PHENYTOIN

Antiepileptic medicine

Dosage Forms

Tablets

50 mg
100 mg

Injection

50 mg/ml

Uses

  • Epilepsy
  • Neuropathic pain (stabbing type)

Dose and Duration

Grand mal epilepsy

Adult: Initially, 3–4 mg/kg (150–300 mg) daily as single dose or 2 divided doses. Increase gradually at intervals of 2 weeks as necessary to usually 200–500 mg daily

Child: Initially, 3–5 mg/kg daily in 2 divided doses. Increased gradually according to clinical response to a usual maintenance dose of 4–8 mg/kg daily (max 300 mg daily)

Status epilepticus

Adult and child over 12 years: by slow IV injection or IV infusion, 15 mg/kg at a rate not more than 50 mg/minute as loading dose. Maintenance dose of 100 mg by mouth or slow intravenous infusion every 6–8 hours

Child 1 month–12 years: 20 mg/kg as a loading dose at a rate of 1 mg/kg/minute (max 50 mg/minute). Maintenance dose of 2.5–5 mg/kg every 12 hours

Neonate: 20 mg/kg as a loading dose at rate of 1–3 mg/kg/minute. Maintenance dose of up to 100 mg every 6–8 hours

Neuropathic pain

Adult: 200–400 mg daily in 1–2 divided doses. Up to 600 mg daily may be needed

Contraindications

  • Heart block
  • Severe liver disease

Side Effects

  • Stomach upset
  • Blood disorders
  • Headache, sleepiness, restlessness, sedation, confusion
  • Blurred vision, droopy eyelids
  • Movement disorders
  • Rash
  • Slurred speech
  • Behavioural disorders, hallucinations
  • Acne

Interactions

  • Amitriptyline (increased anticonvulsant effect)
  • Chlorpromazine (increased anticonvulsant effect)
  • Carbamazepine (increased risk of side effects)
  • Oral contraceptives (reduced contraceptive effect)
  • Dexamethasone (reduced dexamethasone effect)
  • Prednisolone (reduced prednisolone effect)
  • Isoniazid (increased isoniazid effect)
  • Protease inhibitors e.g. lopinavir (reduced plasma concentration)

Patient Instructions

  • Take with or after food
  • Stop taking medicine and report to the health worker immediately in case any sore throat, rash, mouth ulcers, bruising or bleeding occurs
  • May impair ability to perform skilled tasks, such as driving or operating machinery

Pregnancy

  • Do not use in 1ˢᵗ and 3ʳᵈ trimesters

Breast-feeding

  • Can be used

⚠️ Caution

  • Do not stop medicine abruptly; reduce dose slowly to avoid withdrawal symptoms (continuous seizures)
  • Always use the lowest effective dose
  • Give vitamin K to new-borns if mother has been taking phenytoin to prevent bleeding
  • Reduce dose in liver disease
  • Discontinue the medicine if patient develops severe blood disorders
  • Give folic acid 5mg daily to patients to minimise side effect of blood disorders
  • Flush intravenous line before and after administration to prevent local venous irritation