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Phenytoin does not clearly differ from other seizure medicines in the type of defects that may occur.The risk of defects is higher for women who take more than one AED and for women with a family history of birth defects.Advise women who are capable of becoming pregnant to take 400 mcg (0.4 mg) of folic acid (folate) daily to help prevent neural tube defects. Counsel patients, their caregivers, and families that AEDs, including extended phenytoin sodium capsules, may increase the risk of suicidal thoughts and behavior and advise them of the need to be alert for the emergence or worsening of symptoms of depression, any unusual changes in mood or behavior, or the emergence of suicidal thoughts, behavior, or thoughts about self-harm. Periodic measurement of serum phenytoin concentrations should be performed during pregnancy, and the phenytoin dosage should be adjusted as necessary. For most adults, the satisfactory maintenance dosage will be one capsule three to four times a day.In adults, if seizure control is established with divided doses of three 100-mg extended phenytoin sodium capsules daily, once-a-day dosage with 300 mg of extended phenytoin sodium capsules may be considered. For instance, one or two drinks of alcohol will seldom affect the level of phenytoin in any important way, but if a person who does not often consume alcohol drinks a moderate or large amount, the level of phenytoin in the blood may be significantly increased. Bone disease is even more likely if a combination of antiepileptic drugs is used. Adult once-a-day dose: If seizure control is established with divided doses of three 100 mg extended phenytoin sodium capsules daily, once-a-day dosage with 300 mg extended phenytoin sodium capsules may be considered. Advise patients taking phenytoin not to drive, operate complex machinery, or engage in other hazardous activities until they have become accustomed to any such effects associated with phenytoin.Inform pregnant women and women of childbearing potential that use of phenytoin during pregnancy can cause fetal harm, including an increased risk for cleft lip and/or cleft palate (oral clefts), cardiac defects, dysmorphic skull and facial features, nail and digit hypoplasia, growth abnormalities (including microcephaly), and cognitive deficits. The addition or withdrawal of phenytoin during concomitant therapy with these agents may require adjustment of the dose of these agents to achieve optimal clinical outcome.Fluconazole, ketoconazole, itraconazole, posaconazole, voriconazolePhenytoin can substantially reduce the concentrations of delavirdine. The most common adverse reactions are nervous system reactions, including nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion. Limited evidence suggests that HLA-B*1502 may be a risk factor for the development of SJS/TEN in patients of Asian ancestry taking other antiepileptic drugs associated with SJS/TEN, including phenytoin. Individual prescribing information from relevant drugs should be consulted.The addition or withdrawal of these agents in patients on phenytoin therapy may require an adjustment of the phenytoin dose to achieve optimal clinical outcome.Ethosuximide, felbamate, oxcarbazepine, methsuximide, topiramateFluconazole, ketoconazole, itraconazole, miconazole,Sulfamethizole, sulfaphenazole, sulfadiazine, sulfamethoxazole-trimethoprimAcute alcohol intake, amiodarone, chloramphenicol, chlordiazepoxide, disulfiram, estrogen, fluvastatin, isoniazid, methylphenidate, phenothiazines, salicylates, ticlopidine, tolbutamide, trazodone, warfarinCalcium carbonate, aluminum hydroxide, magnesium hydroxide
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