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Mechanism of Action Blocks voltage-gated sodium channels Prolongs the inactivated state of the channel Prevents rapid, repetitive neuronal firing Indications Focal (partial) seizures Generalized tonic-clonic seizures Status epilepticus (IV phenytoin / fosphenytoin for prevention of recurrence) Not effective for absence seizures Pharmacokinetics (Exam Favorite) Non-linear (zero-order) kinetics at therapeutic doses Small dose increase large rise in plasma level Highly protein-bound (albumin) Adverse Effects Dose-Related Nystagmus Ataxia Diplopia Sedation Chronic Use Gingival hyperplasia Hirsutism Acne, coarse facial features Peripheral neuropathy Osteomalacia ( vitamin D) Serious Stevens-Johnson syndrome Bone marrow suppression Teratogenicity (fetal hydantoin syndrome) Contraindications / Cautions Pregnancy (use only if benefits outweigh risks) Liver disease Hypoalbuminemia Drug Interactions Potent enzyme inducer (CYP450) efficacy of: Oral contraceptives Warfarin Steroids Interacts with many AEDs Monitoring Serum phenytoin levels Liver function tests Signs of toxicity Gingival hyperplasia = phenytoin Zero-order kinetics Avoid in absence seizures Strong enzyme inducer To view or add a comment, sign in - 2 2 : - Very interesting paper recently published in Diabetes Care by Natalie McCormick and colleagues

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But one of the first people I used it on, he is a semi-professional water skier