Dilantin adverse reactions: Understanding them and strategies for management
Dilantin, a brand-name drug prescribed for certain types of seizures in adults and children, comes with a range of side effects, some of which can be serious and long-term.
One of the most concerning long-term effects is DRESS syndrome, a type of severe allergy that may cause symptoms such as skin rash, swollen lymph nodes, and fever. Dilantin can also cause Stevens-Johnson syndrome or toxic epidermal necrolysis, a severe skin rash that may cause symptoms such as skin redness or discoloration, peeling or blistering of the skin, painful sores in the mouth, and flu-like symptoms.
In clinical studies, ataxia (problems with coordination) was a common side effect reported with Dilantin. Older adults may be more sensitive to this side effect, as well as to other side effects such as osteoporosis or problems with thinking or memory.
Long-term side effects in adults and children include gingival hypertrophy (gum overgrowth), skin rashes and eruptions, hirsutism (excessive hair growth), and coarse facial features. Neurological symptoms such as ataxia, nystagmus (eye movement abnormalities), diplopia (double vision), impaired coordination, and behavioral and cognitive effects such as sedation, confusion, and impaired learning are also common.
Less common but serious adverse effects include hepatotoxicity as part of multi-organ hypersensitivity, peripheral neuropathy, blood dyscrasias (blood disorders), and cerebellar atrophy. In children and the elderly, irregular jerky movements and other neurological symptoms may occur.
The toxicity risk and side effects necessitate regular blood and urine tests and close medical monitoring to maintain safe drug levels. Adjustments in dose should only be made under medical supervision to avoid seizures or toxicity.
Additional concerns in adults include the risk of toxicity leading to symptoms such as dizziness, drowsiness, confusion, slurred speech, and uncoordinated movements, especially with dose changes or interactions with other medications.
Dilantin may cause suicidal thoughts or behaviors, which may cause symptoms such as changes in sleep, feelings of anxiety, sadness, and hopelessness, severe mood swings, and thoughts of dying. Removing tripping hazards in the home can help reduce the chances of falling due to Dilantin-induced ataxia.
Dilantin can decrease bone mineral density, which may cause symptoms such as bone fractures. It can also cause decreased blood cell counts, which may cause symptoms such as frequent infections or an infection that doesn't go away, easy bruising or bleeding, and tiredness.
Dilantin can cause hyperglycemia (increased blood sugar), which may cause symptoms such as irritability, headache, excessive thirst, and fatigue. Exercises such as yoga can help improve coordination and balance for those taking Dilantin.
Dilantin can cause heart problems, which may cause symptoms such as a feeling like your heart is beating slowly, fainting, dizziness, chest pain, and angioedema (swelling under the skin). It can also cause liver problems, including liver failure, which may cause symptoms such as nausea and vomiting, dark-colored urine or pale stool, yellowing of the skin or the white parts of the eyes, and fever.
Dilantin injection has a boxed warning about the risk of cardiovascular problems with rapid infusion. It should not be used if you have a history of porphyria (a blood disorder).
In summary, the long-term side effects of Dilantin (phenytoin) necessitate close monitoring during long-term phenytoin therapy. The use of Dilantin should be carefully considered, and patients should be informed of the potential risks and benefits.
