Dilantin, Phenytek (phenytion) (diphenylhydantoin)

Classification: antiarrhythmics (group IB), anticonvulsants; hydantoins

Indication (Use): Treatment/prevention of tonic-clonic (grand mal) seizures and complex partial
seizures, Unlabeled used: As an antiarrhythmics, particularly for ventricular arrhythmias
associated with digoxin toxicity, prolonged QT interval, and surgical repair of congenital heart
disease in children. Management of neuropathic pair, including trigeminal neuralgia

Normal dosage: Adult ~ PO Loading dose of 15-20mg/kg as extended capsules in 3 divided

doses given q 2-4hrs; maintenance dose 5-6mg/kg/day given in 1-3 divided doses; usual dosing
range = 200-1200 mg/day IV status epilepticus loading dose- 15-20mg/kg. Rate not to exceed
25-50mg/min. Maintenance dose- same as PO dosing.

Children~ PO (Children 10-16 yr): 6-7mg/kg/day in 2-3 divided doses.

(Children 7-9 yr): 7-8mg/kg/day in 2-3 divided doses.

(Children 4-6 yr): 7.5- 9mg/kg/day in 2-3 divided doses.

(Children 0.5- 3 yr): 8- 10mg/kg/day in 2-3 divided doses.

IV status epilepticus loading dose- 1-3mg/kg. Rate not to exceed

25-50mg/min. Maintenance dose- same as PO dosing.

Neonate up to 6 months~ 5-8 mg/kg/day in 2 divided doses, may require q 8hr

dosing.

Adult: Antiarrhythmic: 50-100mg q 10-15min until arrhythmia is abolished, or a total of

15mg/kg has been given or toxicity occurs

Children: Antiarrhythmic: 1.25 mg/kg/day q 5min, may repeat up to total loading dose of
15mg/kg maintenance dose- 5mg/kg/day in 2-3 day in 2-3 divided doses IV or PO.

Side Effects: CNS ataxia, agitation, confusion, dizziness, drowsiness, dysarthria,

dyskinesia, extrapyramidal syndrome, h/a, insomnia, weakness EENT: diplopia,
nystagmus. CV: hypotension (↑ with IV phenytoin), tachycardia GI: gingival
hyperplasia, N/V, constipation, drug-induced hepatitis. Derm: hypertrichosis, rash,
exfoliative dermatitis, pruritus, Hema: AGRANULOCYTOSIS, APLASIC ANEMIA,
leukopenia, megaloblastic anemia, thrombocytopenia. MS: osteomalacia Misc: allergic
reactions including STEVEN-JOHNSON SYNDROME , fever, lymphadenopathy
Nursing implications: Assess oral hygiene, phenytoin hypersensitivity syndrome

Monitor: V/S, ECG, RESP. continuously during IV admin. And

throughout period when peak serum lvls occur. (15-30min /p admin)

Patient teaching: Explain the purpose of the medication, possible side effects and what adverse
reaction to look for. If a once-a-day med is missed take as soon as possible, if the pt. is taking
several doses a day and one is missed take ASAP and leave at least 4 hours before the next dose.
Explain that the drug my discolor urine, and not to stop the drug abruptly or dosage forms

Administration Principles: Have pt. swallow a liquid before and /p drug admin; should be
given with or pc, chewable versions must be crushed or chewed well before swallowing, may be
mixed with food or fluids. IV Pushed over 1 min (60 sec), flush /p IV push /c 0.9% NaCl, not to
be admix with other solution esp. dextrose