Phenytoin and therapeutic range
Common Questions and Answers about Phenytoin and therapeutic range
dilantin
This reaction is generally confined to the extremities but can affect the trunk and face and may be irreversible. Severe dermatologic reactions to phenytoin are infrequent. Some evidence, however, suggests that erythema multiforme is more likely in patients who undergo radiation therapy while receiving phenytoin.[22]
Lupus-like symptoms have been described for phenytoin. Whether phenytoin administration will exacerbate preexisting idiopathic systemic lupus erythematosus (SLE) is unclear.
I'm a 48 yr old black female who began having seizures 7-8 yrs ago. they have increased to about 1 time a week. I'm taking 750 mg of Keppra and Dilantin 100mg 2 x a day.
Moban® brand of molindone hydrochloride contains calcium ions which interfere with the absorption of phenytoin. Ingestion times of phenytoin and antacid preparations containing calcium should be staggered in patients with low serum phenytoin levels to prevent absorption problems”. Taken from http://www.rxlist.com/cgi/generic/phenyt_od.htm
Our population is divided into 4 type of metabolizers ranging from rapid to slow metabolizers depending upon the speed of elimination of drug from body.
During those times I had not yet been diagnosed and was able to go back to life like normal, however after the diagnosis and being on phenytoin and switching to oxcarbazepine i am feeling awful. Dizzy, nauseated, moody, extremely tired, severe headaches that come and go. All i get from my Neurologist is these are side effects that will eventually go away. Because i never know when these symptoms will come on too strong I have missed a lot of days at work during my probation period.
told me to go back to the 200mg and she would have to talk to my Neurologist, I just had blood work done again and my phenytoin level come back at 2. How is that possible? I take my pills regular, I have had no seizures. I have such a hard time getting a hold of the Neurologist I thought maybe you could help me. Could my others pills be interfering. I have been diagnosed with Hypothyroidism since the seizure and high colestoral. I take Levothyroxine, lipitor, vitamin D, and calcium.
Folic acid supplementation in folate-deficient patients with epilepsy changes the pharmacokinetics of phenytoin, usually leading to lower serum phenytoin concentrations and possible seizure breakthrough..."
It however says that initiation of Folic acid and phenytoin together is beneficial.
Since you can't go back and start all over again, you can take a small dose. It has been observed that as los as 1mg dose can perturb phenytoin’s levels, You may take doses lower than 1mg/day.
Thank you for your question, you are relatively fine with Phenytoin and the seizure episodes in a form of lack of speech are the residue of a generalized type seizure. I don’t have a full description of your consciousness during the lack of speech episodes to decide whether this start is a partial epilepsy which can continue in a generalized or it is a generalized one from the first moment..
Also, Depakote has to reach an effective range in your blood stream which means you will have blood tests to see if you are in the therapeutic range.
Lithium is one of those meds that you just have to play with. It's a trial and error type of med. Honestly, even a level of 0.9 is not therapeutic for bi-polar disorder. It should be at least 1.0 if not up to 1.5. And 0.6 is definitely not therapeutic. I was on 1500mg of Lithium once daily, extended release, and I still wasn't at a therapeutic range. Everyone is different. My metabolism just happens to metabolize lithium at a higher rate than it does for others. That might be your issue.
Surprisingly, much of the literature has focused on the effects of anticonvulsant therapy on intrinsic thyroid function rather than the converse. Such medications as carbamazepine and phenytoin have been shown to displace thyroxine from plasma protein-binding sites and potentially increase its clearance. Free thyroxine (T4) and triiodothyronine (T3) will be increased, while serum T4 and T3 levels will be decreased.
If you are pregnant your doctor may gradually decrease the dose and stop it and may prescribe an alternative anti seizure medicine which is safe during pregnancy. Sudden withdrawal of antiseizure medication may precipitate seizures in a pregnant woman which can be dangerous for the fetus. Medicines are prescribed during pregnancy only if the benefits outweigh the risks. Your doctor may prescribe you high dose folic acid 4 mg to prevent spinal cord deformities. I sincerely hope it helps.
Talking with my new neurologist who is the Newsome chair of epileptology and director of the Epilepsy Program told me that in short the therapeutic range is different for everyone. Back then my levels were low and now they are on the high side which he is not worried about it.
Now I don't know why his doctor wants to up his dose but if you and him are concerned talk with him or her about it and then decide what you feel is in the best interest for his health.
I have been on Coumadin for 18 years due to Lupus Anticoagulant (Antiphospholipid Syndrome) and several DVTs. In 2005 had MI with occlusion of the LAD artery and had drug stent inserted and I am still on plavix. My doc has debated when to take me off the Plavix safely....what are the recent studies about this dilemma? thanks so much!
Subsequent to discharge on 10 July, she was put on phenytoin 200 mg od. She broke out with fever again on 15 July and the fever lasted for about 4 days with daily temperature peaking in the afternoon (max 101 F). The face and body were covered with rash similar to measles which resolved by 20 July. Could she have had measles at her age? Why did she have convulsions? Could anyone throw any light on the episode.
It is slightly painful and very scary but usually only lasts five to ten minutes. I feel nauseous and dizzy and the same time and then for at least an hour after. These started out as once every couple of years and and then one a year. I have not noticed if any seasonal factors play. The last time I was crossing the street with my seven year old and had an attack and it was not safe. I have also had more painful attacks of pins and needles and muscle spasms/cramps in my legs and feet.
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