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Nursing Drug Information About Phenytoin

Phenytoin (brand name Dilantin) is an anticonvulsant drug used to treat and control seizures. It is available in dose ranges for children and adults. An extended-release form is also available, offering patient convenience with just one dose daily. Phenytoin may be used in combination with other anticonvulsants.

  1. Indications

    • Phenytoin is approved for the treatment of tonic-clonic (grand mal) seizures and complex partial seizures. It may be given orally in tablet or liquid form, or as an IV (intravenous) injection. It is very dose-specific for each individual patient.

    Drug Interactions

    • There are many potential drug interactions with phenytoin, of which some may be dangerous. Phenytoin can reduce the concentration of many drugs including corticosteroids, digoxin, coumadin, methadone, oral contraceptives, Paxil and estrogens. Patients on phenytoin may require dosage adjustment their other medications.

      Other drugs also affect phenytoin's metabolism. Rifampin and phenobarbital can reduce phenytoin levels. Other drugs which increase phenytoin levels include amiodarone, Diflucan, Prozac, Tagamet, Prilosec and antacids containing calcium carbonate.

    Pharmacokinetics

    • Phenytoin is absorbed slowly from the gastrointestinal tract and rapidly following IV infusion. It crosses into cerebral spinal fluid, breast milk, the placenta and other tissues and fluids. Most of it is metabolized by the liver, with a small amount excreted in urine.

    Safety in Pregnancy

    • Phenytoin crosses over into breast milk and the placenta and may cause birth defects. It should only be used in pregnancy if the benefits outweigh the risks, and under close supervision by the patient's physician.

    Side Effects

    • Phenytoin may cause nausea, abdominal pain and constipation. Blood sugar can increase so blood sugars should be closely monitored, especially in diabetics. There is an increased risk of bleeding and infection, anemia and weakening of the bones. Dizziness, drowsiness and unsteady gait may occur.

    Nursing Implications

    • Assess patient for fever, skin rashes and enlarged lymph nodes. Monitor oral hygiene and watch for overgrowth of the gums. Monitor lab work including CBC (complete blood count), platelet count, albumin, urinalysis and liver and thyroid function tests. Phenytoin blood levels should be routinely monitored.

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