benefit assessment. The medication is not indicated for absence (petit mal) seizures, as it may potentially exacerbate this seizure type.
Dosage and direction
Dosage must be individualized based on patient response, serum level monitoring, and clinical presentation. For adults initiating therapy, a typical starting dose is 100 mg three times daily, with adjustment thereafter based on therapeutic response and serum concentration measurements. Maintenance dosing for most adults ranges from 300-400 mg daily, though some patients may require higher doses. The extended-release formulation allows for once-daily dosing in controlled patients. Pediatric dosing is weight-based, typically beginning with 5 mg/kg/day divided into 2-3 doses. Administration should occur at consistent times relative to meals, as food can affect absorption. Tablets should be swallowed whole, while capsules may be opened and contents mixed with food or fluid for patients with swallowing difficulties. Regular serum concentration monitoring is essential due to nonlinear pharmacokinetics.
Precautions
Patients require regular monitoring of phenytoin serum levels, with therapeutic range typically 10-20 mcg/mL. Hepatic function, complete blood count, and albumin levels should be assessed periodically. Caution is advised in patients with hepatic impairment, hypoalbuminemia, or renal dysfunction. Abrupt discontinuation may precipitate status epilepticus; dosage reduction should be gradual. Patients should be advised that Dilantin may cause gingival hyperplasia, requiring meticulous oral hygiene and regular dental care. The medication may decrease bone mineral density with long-term use, necessitating calcium and vitamin D supplementation in some cases. Driving and operating machinery may be impaired, particularly during dosage adjustment periods.
Contraindications
Dilantin is contraindicated in patients with known hypersensitivity to phenytoin, other hydantoins, or any component of the formulation. It should not be administered to patients experiencing sinus bradycardia, sinoatrial block, second- or third-degree AV block, or Adams-Stokes syndrome. Concomitant use with delavirdine is contraindicated due to decreased delavirdine concentrations and potential loss of virologic response. The parenteral formulation is contraindicated in patients with sinus bradycardia, sinoatrial block, or other severe cardiac conduction abnormalities.
Possible side effect
Common adverse reactions include nystagmus, ataxia, slurred speech, decreased coordination, mental confusion, dizziness, insomnia, transient nervousness, and headache. Gastrointestinal effects may include nausea, vomiting, and constipation. Gingival hyperplasia occurs frequently, particularly in pediatric patients. Dermatological manifestations range from mild maculopapular eruptions to severe reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis. Hematologic effects may include megaloblastic anemia, leukopenia, thrombocytopenia, and agranulocytosis. Hepatic reactions can range from elevated transaminases to rare cases of hepatitis and hepatic failure. Other potential effects include hyperglycemia, osteomalacia, lymphadenopathy, and coarsening of facial features with long-term use.
Drug interaction
Dilantin demonstrates extensive drug interactions due to its metabolism by cytochrome P450 enzymes and protein binding characteristics. Drugs that may increase phenytoin levels include amiodarone, chloramphenicol, chlordiazepoxide, disulfiram, estrogens, fluoxetine, isoniazid, omeprazole, and valproic acid. Substances that may decrease phenytoin levels include carbamazepine, reserpine, and rifampin. Phenytoin may decrease concentrations of oral contraceptives, corticosteroids, cyclosporine, digoxin, disopyramide, doxycycline, furosemide, levodopa, methadone, quinidine, theophylline, and vitamin D. Concurrent use with warfarin requires careful monitoring as effects may be unpredictable. Alcohol consumption may affect phenytoin metabolism and increase seizure risk.
Missed dose
If a dose is missed, it should be taken as soon as possible. However, if it is almost time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should never take a double dose to make up for a missed one. Consistent timing of administration is crucial for maintaining stable serum concentrations due to phenytoin’s nonlinear pharmacokinetics. Patients should maintain a medication diary or use reminder systems to enhance adherence. Any pattern of missed doses should be discussed with the healthcare provider, as inconsistent dosing may lead to breakthrough seizures or toxicity.
Overdose
Phenytoin overdose manifests primarily as central nervous system effects, including nystagmus, ataxia, dysarthria, tremor, and lethargy. Severe overdose may cause coma, hypotension, and respiratory depression. Cardiac manifestations include arrhythmias and cardiovascular collapse. Treatment is supportive and symptomatic, with maintenance of vital functions. Hemodialysis is not effective due to high protein binding. Multiple-dose activated charcoal may enhance elimination. Serum phenytoin levels should be monitored until concentrations decrease into therapeutic range. Patients require cardiac monitoring and observation for at least 24 hours due to potential delayed peak concentrations with extended-release formulations.
Storage
Store at controlled room temperature (20-25°C or 68-77°F), with excursions permitted between 15-30°C (59-86°F). Protect from light and moisture. Keep in original container with tight closure. Do not remove desiccant from bottle. Keep out of reach of children and pets. Do not use if capsules appear discolored or show signs of deterioration. Do not transfer to other containers, as this may affect stability. Proper disposal of unused medication is essential; consult pharmacist for appropriate disposal methods. Do not flush medications down toilet or drain unless specifically instructed.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual patient needs may vary significantly. Always consult with a qualified healthcare professional before starting, stopping, or changing any medication regimen. The prescribing physician should be the primary source of information regarding appropriate use, dosing, and monitoring. Never disregard professional medical advice or delay seeking it because of information contained in this document. Medical knowledge evolves continuously, and newer information may supersede content presented here.
Reviews
“Dilantin has provided remarkable seizure control for my complex partial seizures after several other medications failed. While I experienced some initial dizziness and coordination issues, these subsided with dosage adjustment. Regular blood level monitoring has been essential for maintaining therapeutic effect without toxicity.” - M.B., treated for 8 years
“As a neurologist with over twenty years of experience, I continue to find Dilantin valuable in my practice, particularly for patients requiring proven, cost-effective seizure control. The nonlinear pharmacokinetics require careful management, but the therapeutic benefits for appropriate patients are substantial.” - Dr. A. Chen, MD
“After my son’s traumatic brain injury, Dilantin prevented post-traumatic seizures effectively. The extended-release formulation allowed once-daily dosing, improving adherence. We’ve maintained regular dental checkups to monitor for gingival changes, which have been minimal with good oral hygiene.” - Parent of pediatric patient