苯妥英

苯妥英is used to prevent andcontrol癫痫发作（也称为anticonvulsantor antiepileptic drug). It works by reducing the spread ofseizureactivityinthe脑.

• 苯妥英may also be used to treat certain types of irregular heartbeats.
• 在以下不同的品牌名称下可用苯妥英：Dilantin,Dilantin 125, and苯克.

苯妥英钠的剂量：

剂型和优势

Capsule, immediate-release

• 30mg
• 100 mg

Capsule, extended-release

• 100 mg
• 200毫克
• 300毫克

药片，可咀嚼

• 50 mg

Oralsuspension

• 125 mg/5mL

Injectable solution

• 50 mg/mL

剂量考虑 - 应如下给出：

癫痫发作

癫痫状态

• Adult: Load 10-15 mg/kg or 15-20 mg/kg at 25-50 mg/min, THEN
• Maintenance: 100 mg intravenously/orally every 6-8 hours as needed
• Administer静脉(IV) slowly; not to exceed 50 mg/minutes
• Pediatric: 15-20 mg/kg intravenously (IV) in single or divided dose; if necessary may administer additional dose of 5-10 mg/kg 10 minutes after loading dose
• Maintenance: 4-8 mg/kg/day IV divided twice daily

抗惊厥的,成人

药片

• 100 mg orally three times daily
• Maintenance: 300-400 mg/day; increase to 600 mg/day if necessary
• May adjust dose no sooner than 7-10 day intervals when indicated

暂停

• 125 mg orally three times daily, initially
• 如有必要，增加至625毫克/天
• May adjust dose no sooner than 7-10 day intervals when indicated

缓释

• Loading dose: 1 g divided into 3 doses (400, 300, 300 mg) administered at 2-hour intervals; initiate dosage 24 hours after loading dose
• 加载剂量不给有病史的患者进行给药renalorhepatic疾病;reserve for patients who require rapid steadyserum水平，当静脉注射不可取时，对于诊所或诊所的患者或医院setting where phenytoin levels can be closely monitored
• Treatment (naive): 100 mg orally three times daily initially
• May adjust dose no sooner than 7-10 day intervals
• 治疗性范围：10-20 MCG/L（总数）或1-2 MCG/L免费药物

Anticonvulsant, Children and Adolescents

立即发布

• 平板电脑和悬架
• 5 mg/kg/day orally in 2-3 divided doses, initially; may make dose adjustments no sooner than 7-10 day intervals
• 维护：4-8 mg/kg/天口服；不超过300毫克/天；可以考虑更高剂量婴儿and young children (range: 8-10 mg/kg/day in divided doses)

缓释

• 口服5 mg/kg/天，最初以2-3个均等的剂量；可能不尽快调整剂量
• Maintenance: 4-8 mg/kg/day orally not to exceed 300 mg/day

控制补品和复杂的部分癫痫发作，小儿

初始剂量

• 新生儿：2分剂量的5 mg/kg/天
• 6个月至16年：2-3分剂量的5 mg/kg/天

Neonates (less than 28 days)

• Initial: 5-8 mg/kg/day intravenously (IV)/orally divided every 8-12 hours

Age-based maintenance dose

• Children 6 months-4 years: Usual range, 8-10 mg/kg/day intravenously (IV)/orally divided two to three times daily
• Children 4-7 years: Usual range, 7.5-9 mg/kg/day IV/orally divided two to three times daily
• 7-10岁的儿童：通常范围7-8 mg/kg/day IV/口腔分配每天两到三次
• 儿童10-16岁：通常的范围，6-7 mg/kg/day IV/口服每天两到三次

剂量考虑

• Children under 6 years: Potential toxic dose, 20 mg/kg
• 治疗范围：10-20 MCG/L（总）或1-2 MCG/L免费药物
• ALWAYS administer intravenous (IV) slowly; not to exceed 1-3 mg/kg/minute

苯妥英的常见副作用包括：

• Drowsiness
• Fatigue
• 无法控制身体运动
• 损失balanceor coordination
• Irritability
• 头痛
• 不安
• Nervousness
• 非自愿, repetitiveeyemovements
• 头晕
• Spinning感觉(vertigo)
• Slurred or slow speech
• Numbness and tingling
• Rash
• 瘙痒
• Swollen or tender gums (pediatric patients)
• 震颤
• 悖论性癫痫发作
• Drug withdrawal seizure
• Double vision
• Psychosis（高剂量）
• Optic nerve损害
• 脑病
• Atrioventricular（AV）传导障碍
• Ventricular fibrillation
• 恶心
• 呕吐
• 便秘
• 腹泻
• 巨大细胞（叶酸-deficiency)贫血
• 低的blood钙levels (hypocalcemia)
• Liver损害
• Abnormalhair growth
• 放大lymphnodes
• 紫色手套syndrome
• Allergic reactions in the form of rash or, rarely, more serious forms (drug reaction witheosinophiliaandsystemic症状，或着装）或过敏反应
• Red or purple spots on theskin
• 有毒的epidermalnecrolysis
• Bullousdermatosis
• 面部特征的粗糙
• 周围炎
• Immunoglobulinabnormalities
• An alteredtaste感觉, including metallic taste
• 佩罗尼氏病

IV greater than 50 mg/min

• CNS沮丧
• Cardiovascularcollapse
• Hypotension

Rare side effects of phenytoin reported include:

• 非自愿musclemovements
• Weakness orparalysisof eye muscles
• Kidney损害
• 史蒂文斯 - 约翰逊综合症
• Lupuserythematosus
• 疳
• Softening of the bones

Postmarketing side effects of phenytoin reported include:

• 小脑萎缩

This document does not contain all possible side effects and others may occur. Check with your医师for additional information about side effects.

If yourdoctorhas directed you to use thismedication, your doctor or药剂师may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor,healthcare provider, or pharmacist first.

• 苯妥英has severe interactions with at least 28 different drugs.
• 苯妥英has serious interactions with at least 83 different drugs.
• 苯妥英has moderate interactions with at least 286 different drugs.
• 苯妥英has mild interactions with at least 121 different drugs.

本文件并不包含所有可能的相互作用。因此，在使用此产品之前，请告诉您的医生或药剂师使用您使用的所有产品。与您一起保留所有药物的清单，并与您的医生和药剂师分享清单。如果您有健康问题或疑虑，请与您的医生联系。

Warnings

Cardiovascular risk associated with rapid infusion rates:

• 风险low blood pressure（低血压）和不规则的心跳（心律不齐），成人的输注率超过50 mg/分钟，儿科患者为1-3 mg/kg/分钟（或50 mg/minnuse）（以较低者为准）
• Carefulcardiacmonitoring is needed during and after intravenous (IV) administration
• These events have also been reported at or below 50 mg/minute
• 可能需要降低输注率或停用

This medication contains phenytoin. Do not take Dilantin, Dilantin 125, or Phenytek if you are allergic to phenytoin or any ingredients contained in this drug.

请将本品放在儿童不能接触的地方。如果服用过量，请获得医疗帮助或联系Poison Control Center立即地。

禁忌症

• 超敏反应
• Sinus bradycardia
• Sinoatrial block
• Second and third-degreeA -V block
• 亚当斯 - 斯托克斯综合症
• 与Delavirdine并发使用
• History of prior急性hepatotoxicity attributable to phenytoin

吸毒的影响

• 无资料

短期影响

• See "What Are Side Effects Associated with Using Phenytoin?”

长期影响

• Decreased骨密度reported withchronic利用。
• See "What Are Side Effects Associated with Using Phenytoin?”

警告

• Erratically absorbed when administered intramuscularly (IM), so this route should be used as a last resort.
• ONLY extended-release capsules should be used for once-daily dosing regimens.
• Decreased骨mineral density reported with chronic use.
• 快速静脉内给药增加了心血管不良反应的风险，包括严重的低血压和心律不齐；在儿科患者中，以不超过1至3 mg/kg/分钟或每分钟50 mg的速率给药，以较慢者为准；虽然心血管的风险毒性随着输注率高于建议的输注率的增加，这些事件也以建议的输注率或低于建议的输注率报告。
• May cause fetal harm when administered to apregnantwoman.
• 如果剂量有关的早期迹象中枢神经系统（CNS）毒性发展，应立即检查血清水平。
• DRESS typically, although not exclusively, presents with发烧，皮疹，淋巴结肿大（淋巴结肿大), and/or facial swelling, in协会with otherorgansystem involvement.
• 苯妥英induces hepatic metabolizing酶, which may enhance themetabolismof维生素D并降低维生素D水平，导致维生素D缺乏症，低钙血症和hypophosphatemia;consideration should be given to screening with bone-related实验室and radiological tests as appropriate and initiating treatment plans according to established guidelines.
• Use caution incardiovascular disease,低白蛋白血症，肝障碍，甲状腺功能减退症或癫痫发作；由于肾脏或肝病患者或患有低珠蛋白血症的患者的苯妥英一小部分增加，因此对苯妥英钠血清水平的监测应基于这些患者的未结合分数。
• 有关联exacerbationof卟啉症;exercise caution when used in patients with this disease.
• Extensively bound to serumplasmaproteins并且是易于竞争性位移。
• 急性酒精摄入量可能会增加苯妥英钠血清水平，而慢性酒精使用可能会降低血清水平。
• 由肝细胞色素P450酶CYP2C9和CYP2C19代谢，并且特别容易受到抑制性药物相互作用subject可饱和代谢；如果抑制新陈代谢，可能会在循环苯妥英浓度上显着增加并增强药物毒性的风险。
• 低风险blood pressure（低血压）和不规则的心跳（心律不齐），成人的输注率超过50 mg/分钟，儿科患者为1-3 mg/kg/分钟（或50 mg/分钟，以较低者为准）。
• Hematologic effects reported with use including农业细胞增多症,leukopenia,全年,中性粒细胞减少,血小板减少症, and anemias.
• 苯妥英is a potent inducer of hepatic drug-metabolizing enzymes.
• Increased risk of自杀报告的思想或行为。
• 可能渲染oral contraceptive药丸由于诱导肝代谢而无效。

牙龈的风险增生.

• If rash occurs including toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS报告；onsetof symptoms is usually within 28 days, but can occur later; phenytoin should be discontinued at the firstsignof a rash unless the rash is clearly not drug-related; if signs or symptoms suggest SJS/TEN, discontinue治疗永久考虑替代疗法；评估着装的体征和症状，也称为多器官超敏反应。
• 局部毒性（紫色手套综合征）包括edema, discoloration, and疼痛distal据报道，注射现场以下是peripheral静脉注射（IV）注射；可能与渗出有关或可能不会关联；注射后几天可能不会发展该综合征。
• 由于溶解度差和形成晶体的风险，许多人不建议静脉输注（IV）输注。其他人则说，它可以与正确的溶剂和集中度可行。
• Good for automatic and reentrant arrhythmias, not paroxysmal supraventricular tachycardias (PSVTs).
• 苯托因列出了FDAas one of the drugs to monitor after having identified potential signs of serious risks or new safety information in the agency's不良事件报告系统（AERS）数据库在2011年的最后三个月中。
• Drug interactions resulting in decreased effectiveness of non-depolarizingneuromuscular据报道阻止剂。
• The FDA has not suggested that clinicians stop prescribing any drugs on the watch list or that patients stop taking them; it has, however, advised that patients with questions about watch-list drugs discuss them with their clinician.
• Antiepileptic drugs should not be abruptly discontinued because of the possibility of increased seizure frequency, including status epilepticus.
• 高血糖(hyperglycemia），由药物对胰岛素release reported; phenytoin may also raise serumglucoselevel in patients with糖尿病;use caution.
• Not indicated for seizures resulting from低血糖or othermetabolic原因；应如图所示执行适当的诊断程序。
• Not effective for absence seizures; if tonic-clonic and absence seizures are present, combined drug therapy is needed.
• Sustained serum levels of phenytoin above optimal range may produce confusional states referred to as "delirium", "psychosis", or "encephalopathy", or rarely irreversible cerebellardysfunction;因此，在急性毒性的第一个迹象时，建议血浆水平；如果血浆水平过高，则表明苯妥英钠治疗的剂量降低；如果症状持续存在，建议终止。
• Thelethaldose in pediatric patients is not known; in adults, the lethal dose is estimated to be 2- 5 g; initial symptoms includenystagmus,共济失调, and构造障碍;other signs aretremor, hyperreflexia,lethargy, slurred speech,blurred vision， 恶心和呕吐;死亡是由于respiratoryandcirculatory沮丧.

怀孕and Lactation

• 怀孕exposure注册表可以在怀孕期间监视暴露于抗癫痫药（AED）的妇女（例如AED）的妊娠结局；服用的孕妇应注册北美
• Antiepileptic Drug (NAAED) Pregnancy Registry by calling the toll-free number 1-888-233-2334; it must be done by patients themselves; Information on the registry can also be found on the website http://www.aedpregnancyregistry.org/.
• An increased发病率of重大的malformations (such as orofacial clefts and cardiac defects) and abnormalities characteristic of fetal hydantoin syndrome (dysmorphicskulland facial features,nailanddigit发育不全, growth abnormalities [including小头畸形], andcognitivedeficits) was reported among children born to epileptic women who took phenytoin alone or in combination with other antiepileptic drugs during pregnancy.
• 期间可能发生癫痫发作频率增加pregnancy; periodic measurement of plasma phenytoin concentrations may be valuable to make appropriate dosage adjustments;产后restoration of original dosage will probably be indicated.
• Consider维生素K。出生前一个月补充。
• 苯妥英is secreted in human milk; developmental and health benefits of哺乳should be considered along with the母亲'sclinicalneed for therapy and any potential adverse effects on breastfed infants from phenytoin or the underlyingmaternalcondition.