Dilantin: Uses, Side Effects and Dosage

What is DILANTIN used for?

DILANTIN is used to help:

• control certain types of seizures, called tonic-clonic (grand mal) seizures, and psychomotor (temporal lobe) seizures.
• prevent and treat seizures that may occur during or after surgery to the brain.

How does DILANTIN work?

DILANTIN belongs to a group of medicines called anti-seizure medicines. It works by slowing down electrical impulses in the brain that cause seizures.

What are the ingredients in DILANTIN?

Medicinal ingredients: Phenytoin sodium.

Non-medicinal ingredients: D&C red No. 28 (100 mg only), D&C Yellow No. 10 (30 mg only), FD&C Red No. 3 (30 mg only), FD&C Yellow No. 6 (100 mg only), gelatin, lactose, magnesium stearate, sugar, talc and titanium dioxide.

DILANTIN comes in the following dosage forms:

Capsules: 30 and 100 mg.

DILANTIN is also available as chewable tablets and oral suspensions.

Do not use DILANTIN if you/your child:

• are allergic to phenytoin or any other ingredients in DILANTIN or its container.
• are allergic to other medicines of the hydantoin family, including fosphenytoin.
• take delavirdine (used to treat HIV infection).
• have a heart rhythm condition, such as slow heart rate (bradycardia), heart block, or certain other heart conditions.

To help avoid side effects and ensure proper use, talk to your healthcare professional before you/your child take DILANTIN. Talk about any health conditions or problems you may have, including if you/your child:

• are taking any other medications, supplements or other special treatments.

  • they may interact with DILANTIN, and this can change how well they or DILANTIN works.
  • they include prescription or non-prescription medications, dietary supplements (e.g., vitamins), herbal supplements, nutritional drinks, and enteral feeding preparations.
• have ever had an allergic rash while taking phenytoin or any other anti-seizure medicine.

• have a personal or family history of severe allergic reaction to phenytoin or any other anti-seizure medicines.

  • symptoms can include fever, rash, swollen lymph gland, and liver problems (seen as yellowing of skin and the whites of the eyes)
• drink alcohol occasionally or regularly.
• are 65 years of age or older.

• are female and:

  • are breastfeeding or plan to breastfeed.
  • are pregnant or plan to become pregnant.
  • are using hormonal birth control, such as the birth control pill.
• are of Asian and/or Black descent. You or your child may be at a higher risk of developing serious skin reactions during treatment with DILANTIN.

• have or have had any of the following diseases or conditions:

  • depression, mood problems, or suicidal thoughts or behaviours.
  • diabetes.
  • heart problems, including slow or fast heart rate, or past heart attack.
  • liver or kidney problems.
  • low levels of albumin or high levels of bilirubin in the blood.
  • porphyria (a condition that affects the nervous system and skin). DILANTIN can worsen your condition.
  • immune system problems, such as immune suppression or compromise.
  • are having radiation therapy for the brain and take corticosteroids (medicines used to treat inflammation).
  • a medical condition (such as surgery) that prevents you from taking DILANTIN orally.
  • lactose intolerance, or other conditions that might make it difficult to digest the lactose in DILANTIN capsules.

Other warnings you should know about:

Do not stop your treatment with DILANTIN without first checking with your healthcare professional. This could lead to a sudden worsening of your seizures.

Pregnancy, birth control and breastfeeding:

• Avoid becoming pregnant while you are on DILANTIN. If you become pregnant while taking DILANTIN, your seizures may become worse. Your healthcare professional may change your dose of DILANTIN.
• If you take DILANTIN during pregnancy, your baby is at risk for serious birth defects, and cognitive disabilities. Your baby is also at risk for bleeding problems right after birth.
• If you are pregnant or able to get pregnant, talk to your healthcare professional about using other treatments instead of DILANTIN. If the decision is made to use DILANTIN, you should use effective birth control (contraception) during your treatment. If you are using hormonal birth control, it might not work with DILANTIN. Talk to your healthcare professional about the best kind of birth control to use while you are taking DILANTIN.
• Tell your healthcare professional right away if you become pregnant or think you are pregnant during treatment with DILANTIN. You and your healthcare professional should decide if you will continue to take DILANTIN while you are pregnant.
• Pregnancy Registry: If you become pregnant while taking DILANTIN, talk to your healthcare professional about registering with the North American Antiepileptic Drug Pregnancy Registry. You can enroll in this registry by calling 1-888-233-2334. The purpose of this registry is to collect information about the safety of antiepileptic medicines during pregnancy. Information about the registry can also be found at the website: http://www.aedpregnancyregistry.org/.
• DILANTIN passes into breast milk and may harm your baby. Do not breastfeed during treatment with DILANTIN. Talk to your healthcare professional about the best way to feed your baby during this time.

Driving or using machines: DILANTIN may make you feel dizzy, drowsy and affect your coordination. Avoid driving, using machinery, or doing activities that requires you to be alert until you know how DILANTIN affects you.

Alcohol: Do not drink alcohol while taking DILANTIN without first talking to your healthcare professional. Drinking alcohol while taking DILANTIN may change your blood levels of phenytoin, which can cause serious side effects.

Check-ups and testing:

• Your healthcare professional may ask you to do a genetic test before you take DILANTIN.

  This test will determine if you have a high risk of experiencing serious skin reactions if you are given DILANTIN.

• You will have regular visits with your healthcare professional while you are taking

  DILANTIN to monitor your health. They will:

  • do blood tests to monitor the amount of phenytoin in the body.
  • do scans to check your bone health.
  • talk to you about how you are feeling, and if you have suicidal thoughts and behaviours.
• DILANTIN can cause abnormal blood test results. Your healthcare professional will decide when to perform blood tests and will interpret the results.

DILANTIN can cause serious side effects, including:

• Suicidal thoughts and behaviour changes: This medicine may cause some people to be agitated, irritable, or display other unusual behaviours. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. You may find it helpful to tell a relative or close friend you are taking DILANTIN. Ask them to read this leaflet. You might ask them to tell you if they:

  • think your depression is getting worse, or
  • are worried about changes in your behaviour.

If you have thoughts of harming or killing yourself or others at any time, tell your healthcare professional or go to a hospital right away. Close observation by a healthcare professional is necessary in this situation.

• Bone problems (including osteoporosis, osteopenia, osteomalacia): If you have taken anti-seizure medicines for a long time, it can lead to bone problems. This includes painful and weakened or brittle bones, and possibly bone fractures.
• Gingival hyperplasia (overgrowth of gum tissue around the teeth): Talk to your healthcare professional about the best way to care for your teeth, gums, and mouth during your treatment with DILANTIN. It is very important that you care for your mouth properly to decrease the risk of gum damage.

See the Serious side effects and what to do about them table for more information on these and other serious side effects.

Tell your healthcare professional about all the medicines you/your child take, including any drugs, vitamins, minerals, natural supplements or alternative medicines.

Serious Drug Interactions

DILANTIN may interact with a number of other medicines. Your healthcare professional will monitor you while you are taking DILANTIN to ensure you are taking the dose that is right for you.

DILANTIN must not be taken with delavirdine, used to treat HIV infection.

The following may interact with DILANTIN:

• medicines used to treat or prevent:

  • seizures or epilepsy (other than DILANTIN)
  • bacterial, fungal and parasitic infections
  • HIV infection
  • cancer
  • high blood pressure or certain heart conditions
  • high blood cholesterol
  • high blood sugar
  • blood clots (anticoagulants)
  • depression and other psychological conditions
  • anxiety or alcohol withdrawal
  • pain and inflammation
  • excess stomach acid or ulcers,
  • medicines used to suppress your immune system, and
  • medicines used as a muscle relaxant for intubation or surgery

• these medicines:

  • birth control pills and other birth control methods that use hormones
  • theophylline, used to treat asthma or other breathing problems
  • furosemide, used to lower extra fluid levels
  • halothane, used for general anesthesia
  • methadone, used to treat pain and opioid dependence
  • corticosteroids, used to treat inflammation
  • diazoxide, used to treat low blood sugar

• other supplements:

  • St. John’s Wort, a herbal remedy
  • vitamin D, vitamin B9 (folic acid)
  • tube feeding preparations and related nutritional drinks or supplements
• alcohol.

This is not a complete list.

How to take DILANTIN:

• Always take DILANTIN exactly as your healthcare professional has told you to. They will decide on the dose that is right for you/your child. Never increase or decrease your dose without talking to your healthcare professional.

• Do not stop taking DILANTIN without talking to your healthcare professional. Stopping

  DILANTIN suddenly can cause serious problems, including seizures that will not stop. Your healthcare professional will tell you if and when you/your child can stop taking this medicine.

• Do not take capsules that are discoloured.
• Tell your healthcare professional if you/your child have difficulty swallowing the capsules. They may prescribe you the oral suspension (DILANTIN-30 SUSPENSION, DILANTIN-125 SUSPENSION) or chewable tablets (DILANTIN INFATABS) instead.

Usual dose:

Adults:

• Usual initial dose: 300 mg total a day, divided into 3 doses (one 100 mg capsule, three times a day). Your DILANTIN dose may be adjusted according to the effect it has, and to the level of medicine in your blood.
• Usual dose: 300 - 400 mg total a day, in divided doses. Your healthcare professional may adjust your dose if necessary. In some cases they may recommend that you take 300 mg once a day (3 capsules of 100 mg, taken together once a day). Follow your healthcare professional’s instructions carefully.

Children (below 18 years of age):

• Your child’s healthcare professional will determine the right dose based on your child’s weight. Follow their instructions carefully.
• Usual initial dose: A total of 5 mg/kg/day (5 mg per day for every kg they weigh), to be divided and given in 2 or 3 doses. Your child’s DILANTIN dose may be adjusted according to the effect it has, and to the level of medicine in their blood. The maximum dose is 300 mg (total) a day.
• Usual dose: 4 to 8 mg/kg/day, in divided doses. Children over 6 years old may require the minimum adult dose (300 mg/day).

Overdose:

Signs of an overdose with DILANTIN include:

• blurred vision, involuntary eye movements (side-to-side, up and down, circular motion),
• lack of muscle control or coordination, shaking (tremors), overactive reflexes,
• low blood pressure, slow heart rate, poor blood circulation, heart suddenly stops beating (cardiac arrest),
• feeling sleepy or tired, lack of energy,
• slurred or slow speech,
• nausea or vomiting,
• slow and ineffective breathing,
• coma.

If you think you, or a person you are caring for, have taken too much DILANTIN, contact a healthcare professional, hospital emergency department, or regional poison control centre immediately, even if there are no symptoms.

Missed Dose:

If you/your child miss a dose, take it as soon as you remember. However, if it is almost time for the next dose, skip the missed dose and take your next dose as scheduled. Do not take a double dose to make up for the missed dose.

What are possible side effects from using DILANTIN?

These are not all the possible side effects you may have when taking DILANTIN. If you experience any side effects not listed here, tell your healthcare professional. Side effects may include:

• high blood sugar. If you have diabetes, closely monitor your blood sugar while taking

  DILANTIN.

• spinning or dizziness (vertigo)
• trouble falling asleep, or feeling sleepy
• nausea or vomiting, constipation
• nervousness
• headache
• burning or prickling sensation on the skin (sometimes called “pins and needles”)
• changes in facial features
• additional body and facial hair
• change in tastes

Serious side effects and what to do about them

Serious side effects and what to do about them

Serious side effects and what to do about them

If you have a troublesome symptom or side effect that is not listed here or becomes bad enough to interfere with your daily activities, tell your healthcare professional.

Reporting Side Effects

You can report any suspected side effects associated with the use of health products to Health Canada by:

• Visiting the Web page on Adverse Reaction Reporting

  (https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/adverse-reaction-reporting.html) for information on how to report online, by mail or by fax; or

• Calling toll-free at 1-866-234-2345.

NOTE: Contact your health professional if you need information about how to manage your side effects. The Canada Vigilance Program does not provide medical advice.

Storage:

• Store between 15 - 30°C. Protect from light and moisture.
• Keep out of reach and sight of children.

If you want more information about DILANTIN:

• Talk to your healthcare professional
• Find the full product monograph that is prepared for healthcare professionals and includes this Patient Medication Information by visiting the Health Canada website: (https://www.canada.ca/en/health-canada/services/drugs-health-products/drug- products/drug-product-database.html); the manufacturer’s website http://www.viatris.ca, or by calling 1-844-596-9526.

Last Revised JUN 07, 2023

BGP Pharma ULC

Etobicoke, Ontario

M8Z 2S6

® Viatris Specialty LLC

BGP Pharma ULC, a Viatris company, Licensee

© BGP Pharma ULC, 2023