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Patients should report cardiac signs or symptoms to their healthcare provider Advise patients to discontinue DILANTIN and seek immediate medical care if they develop signs or symptoms of angioedema, such as facial, perioral, or upper airway swelling Caution patients against the use of other drugs or alcoholic beverages without first seeking their physician's advice Inform patients that certain over-the-counter medications (e.g., antacids, cimetidine, and omeprazole), vitamins (e.g., folic acid), and herbal supplements (e.g., St. John's wort) can alter their phenytoin levels.Advise patients that DILANTIN may cause an increase in blood glucose levels Advise patients of the importance of good dental hygiene in order to minimize the development of gingival hyperplasia and its complications.Counsel patients that DILANTIN may cause dizziness, gait disturbance, decreased coordination and somnolence. Normal maintenance dosage is then instituted 24 hours after the loading dose, with frequent serum level determinations.The recommended starting dosage for pediatric patients is 5 mg/kg/day by mouth in two or three equally divided doses, with subsequent dosage individualized to a maximum of 300 mg daily in divided doses. Nitro ointment is prescribed by the physician in inches. May use continuously for unstable patients for 48 to 72 hours. As a result, any regimen of NITRO-BIDThus, one appropriate dosing schedule for NITRO-BIDEach tube of ointment and each box of foilpacs is supplied with a pad of ruled, impermeable, paper applicators. DILANTIN is indicated for the treatment of tonic-clonic (grand mal) and psychomotor (temporal lobe) seizures and prevention and treatment of seizures occurring during or following neurosurgery. Urinary excretion of phenytoin and its metabolites occurs partly with glomerular filtration but, more importantly, by tubular secretion.Phenytoin clearance tends to decrease with increasing age (20% less in patients over 70 years of age relative to that in patients 20 to 30 years of age). Reported reactions in phenytoin-treated patients have included toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), acute generalized exanthematous pustulosis (AGEP), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Cases of bradycardia and cardiac arrest have been reported in DILANTIN-treated patients, both at recommended phenytoin doses and levels, and in association with phenytoin toxicity Angioedema has been reported in patients treated with DILANTIN in the postmarketing setting. These events may be part of the spectrum of DRESS or may occur in isolation Hematopoietic complications, some fatal, have occasionally been reported in association with administration of DILANTIN.
1985 Aug;37(8):570-2. doi: 10.1111/j.2042-7158.1985.tb03070.x.Clin Pharmacokinet. Although the minimum nitrate-free interval has not been defined, data show that a nitrate-free interval of 10 to 12 hours is sufficient (see CLINICAL PHARMACOLOGY ). OR. Because there is approximately an 8% increase in drug content with the free acid form over that of the sodium salt, dosage adjustments and serum level monitoring may be necessary when switching from a product formulated with the free acid to a product formulated with the sodium salt and vice versa.Because the fraction of unbound phenytoin is increased in patients with renal or hepatic disease, or in those with hypoalbuminemia, the monitoring of phenytoin serum levels should be based on the unbound fraction in those patients Phenytoin clearance is decreased slightly in elderly patients and lower or less frequent dosing may be required Decreased serum concentrations of phenytoin may occur during pregnancy because of altered phenytoin pharmacokinetics. We comply with the HONcode standard for trustworthy health information -
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