ANTICONVULSANT DRUGS (DILANTIN (PHENYTOIN)

DESCRIPITON: - Dilantin is an anti epileptic drug or otherwise known as an anti convulsant. It is available in the form of capsules of 100mg phenytoin. Dilantin is marketed by the company Pfizer. It works by the slowing down impulses in the brain that cause seizures. Dilantin is used to control seizures; also this is not made for the all types of seizures.

INDICATION: Dilantin is used for the treatment of generalized tonic clonic seizures and complex partial seizures. This is also used for the prevention and treatment of seizures occurring in neurosurgery.

MECHANISM OF ACTION: The mechanism of action of Dilantin is by increasing efflux of sodium ions or by decreasing the influx of sodium ions across the cell membrane in the motor cortex when the generation nerve impulses.  Thus it stabilizes the neuronal membrane and decreases the seizure activity. It acts as an antiarrhythmic by increasing effective refractory period and suppressing ventricular pacemaker automaticity shortens the potential in the heart.

SIDE EFFECTS: Nausea, vomiting, constipation, hypersensitivity, lack of appetite, transient nervousness, headache, dizziness, tremor, hyperplasia and tenderness of the gum, acne, hirsutism, rashes, coarsening of the facial characteristics, osteomalacia etc. Phenytoin toxicity as marked as a syndrome of vestibular, cerebellar, ocular effects like nystagmus, slurred speech, diplopia, ataxia and also with mind confusion, dyskinesias, exacerbation of seizure frequency, hyperglycemia. Injection of Dilantin may origin local phlebitis or irritation. Prolonged use of Dilantin will cause subtle effect of mind function and cognition especially in kids.Dilantin may also cause toxic epidermal necrolysis, Steven-Johnson syndrome.

CONTRA INDICATION: Dilantin is contra indicated in pregnancy, IV administration in sinus bradycardia, heartblock or stroke-Adams syndrome.
Take special precaution with Dilantin in cardiovascular disease, hepatic impairment, hypoalbunemia. Caution in IV administration in hypotension, heart failure, monitor BP and ECG during the therapy.

DRUG INTERACTION: Effect of sedative drugs will be potentiated by Dilantin.  Phenytoin increases the toxicity of paracetamol and lithium. Increased risk of osteomalacia with acetazolamide, decreased serum level with acyclovir, antineoplastic drugs, benzodiazenes, ciprofloxacin, CYP2C19 inducers like rifampicin, CYP2C9 inducers like carbamazepine, folic acid and vigabtrin. Increased serum concentration with allopurinol, cimetedine, capcetabine, CYP2C9 inhibitors, CYP2C19 inhibitors, trazodone, trimethoprim, disulfiram, and omeprazole. Dilantin increases the metabolism of anticonvulsant, beta blockers, calcium channel blockers, antipsychotics, chloramphenicol, doxycycline, estrogens, corticosteroids, HMG-CoA reductase inhibitors methadone and thiophylline. Dilantin decreases the level of ciclosporins, clozapines, CYP2B6 substrates, neuromuscular blocking agent, thyroid hormones and topiramates.

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