Has your doctor prescribed Phenytoin suspension for you or someone in your family for epilepsy/seizure disorder? This is a very important and long-standing medication that is used to control seizures in Sri Lanka and around the world. So it is very important to be fully aware of this medication when using it. Today, we will talk about it simply and in a way that you can understand.
What exactly is Phenytoin?
Simply put, phenytoin is a drug that controls the overactivity of nerve cells in your brain . A seizure is caused by a sudden, uncontrolled increase in the activity of nerves in the brain. So this medicine works by calming those nerves and preventing and controlling the seizure. It can sometimes be used for other medical reasons. Your doctor will explain this to you.
What are the things I need to tell the doctor before starting this medication?
Before starting phenytoin, it is very important to tell your doctor about your complete health history. Be sure to tell your doctor if you have any of the following:
- If you have an alcohol addiction .
- If you are of Asian descent (some genetic factors may affect how you respond to the medicine).
- If you have a blood disease or blood clotting problem.
- If you have diabetes mellitus .
- If you have heart disease or heart problems.
- If you have kidney disease .
- If you have liver disease .
- If you have a rare condition called Porphyria .
- If you are receiving radiation therapy for cancer .
- If you are having thoughts of ending your life , have attempted to do so before, or have a family history of doing so.
- If you have thyroid disease .
- If you have an allergy to phenytoin or any other medicine, food, or preservative.
- If you are pregnant or trying to get pregnant .
- If you are breastfeeding your baby .
Hiding this information can cause serious problems. So discuss all this clearly with your doctor.
How to use the medicine correctly?
Since this is a liquid medicine, it is very important to measure the exact dosage.
- Shake well: Always shake the medicine bottle well before using it, as particles of medicine may settle to the bottom of the bottle.
- Correct measurement: Use only the special measuring cup, syringe, or oral syringe/spoon/dropper provided by your doctor or pharmacy to measure your medicine. Do not measure with household teaspoons or tablespoons. They are not accurate.
- On time: Try to take your medicine at the same time every day. This will help keep the levels of the medicine in your blood consistent.
- With or without food: This can be taken before or after meals. However, if you experience stomach upset, it is best to take it with food .
- Don't stop: Don't stop taking the medication suddenly unless your doctor tells you to. Doing so increases the risk of the fit coming back.
If you are giving this medicine to children, talk to your doctor about any special instructions.
Oh! What if I take too much medicine? (Overdose)
If you think you've had more than you thought, don't delay .
Go to the nearest hospital Emergency Treatment Unit (ETU) immediately. Also, if possible, call the National Poisons Information Centre at the Colombo National Hospital for advice. This is very important.
What to do if you miss a dose of medication?
If you forget to take a dose, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take your next dose at the scheduled time . Never take a double dose .
Are there any other medications that are incompatible with this medicine? (Drug Interactions)
Yes, absolutely. Phenytoin is a drug that can interact with many other medications. This means that when taken with other medications, the effectiveness of phenytoin may be reduced, increased, or the side effects may increase.
Tell your doctor about all the medications you take (including vitamins, herbal remedies, and supplements) . Below are some medications that may cause problems with phenytoin.
- Some antiviral medications (those given for HIV or Hepatitis)
- Antifungals (e.g. `(fluconazole)`, `(ketoconazole)`)
- Other seizure medications (e.g., carbamazepine, valproic acid)
- Medicines that prevent blood clotting (e.g. warfarin, aspirin)
- Cholesterol-lowering medications (e.g., atorvastatin, simvastatin)
- Medication for depression or anxiety
- Antibiotics (e.g. `(doxycycline)`, `(chloramphenicol)`)
- Medicines for stomach upset/gastritis (e.g. antacids, omeprazole)
- Birth control pills containing hormones
- Types of steroids (e.g. `(prednisone)`)
- Alcohol
This list is not complete, so it's safest to tell your doctor about any medications you take.
Things to be especially careful about when taking medication
- Regular checkups: Your doctor will ask you to have regular blood tests. This will check the level of phenytoin in your blood and determine if the dosage needs to be increased or decreased. Do not skip these tests.
- Serious skin reactions: Some people may develop serious skin reactions a few weeks or months after starting this medicine. Tell your doctor right away if you have a fever, body aches, red or purple skin rash, blisters, or sores inside your mouth, swelling of your face or lips, or a rash on your neck or armpits .
- Drowsiness and dizziness: This medicine may cause drowsiness and dizziness. Therefore , do not drive or operate machinery until your body adjusts to the medicine. Be careful when getting up suddenly from a sitting position, especially if you are elderly.
- Birth control pills: Taking phenytoin may reduce the effectiveness of birth control pills. So if you are not planning to have a baby, talk to your doctor about using another form of birth control (e.g., condoms).
- Gum swelling: This is a common side effect of phenytoin. The gums can grow abnormally. So brush your teeth thoroughly every day and see your dentist regularly .
- Vitamin deficiencies: Long-term use of this medication may cause low levels of vitamin D and folic acid. Therefore, talk to your doctor about eating a nutritious diet and taking vitamin supplements if necessary.
Side effects that may occur due to medication
Like any medicine, phenytoin can cause side effects. Some of them are serious, some are common.
| Side effect | Description and what to do |
|---|---|
| Things to report to the doctor or ETU immediately | |
| Serious allergies | Skin rash, itching, swelling of the face/lips/tongue, difficulty breathing. |
| Symptoms of liver damage | Pain in the upper right abdomen, loss of appetite, nausea, yellowing of the eyes/skin, dark urine. |
| Serious skin diseases | Fever, accompanied by red/purple blisters on the skin, peeling skin, and mouth sores. |
| Symptoms of Phenytoin Poisoning (Toxicity) | Uncontrolled eye movements, difficulty walking (loss of balance), difficulty speaking, excessive sleepiness, nausea/vomiting. |
| Mental changes | Thoughts of suicide, increased depression. |
| Abnormal bleeding | Bruising or bleeding of the skin for no reason. |
| Things to tell your doctor if they persist or are bothersome | |
| Common side effects | Drowsiness, dizziness, headache, difficulty concentrating. |
Take-Home Message
- Phenytoin is a very important medication that controls fits. Take it exactly as your doctor tells you, in the right dose, at the right time.
- Before starting the medication, tell your doctor about all your medical conditions and all other medications you are taking.
- Avoid risky activities while taking the medication as it may cause drowsiness and dizziness. Avoid alcohol completely.
- If you experience any serious side effects such as severe skin lesions, mouth sores, yellowing of the eyes, or excessive drowsiness, seek medical advice immediately.
- Do not stop taking the medication suddenly or change the dosage without your doctor's advice.
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