Phenytoin Injection Rx
Generic Name and Formulations:
Phenytoin 50mg/mL; contains alcohol, propylene glycol.
Various generic manufacturers
Indications for Phenytoin Injection:
Status epilepticus (tonic-clonic). Seizure prophylaxis and treatment in neurosurgery.
Status epilepticus: IV not to exceed 50mg/min. Loading dose: 10–15mg/kg followed by maintenance doses of 100mg orally or IV every 6–8 hrs. Do not dilute solution in IV fluids. Neurosurgical procedures: see full labeling.
Status epilepticus: IV not to exceed 1–3mg/kg/min. Loading dose: 15–20mg/kg. Neurosurgical procedures: see full labeling.
History of prior acute hepatotoxicity due to phenytoin. Heart block and sinus bradycardia. Adams-Stokes syndrome. Concomitant delavirdine.
Increased cardiovascular risk associated with rapid infusion; monitor during and after therapy; rate reduction or discontinuation may be needed. Hypotension. Severe myocardial insufficiency. Monitor ECG, BP, respiration, phenytoin levels. Diabetes. Change dose gradually. Monitor for signs/symptoms of serious dermatological reactions; discontinue if rash develops. Maintain proper dental hygiene. Oral contraception. Porphyria. Renal and/or hepatic impairment. Hypoalbuminemia. Elderly. Debilitated. Pregnancy (see full labeling). Nursing mothers.
See Contraindications. Potentiated by acute alcohol ingestion, amiodarone, benzodiazepines (eg, chlordiazepoxide, diazepam), chloramphenicol, dicumarol, disulfiram, estrogens, fluoxetine, halothane, H2 blockers (eg, cimetidine), isoniazid, methylphenidate, phenothiazines, phenylbutazone, salicylates, succinamides (eg, ethosuximide), sulfonamides, tolbutamide, trazodone, others. Antagonized by chronic alcohol ingestion, carbamazepine, reserpine, others. Antagonizes tricyclic antidepressants, oral anticoagulants, oral contraceptives, estrogens, corticosteroids, doxycycline, digitoxin, furosemide, theophylline, rifampin, quinidine, vitamins D and K, others. Variable effects with phenobarbital, valproic acid, divalproex, others. Absorption decreased by calcium.
Nystagmus, drowsiness, dizziness, insomnia, dyskinesias, ataxia, GI disturbances, gingival hyperplasia, osteomalacia, blood dyscrasias, atrial and ventricular conduction depression, slurred speech, lymphadenopathy, hepatic disease, rash, hyperglycemia, SLE, hypertrichosis, immunoglobulin abnormalities; DRESS, multiorgan hypersensitivity (may be fatal), local toxicity (eg, purple glove syndrome).
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