Indications

• Seizures (see Seizures)

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Pharmacology

• Anticonvulsant

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Administration

• PO: 100 mg TID
• IV: 15-20 mg/kg (usually 1 g) load over 1 hr
  • Monitor EKG for arrhythmias
  • Monitor BP for hypotension

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Adverse Effects

Cardiovascular Adverse Effects

• Hypotension (see Hypotension, [[Hypotension]]): increased risk with rapid infusion

Dermatologic Adverse Effects

• Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome) (see Drug Rash with Eosinophilia and Systemic Symptoms, [[Drug Rash with Eosinophilia and Systemic Symptoms]])
• Morbilliform Rash (see Exanthems, [[Exanthems]])

Hematologic Adverse Effects

• Megaloblastic Anemia (see Anemia, [[Anemia]])

Pulmonary Adverse Effects

• Lymphocytic Interstitial Pneumonia (see Lymphocytic Interstitial Pneumonia, [[Lymphocytic Interstitial Pneumonia]])
  • Diagnosis
    • FOB-BAL: lymphocytosis
    • OLB: lymphocytosis
• Drug-Induced Pulmonary Eosinophilia (see Drug-Induced Pulmonary Eosinophilia, [[Drug-Induced Pulmonary Eosinophilia]])
• Drug Rash with Eosinophilia and Systemic Symptoms (DRESS Syndrome) (see Drug Rash with Eosinophilia and Systemic Symptoms, [[Drug Rash with Eosinophilia and Systemic Symptoms]])
• Diffuse Alveolar Hemorrhage (see Diffuse Alveolar Hemorrhage, [[Diffuse Alveolar Hemorrhage]])
  • Diagnosis
    • ANCA: may be elevated
    • OLB: capillaritis
  • Elevated ANCA may be seen

Renal Adverse Effects

• Glomerulonephritis (see Acute Glomerulonephritis[[Acute Glomerulonephritis]])

Rheumatologic Adverse Effects

• Drug-Induced SLE (see Systemic Lupus Erythematosus, [[Systemic Lupus Erythematosus]])

Other Adverse Effects

• xxx

Phenytoin Intoxication

Epidemiology

• xxx

Diagnosis

• xxxx

Clinical

• Hypotension
• xxx

Treatment

• Charcoal: 50 g with sorbitol x 1

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References

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• Acute pulmonary disease caused by phenytoin. Ann Int Med 1981; 95: 452-454
• Development of a pulmonary phenytoin-associated hypersensitivity reaction despite concomitant dexamethasone and prednisolone administration. International Journal of Clinical Pharmacology and Therapeutics 2000; 38: 452-456
• Anticonvulsant hypersensitivity syndrom occurring as sepsis with multiorgan dysfucntion. Pharmacotherapy 1999; 19: 346-348
• Early-onset phenytoin toxicity mimicking a renopulmonary syndrome. Eur Respir J 1998; 11: 501-503
• Bronchiolitis obliterans with organizing pneumonia and cold agglutinin disease associated with phenytoin hypersensitivity syndrome. Chest 1997; 112: 1697-1699
• Carbamazepine hypersensitivity syndrome: report of 4 cases and review of the literature. Medicine (Baltimore) 1995; 74: 144-150
• Phenytoin related immunodeficiency associated with Löffler’s syndrome. Ann Allergy Asthma Immunol 1995; 74: 479-482
• Activation of drug-specific CD4+ and CD8+ T cells in individuals allergic to sulfonamides, phenytoin, and carbamazepine. J Immunol 1995; 155: 462-472
• Acute respiratory failure mediated by reactive drug metabolites. Biol Neonate 1995; 67: 223-229
• The role of gallium-67-citrate in the detection of phenytoin-induced pneumonitis. J Nucl Med 1994; 35: 471-473
• Phenytoin-induced pseudolymphoma. A report of a case and review of the literature. Br J Dermatol 1992; 127: 403-406
• Radionuclide scanning in the detection of drug-induced lung disorders. J Thorac Imaging 1991; 6: 62-67
• Summer W R. Phenytoin-induced acute respiratory failure with pulmonary eosinophilia. Am J Med 1989; 87: 93-94
• Cavitary pulmonary nodules in atypical collagen disease and lupoid drug reaction. Acta Radiol 1989; 30: 281-284
• Phenytoin-carbamazepine cross-sensitivity. Ann Pharmacother 1989; 23: 235-236
• Diphenylhydantoin-induced lymphocytic interstitial pneumonia. Chest 1986; 90: 458-460
• Does prolonged use of diphenylhydantoin predispose to pulmonary sarcoidosis ? Eur Neurol 1986; 25: 281-284
• Bronchoalveolar lavage in acute drug-hypersensitivity pneumonitis probably caused by phenytoin. South Med J 1984; 77: 1594-1596
• Anticonvulsant-induced aplastic anemia: increased susceptibility to toxic drug metabolites in vitro. Blood 1983; 61: 889-893
• Abnormal biodistribution of radiogallium in persons treated with phenytoin. J Can Assoc Radiol 1983; 34: 114-115
• Necrotizing vasculitis associated with diphenylhydantoin: two fatal cases. Human Pathology 1983; 14: 182-4
• Lymphadenopathy associated with diphenylhydantoin therapy. Clin Oncol 1982; 8: 351-356
• Diphenylhydantoin-induced pseudolymphoma syndrome. With severe thrombocytopenia. NY State J Med 1981; 81: 1085-1087
• Acute pulmonary disease caused by phenytoin. Ann Intern Med 1981; 95: 452-454
• Angioimmunoblastic lymphadenopathy in a patient taking diphenylhydantoin. Ann Clin Lab Sci 1981; 11: 542-545
• Phenytoin-induced pseudolymphoma syndrome. An immunologic study. Arch Dermatol 1977; 113: 477-480
• Dilantin toxicity: miliary pulmonary infiltrates and hypoxemia. Ann Intern Med 1976; 85: 475-476
• Immunoblastic lymphadenopathy associated with phenytoin (diphenylhydantoin). Lancet 1976; i: 198
• Anticonvulsant-induced lymphoma. Laryngoscope 1975; 85: 1770-1781
• Localized cervical lymphadenopathy induced by diphenylhydantoin sodium. Arch Otolaryngol Head Neck Surg 1975; 101: 446-448
• Severe hypersensitivity to diphenylhydantoin with circulating antibodies to the drug. Ann Intern Med 1975; 83: 522-523
• Malignant lymphoma after diphenylhydantoin (Dilantin) therapy. Cancer 1975; 36: 1359-1362
• Phenytoin sensitivity in a case of phenytoin-associated Hodgkin’s disease. Aust NZ J Med 1975; 5: 144-147
• Drug-associated lymphadenopathies with special reference to the Reed-Sternberg cell. Med J Aust 1971; 58: 375-378
• Malignant lymphoma associated with hydantoin drugs. Arch Neurol 1970; 22: 450-454
• The development of Hodgkin’s disease and lymphoma during anticonvulsant therapy. Blood 1966; 28: 416-427
• Diagnostically confusing complications of diphenylhydantoin therapy. A review. Ann Intern Med 1963; 59: 914-930
• Syndrome simulating lymphosarcoma induced by diphenylhydantoin sodium. JAMA 1961; 176: 491-493