Phenytoin and agranulocytosis

Uncommon 01 to 1. Um et al.

Phenytoin sodium 100 mg tablets are indicated for the following.

Phenytoin and agranulocytosis. Phenytoin PHT sold under the brand name Dilantin among others is an anti-seizure medication. It is useful for the prevention of tonic-clonic seizures also known as grand mal seizures and focal seizures but not absence seizures. The intravenous form fosphenytoin is used for status epilepticus that does not improve with benzodiazepines.

It may also be used for certain heart arrhythmias. Preparations containing phenytoin sodium are not bioequivalent to those containing phenytoin base such as Epanutin Infatabs and Epanutin suspension. 100 mg of phenytoin sodium is approximately equivalent in therapeutic effect to 92 mg phenytoin base.

The dose is the same for all phenytoin products when initiating therapy. However if switching between these products the difference in. Phenytoin is an antiepileptic agent which is effective for tonic-clonic and focal seizures 1.

It has a narrow therapeutic index and the relationship between dose and serum phenytoin concentration is non-linear. A small change in dose can result in a large increase in serum concentration and can result in acute toxicity. By the same principle missing several doses or a small change in drug.

Serum phenytoin levels should be obtained when tricyclic antidepressant agents are added to therapy due to the potential for impaired phenytoin metabolism and decreased seizure threshold. Tricyclic antidepressants when given concomitantly with anticonvulsants can increase CNS depression. Phenytoin will decrease the level or effect of amitriptyline by P-glycoprotein MDR1 efflux transporter.

Commonly reported side effects of phenytoin include. Granulocytopenia agranulocytosis pancytopenia with or without bone marrow suppression aplastic anemia. Uncommon 01 to 1.

Liver function tests abnormal kidney failure. Toxic hepatitis hepatocellular damage. Leukopenia thrombocytopenia agranulocytosis pancytopenia - bone marrow suppression.

Decreased bone mineral density vitamin D deficiency Dermatologic reactions including Stevens-Johnson Syndrome SJS and Toxic Epidermal Necrolysis TEN Hepatotoxicity. Phenytoin Dose-Dependent Adverse Effects aka indications of. Phenytoin is a hydantoin derivative and a non-sedative antiepileptic agent with anticonvulsant activity.

Phenytoin potentially acts by promoting sodium efflux from neurons located in the motor cortex reducing post-tetanic potentiation at synapses. The reduction of potentiation prevents cortical seizure foci spreading to adjacent areas stabilizing the threshold against hyperexcitability. Phenytoin sodium 100 mg tablets are indicated for the following.

Control of tonic-clonic seizures grand mal epilepsy partial seizures focal including temporal lobe or a combination of these Prevention and treatment of seizures occurring during or following neurosurgery andor severe head injury. Phenytoin sodium has also been employed in the treatment of trigeminal neuralgia but. Dilantin phenytoin is a seizure medication anticonvulsant used to prevent or treat seizures.

Common side effects of Dilantin include dizziness drowsiness difficulty focusing vision unsteady gate tiredness abnormal involuntary movements nausea vomiting constipation abdominal pain and loss of appetite. Consult your doctor before taking Dilantin if pregnant or breastfeeding. Hematologic and Lymphatic System.

Hematopoietic complications some fatal have occasionally been reported in association with administration of phenytoin. These have included thrombocytopenia leukopenia granulocytopenia agranulocytosis and pancytopenia with or without bone marrow suppression. While macrocytosis and megaloblastic anemia.

These have included thrombocytopenia leucopenia granulocytopenia agranulocytosis and pancytopenia with or without bone marrow suppression. Phenytoin may affect glucose metabolism and inhibit insulin release. Hyperglycaemia has been reported.

Phenytoin is not indicated for seizures due to hypoglycaemia or other metabolic. By mouth or by intravenous infusion. For Child 1617 years.

Initially 250 mg once daily for 1 week then increased to 250 mg twice daily then increased in steps of 250 mg twice daily max. Per dose 15 g twice daily adjusted according to response dose to be increased every 2 weeks. Avoid use of deferiprone with other drugs known to be associated with neutropenia or agranulocytosis.

If an alternative is not possible monitor absolute neutrophil count more frequently. Ethotoin decreases levels of mebendazole by increasing metabolism. Fosphenytoin decreases levels of mebendazole by increasing metabolism.

If phenytoin Dilantin or carbamazepine Tegretol is used for treatment the nonconvulsive seizures are often worsened. In contrast valproate Depakote provides complete seizure control in. -Because of the very low incidence of agranulocytosis and aplastic anemia the vast majority of minor hematologic changes observed in monitoring of patients on this drug are unlikely to signal the occurrence of either abnormality.

Nonetheless complete pretreatment hematologic testing should be obtained as a baseline. If a patient during treatment exhibits low or decreased white blood. Trimethoprim and sulfamethoxazole are antibiotics for dogs and cats commonly called Tribrissen.

Find out its side effects and precautions to take here. Phenytoin 18 Dapsone 17 CBZ cotrimoxazole penicillin NSAIDs 5 each Lamotrigine antituberculous drugs Chinese drugs 3 each 376 207 Systemic CTS45 75 either methylprednisone or oral prednisone IVIG2 out of the 45one recovered and one died. Only supportive care10 patients.

Um et al. Leukopenia Neutropenia and Agranulocytosis. Monitor complete blood count frequently during the first few months of treatment in patients with a pre-existing low white cell count or a history of leukopenianeutropenia and discontinue SEROQUEL at the first sign of a decline in WBC in 510 Cataracts.

Lens changes have been observed in patients during long-term quetiapine treatment. Agranulocytosis aplastic anemia and other blood dyscrasias. Sulfonamides including sulfonamide-containing produc ts such as BACTRIM should be discontinued at the first appearance of skin rash or any sign of adverse reaction.

Clinical signs such as rash sore. Clopidogrel is used to prevent heart attacks and strokes in persons with heart disease recent heart attack recent stroke or blood circulation disease peripheral vascular disease. Clopidogrel is also used with aspirin to treat newworsening chest pain new heart attack unstable angina and to keep blood vessels open and prevent blood clots after certain procedures such as.

Clozapine is well known for its side effects which include agranulocytosis with a fatality rate as high as 30 percent sedation seizures sialorrhea hypotension weight gain tachycardia and. Blood disorders agranulocytosis leucopenia granulocytopenia haemolytic anaemia thrombocytopenia megaloblastic anaemia glucose-6-phosphate dehydrogenase deficiency anaemia and eosinophilia rare. Gastrointestinal nausea and anorexia.

Vomiting abdominal pain and diarrhoea are less common. Hepatobiliary disorders chronic hepatitis cholestatic jaundice rarely. By mouth using immediate-release medicines.

For Child 1 month11 years. Initially 5 mgkg once daily dose to be taken at night alternatively initially 25 mgkg twice daily then increased in steps of 255 mgkg every 37 days as required. The most common medications associated with eosinophilia include antibiotics penicillin cephalosporins non-steroidal anti-inflammatory medications aspirin ibuprofen phenytoin anti-seizure and allopurinol used to treat gout.

The most severe form is called drug reaction with eosinophilia and systemic symptoms DRESS. Ghannam M Mansour S Nabulsi A Abdoh Q. Anticonvulsant hypersensitivity syndrome after phenytoin administration in an adolescent patient.

A case report and review of literature. Clin Mol Allergy 2017. Kumar KL Reuler JB.

West J Med 1986. Davis RS Stoler BS. Febrile reactions to INH.

N Engl J Med 1977.