The therapeutic range is 10-20 mcg/mL. Total phenytoin levels (mcg/mL) and typical corresponding signs and symptoms are as follows: Lower than 10 – Rare.
What should your Dilantin level be?
Results are given in micrograms per milliliter (μ/mL). The normal therapeutic range for children and adults is 10 to 20 μ/mL (8 to 15 μ/mL in newborns).
What are symptoms of high dilantin levels?
- Coma.
- Confusion.
- Staggering gait or walk (early sign)
- Unsteadiness, uncoordinated movements (early sign)
- Involuntary, jerky, repeated movement of the eyeballs called nystagmus (early sign)
- Seizures.
- Tremor (uncontrollable, repeated shaking of the arms or legs)
- Sleepiness.
How do you interpret phenytoin levels?
Toxic phenytoin levels are defined as greater than 30 µg/mL. Lethal levels are defined as greater than 100 µg/mL. The reference range of free phenytoin is 1-2.5 µg/mL. In patients with renal failure associated with hypoalbuminemia, free phenytoin levels may be more accurate than total phenytoin levels.How often should a Dilantin level be checked?
A level can be taken 2-4 hours following an IV loading or top-up dose (12-24 hours for oral doses) and levels should then be monitored every 24 hours until control is achieved and concentration has stabilised.
What causes low Dilantin levels?
Drugs which may decrease phenytoin levels include: carbamazepine, chronic alcohol abuse, reserpine, and sucralfate. Moban® brand of molindone hydrochloride contains calcium ions which interfere with the absorption of phenytoin.
What is toxic level of Dilantin?
Thirty to 40 mg/L: Ataxia, slurred speech, tremor, nausea, and vomiting. Forty to 50 mg/L: Lethargy, confusion, hyperactivity. Greater than 50 mg/L: Coma and seizures.
How do you monitor Dilantin levels?
Laboratories often report the value in g/L instead (g/dL = g/L x 0.1). After a patient has received a loading dose of intravenous phenytoin, levels can be checked one hour after the dose. If loading is achieved by oral dosing, phenytoin levels can be checked 24 hours after the last dose10.When do you draw a Dilantin level?
Drawing levels: -Determine serum digoxin levels at least 6 to 8 hours after the last regardless of the route of administration in order to allow sufficient time for drug distribution. -Optimal timing: 12 to 24 hours after a dose or initial loading dose.
How do you adjust phenytoin levels?A rough guide to making an adjustment to the daily dose that should increase a serum level without leading to supratherapeutic / toxic levels is: If the phenytoin concentration is < 7 mcg/mL, the dose may be increased by 100 mg/day. If the phenytoin concentration is 7-12 mcg/mL, the dose may be increased by 50 mg/day.
Article first time published onWhat is a major complication of status epilepticus?
Acute complications result from hyperthermia, pulmonary edema, cardiac arrhythmias, and cardiovascular collapse. Long-term complications include epilepsy (20% to 40%), encephalopathy (6% to 15%), and focal neurologic deficits (9% to 11%).
How fast do Dilantin levels drop?
This is the amount of time it takes for the levels of the drug in the body to be reduced by one-half. When taken orally, Dilantin has a 22-hour plasma half-life and peaks 4 to 12 hours after ingestion. With intravenous administration, that half-life drops to 10 to 15 hours.
What are the usual signs of acute phenytoin toxicity?
Unsteady gait, dizziness/vertigo, nausea/vomiting, general weakness, and drowsiness were the most common presenting symptoms.
What pregnancy category is Dilantin?
Pregnancy Category D; See WARNINGS section. To provide information regarding the effects of in utero exposure to Dilantin, physicians are advised to recommend that pregnant patients taking Dilantin enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry.
Can you take vitamin D with Dilantin?
Dear Seizure patient, The biggest thing to know, related to vitamin supplementation while taking this medications involves your vitamin D levels. Long term use of phenytoin (Dilantin) can deplete your vitamin D levels leading to the potential for other problems.
Is phenytoin a high risk medication?
The high-alert medications were: amiodarone, digoxin, dopamine, epinephrine, fentanyl, gentamycin, heparine, insulin, morphine, norepinephrine, phenytoin, potassium, propofol and tacrolimus.
What is the major concern after administering phenytoin to a patient with seizure?
Nervous System: The most common adverse reactions encountered with phenytoin therapy are nervous system reactions and are usually dose-related. Reactions include nystagmus, ataxia, slurred speech, decreased coordination, somnolence, and mental confusion.
What color vacutainer would be used for a Dilantin level?
Specimen Requirements Red-top tube or green-top (heparin) tube. Do not use a gel-barrier tube. The use of gel-barrier tubes is not recommended due to slow absorption of the drug by the gel.
What is free Dilantin level?
The range for percent free phenytoin is 8% to 14%. However, response and side effects will be individual. In patients with renal failure, total phenytoin is likely to be less than the therapeutic range of 10.0 to 20.0 mcg/mL. Severe toxicity occurs when the total blood concentration exceeds 30.0 mcg/mL.
What are the indications of an abnormal phenytoin serum level?
Between 20 and 30 – Nystagmus. Between 30 and 40 – Ataxia, slurred speech, nausea, and vomiting. Between 40 and 50 – Lethargy and confusion. Higher than 50 – Coma and seizures.
When is corrected phenytoin level used?
Corrects serum phenytoin level for renal failure and/or hypoalbuminemia. Use in patients with albumin ≤3.2 g/dL (32 g/L). The “Sheiner-Tozer Equation” is the official name of this correction.
What is the difference between epilepsy and status epilepticus?
If you have epilepsy, you may have seizures repeatedly. A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus.
What are three major seizures?
- Generalized onset seizures:
- Focal onset seizures:
- Unknown onset seizures:
What type of seizure does the person lose consciousness?
A grand mal seizure causes a loss of consciousness and violent muscle contractions. It’s the type of seizure most people picture when they think about seizures. A grand mal seizure — also known as a generalized tonic-clonic seizure — is caused by abnormal electrical activity throughout the brain.
Is Dilantin good for seizures?
Dilantin (phenytoin) is an anti-epileptic drug, also called an anticonvulsant. It works by slowing down impulses in the brain that cause seizures. Dilantin is used to control seizures. Phenytoin does not treat all types of seizures, and your doctor will determine if it is the right medicine for you.
What type of seizures does phenytoin treat?
Phenytoin is effective for treating generalized tonic-clonic seizures, partial seizures with or without generalization, and convulsive status epilepticus.
What is the difference between Dilantin and phenytoin?
Phenytoin is the generic name of a widely used antiepileptic drug (AED). In the United States, phenytoin is known by the brand names Dilantin and Phenytek (an extended-release form).
Can Dilantin cause birth defects?
Fetal hydantoin syndrome is a characteristic pattern of mental and physical birth defects that results from maternal use of the anti-seizure (anticonvulsant) drug phenytoin (Dilantin) during pregnancy. The range and severity of associated abnormalities will vary greatly from one infant to another.
How does Dilantin affect pregnancy?
Phenytoin is a medication used to treat epilepsy (seizure disorder). If phenytoin is taken by the mother in the first trimester, there is approximately a 5 to 10 percent chance that the baby could be born with a combination of birth defects known as the Fetal Hydantoin Syndrome.
Is phenytoin bad for pregnancy?
Phenytoin is a medicine used to treat seizures (epilepsy). But the medicine can cause birth defects if a woman takes it during pregnancy. A baby born to a mother who took phenytoin has a 5 in 100 to a 1 in 10 chance of having a birth defect.
