Brand name: Dilantin

Generic name: Phenytoin

Indication: Dilantin is indicated for the control of tonic-clonic ( grand mal) and
psychomotor( temporal lobe) seizures.
Drug Classification: Therapeutic category: Anticonvulsants, Hydantoin, Anti-
arrhythmic
Mechanism of Action: Decreases seizure activity by increasing efflux or decreasing
influx of sodium ions across cell membranes in the motor cortex during
generation of nerve impulses; prolongs effective refractory period and
suppresses ventricular pacemaker automaticity , shortens action potential in the
heart.
Dosage: Adults and elderly:
Status epilepticus: IV: loading dose:15-20 mg/kg in a single or divided dose,
followed by 100-150 mg/dose at 30-minute intervals up to a maximum of
1500mg/24 hours;
Maintenance dose: 300 mg/day or 5-6 mg/kg/day in 3 divided doses or 1-2
divided doses using extended release.
 Anticonvulsant: oral: loading dose: 15-20 mg/kg; based on phenytoin serum
concentrations and recent dosing history; administer oral loading dose in 3
divided doses given every 2-4 hours to decrease GI adverse effects

Special Precaution: May increase frequency of petit mal seizures. I.V. form may cause
hypotension, , skin necrosis at IV site. Avoid IV administration in small veins.
Use with caution in patients with porphyria. Discontinue if rash or
lymphadenopathy occurs. Use with caution in patients with hepatic dysfunction,
sinus bradycardia, S-A block, A-V block, or hepatic impairment. Elderly may
have reduced hepatic clearance and low albumin levels, which will increase the
free fraction of phenytoin in the serum and increase drug response
Pregnancy risk category D
Adverse Effects: If you experience any of the following serious side effects, stop taking
phenytoin and seek emergency medical attention or contact your doctor
immediately: an allergic reaction (difficulty breathing; closing of the throat;
swelling of the lips, tongue, or face; or hives), hallucinations, slurred speech or
staggering walk, a rash, changes in vision, agitation, low blood pressure, slow or
irregular heartbeats, abdominal pain, dark urine, light colored stools, or jaundice
(continuation Dilantin)
(yellow skin or eyes), easy bruising or bleeding or swollen or tender gums.
nausea, vomiting, constipation, or diarrhea, mild dizziness or drowsiness, tender
or swollen glands, swollen or painful gums, headache, muscle twitches,
increased facial hair, swelling of breasts, or insomnia.
Contraindication: Hypersensitivity to phenytoin, other hydantoins, or any component;
heart block; sinus bradycardia
Form: capsule, tablet( precision released, time released)
Nursing Responsibilities: Obtain data relating to the six cardinal signs of cardiovascular
disease to be used as a baseline for subsequent evaluation of response therapy.
Record date relating to any GI symptoms present before initiation of therapy.
Assess and record data relating to the patient’s mental status ( e.g. orientation,
agitation, confusion).

Phenytoin is a Pregnancy risk factor D- Assess knowledge/teach appropriate use

of barrier contraceptives (phenytoin may interfere with effectiveness of oral
contraceptives). Instruct patient to take this drug as directed, with food; to
follow good oral hygiene practices; monitor serum glucose regularly as
 prescribed if patient is diabetic; if GI upset occurs, frequent small meals may
help; be cautious in engaging in hazardous tasks; report difficulty of breathing,
rash, unresolved nausea or vomiting, slurring speech, swollen glands, bleeding
gums, yellowish color to skin or eyes, palpitations.