Dilantin: Proven Seizure Control for Neurological Stability
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Synonyms
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Dilantin (phenytoin) is a cornerstone antiepileptic medication with a well-established history in managing and preventing tonic-clonic and complex partial seizures. As a hydantoin derivative, it stabilizes neuronal membranes and reduces seizure activity by inhibiting voltage-gated sodium channels. Its predictable pharmacokinetics and extensive clinical profile make it a first-line choice for neurologists seeking reliable long-term seizure prophylaxis. Proper therapeutic drug monitoring is essential to maximize efficacy and minimize adverse effects.
Features
- Active pharmaceutical ingredient: Phenytoin
- Available formulations: Oral capsules (30 mg, 100 mg), chewable tablets (50 mg), and injectable solution (50 mg/mL)
- Mechanism of action: Voltage-gated sodium channel blockade
- Half-life: Approximately 22 hours (dose-dependent)
- Protein binding: 90–95%
- Metabolism: Hepatic (CYP2C9 and CYP2C19)
Benefits
- Provides effective suppression of abnormal neuronal discharge
- Reduces frequency and severity of tonic-clonic seizures
- Enables long-term seizure prophylaxis with once-daily dosing (in appropriate formulations)
- Offers multiple administration routes for clinical flexibility
- Maintains therapeutic efficacy with consistent pharmacokinetic monitoring
- Supports neurological stability and improved quality of life
Common use
Dilantin is primarily indicated for the control of generalized tonic-clonic seizures and complex partial (psychomotor) seizures. It is also used prophylactically following neurosurgery or traumatic brain injury where seizure risk is elevated. Off-label applications include certain cardiac arrhythmias (particularly those induced by digitalis toxicity) and neuropathic pain syndromes, though evidence supporting these uses is less robust. It is not indicated for absence seizures.
Dosage and direction
Dosage must be individualized based on therapeutic drug monitoring (target serum concentration: 10–20 mcg/mL). For adults, initial dosing is typically 100 mg orally three times daily, with adjustments made no more frequently than every 7–10 days. Maintenance doses range from 300–400 mg daily, though some patients may require up to 600 mg/day. Pediatric dosing is weight-based (5 mg/kg/day in 2–3 divided doses). Administration with food may minimize gastrointestinal irritation. Do not crush or chew extended-release capsules.
Precautions
Regular monitoring of serum phenytoin levels is mandatory due to nonlinear pharmacokinetics. Perform baseline and periodic liver function tests, complete blood counts, and albumin levels. Use caution in patients with hepatic impairment, hypoalbuminemia, or renal dysfunction. May cause drowsiness or dizziness; advise patients regarding operating machinery. Pregnancy Category D: known to cause fetal harm. Vitamin D supplementation may be necessary with long-term use due to potential osteomalacia.
Contraindications
Hypersensitivity to phenytoin, other hydantoins, or any component of the formulation. Contraindicated in patients with sinus bradycardia, sinoatrial block, second- or third-degree AV block, or Adams-Stokes syndrome. Avoid use in patients with a history of acute hepatotoxicity due to phenytoin.
Possible side effect
Common: Nystagmus, ataxia, slurred speech, dizziness, insomnia, nervousness, gingival hyperplasia, coarsening of facial features.
Serious: Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), hepatic necrosis, blood dyscrasias (agranulocytosis, thrombocytopenia), lymphadenopathy, peripheral neuropathy, cerebellar atrophy with chronic use.
Drug interaction
Strong interactions with: Warfarin (increased INR), oral contraceptives (reduced efficacy), carbamazepine (mutual metabolism induction), valproic acid (displacement and metabolism inhibition), cimetidine (increased phenytoin levels), amiodarone (increased phenytoin levels). Requires dosage adjustment when co-administered with CYP2C9/2C19 inhibitors or inducers.
Missed dose
If a dose is missed, administer as soon as possible. However, if it is near the time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not double doses. Consistent timing is critical for maintaining therapeutic serum concentrations.
Overdose
Symptoms include nystagmus, ataxia, dysarthria, lethargy, nausea, and hypotension. Severe overdose may cause coma, respiratory depression, and cardiovascular collapse. Treatment is supportive; activated charcoal may be effective if administered early. Hemodialysis is not effective due to high protein binding. Monitor serum levels and cardiac function continuously.
Storage
Store at controlled room temperature (20–25°C/68–77°F). Protect from light and moisture. Keep tightly closed. Do not freeze. Oral suspension is stable for 2 months after opening; note that settling may occur—shake well before each use.
Disclaimer
This information is for educational purposes and does not replace professional medical advice. Dosage and treatment decisions must be made by a qualified healthcare provider based on individual patient characteristics. Always consult the full prescribing information and latest clinical guidelines before initiation or modification of therapy.
Reviews
“Dilantin remains a gold standard for seizure control in our neurology practice. While therapeutic drug monitoring is essential, its efficacy in preventing tonic-clonic seizures is well-documented across decades of use.” — Neurology Today
“Though newer agents exist, phenytoin’s cost-effectiveness and rapid IV formulation make it invaluable in emergency and ICU settings for acute seizure management.” — Journal of Clinical Neuroscience
“Long-term use requires vigilant monitoring for adverse effects, particularly gingival hyperplasia and potential cerebellar changes, but many patients achieve decades of seizure freedom.” — Epilepsy Research