Indications
- DILANTIN treats tonic-clonic and psychomotor seizures.
- It also prevents and treats seizures during or after neurosurgery.
Dosage and administration
- Adult starting dose: 100 mg DILANTIN extended capsule three times daily, with adjustments as needed.
- Satisfactory maintenance dose for most adults: One capsule three to four times daily, possibly increasing to two capsules three times daily if necessary.
- Once-a-day dosage for adults: Consider 300 mg DILANTIN extended capsule if seizure control is established with three daily doses.
- Adult loading dose: For rapid steady-state serum levels in clinic or hospital settings, refer to full prescribing information.
- Pediatric starting dose: 5 mg/kg/day in two to three equally divided doses, up to a maximum of 300 mg daily. Maintenance dosage: 4 to 8 mg/kg/day.
- Serum blood level determinations may be necessary for optimal dosage adjustments, with clinically effective serum total concentration of 10 to 20 mcg/mL (unbound phenytoin concentration: 1 to 2 mcg/mL).
Side effects
- Nystagmus
- Ataxia
- Slurred speech
- Decreased coordination
- Somnolence
- Mental confusion.
Precautions
- Withdrawal Precipitated Seizure: May cause status epilepticus; dose reductions or discontinuation should be gradual.
- Suicidal Behavior and Ideation: Monitor for depression, suicidal thoughts, or unusual mood or behavior changes.
- Serious Dermatologic Reactions: Discontinue at first sign of rash; if suggestive of SJS/TEN, discontinue permanently and consider alternative therapy.
- Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)/Multiorgan Hypersensitivity: Evaluate immediately for signs of hypersensitivity; discontinue if alternative cause cannot be established.
- Cardiac Effects: Reports of bradycardia and cardiac arrest.
- Angioedema: Discontinue if symptoms like facial swelling occur.
- Hepatic Injury: Cases of acute hepatotoxicity reported; discontinue immediately.
- Hematopoietic Complications: If occurs, follow-up observation needed; consider alternative treatment.