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Doctors' Answers to "Frequently Asked Questions" - Dilantin


These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 09/20/2000]
Question: I read that Dilantin may safely treat anxiety, depression, and low energy and aid concentration at a dose of 100 mg per day. I experience these symptoms frequently, although they are fairly mild, so I would like to try Dilantin. I have successfully treated my mild depression with St. John's Wort, but Dilantin at this dosage is much less expensive. Is is safe to drink alcohol while taking 100 mg of Dilantin daily? Also, would it interfere with the use of Doxicyclene to treat acne?

Answer: Not a usual treatment for this problem and potentially a toxic drug. Alcohol is probably ok, depending on how much sedation you experience.

[posted 06/18/2000]
Question: can dilantin be given for depression and how useful
is it?

prozac does not work
please give me the name of the best drug for depression

Answer: Dilantin is usually of no help in depression. There are several classes of drugs that are useful in depression and the effectiveness varies by individual. You need to stick with one md who is comfortable using the different medications and go through them one at a time.

[posted 04/6/2000]
Question: Following a grande-mal seizure, I was diagnosed with a brain metastasis from a primary lung tumor. The brain met was treated sucessfullt with Gamma-Knife. Subsequently I had partial seizures. I started with Dilantin and after 4 weeks developed a whole-body rash. I was then given Tegretol and Depakote but the rash stayed on for 8 weeks. I was then taken off Tegretol and Depakote, given Neurontin 1500 mg. per day and 60mg Prednisone per day. Immediately the itching went away and the rash faded. Now, 3 weeks later I have tapered off the Prednisone and the rash is coming back -- slowly but much the same. Could the Neurontin be the culprit or might this be a flare-up of the original rash precipitated by the Prednisone taper?

Answer: Probably the original rash, the rash from dilantin often lasts up to 2-3 months. But, if it persists another couple of weeks, you need further testing. The neurontin would rarely be a suspect with rashes.

[posted 03/18/2000]
Question: I have been on Dilantin for almost two years now and I believe I am experiencing some of the side effects.
I was just wondering if it is possible to experience these side effects after being on the medication for this long.
I take 4/100mg pills a day. The side effects I believe I am having are mood swings, I have a hard time controlling my
emotions. I am a University student and I feel like I cannot concentrate on my classes and that I am almost feeling
dumber when I compare myself to when I was not on the medication. I also am having problems remembering things, mostly my short
term memory. The best way I can describe myself is that I feel very unbalanced, I would not say it's depression, but I do
feel like I am basically skipping a beat so to speak. Any insight into what I have said would be greatly appreciated.
Thank you.

Answer: There are several possible problems with dilantin. One is an allergic type reaction that can occur at any time and comes with a rash, fever, confusion etc. Possibly this is what is going on, but sounds somewhat atypical. Another, is that your dosage is too high. If above 20, you'll act somewhat drunk. Have your md check your levels if this hasn't been done recently.

[posted 02/11/2000]
Question: I've been on Dilantin for approx. 2 year for seizures.
I was told of the possibility of effects on the gums, and that I'd be an unlikely candidate, but that was the only
side effect brought to my attention.

Last summer I had a terrible outbreak of cystic pimples on my face (at 40 years old), such that I was inclined to stay indoors. I went to a dermatologist and was brought under control with antibiotics. While it was never confirmed what the outbreaks were from, I thought it may have been staph or similar from a pollution/sewage problem at my local beach. The outbreak returned, but was brought under control again with antibiotics and topical treatment.

Just today in a sepearate discussion about Dilantin, Accutaine, I was told that Dilantin can cause cystic outbreaks. I've search high and low on the internet to find something, but this is not stated anywhere I've looked.
Hoping I could get this cleared up.
Thanks



Answer: Not one that I've seen. I would contact the scientific department of Parke-Davis-800-223-0432-they can direct you to any studies/research here.

[posted 11/22/1999]
Question: Recently I experienced an increase in my dilantin level to 52 on one occasion and 42 on another. This led to grand mal seizure activity which I had never experienced. I have been treated since 1958 for absence or petit mal seizures, no one knows which for sure.
At the time of the increased dilantin level there had been no changes in my lifestyle and no apparent reason for the increase..except one possibility. Because of a heart murmur, my dentist, in corroboration with a cardiologist at Kaiser, insists that I take an antibiotic before each appointment. Two days before the discovery of the increased dilantin level, I had taken four capsules of amoxicillin 500mg. This situation of increased dilantin level occured twice, coincidentally a few days after the intake of amoxicillin. No other medication was administered by the dentist including novacaine. My neurologist and pharmacist insist there is no connection but neither do they have an explanation for the increased dilantin levels. On one trip to ER following a seizure, the doctor on duty asked me if I had taken an antibiotic but at that time I didn't remember the amoxicillin and when I mentioned it to my neurologist she insited there was no connection.Is there any other possible answer?

Answer: Easy to check daily levels prior to during and after use of the antibiotic. Sounds like the metabolism is changing due to the drug. You might call the company for more information Parke-Davis 800-223-0432.

[posted 11/15/1999]
Question: I had two surgeries in July 1998 to remove a tumor (neurocytoma)
My Doctor put me on Dilantin...400mg a day. I had had the
tumor since I was a baby...i had one cell when i was born..and
all my life i've been overweight..my doctor said that after
surgery and 6 1/2 weeks of radiation...when i got my immune
system back to normal and started getting active again...that
I could lose up to 80 pounds...well i've done everything...
i've joined the local "YMCA," go walking with my friends 3
times a week and, above all i've changed my eating habits...
but I haven't lost any weight...i was wondering if it was the
dilantin...does this drug make you retain water, gain weight,
...it seems like no matter what i do...i can't lose weight.
HELP...ALL I WANT TO DO IS LOSE SOME WEIGHT...BUT EVERYTHING
I TRY SEEMS USELESS...

Thank you for your time concerning this matter.

Sincerely,
Kristi Bruce

Answer: It's not the dilantin, but I really have no idea why resection of the tumor would cause you to loose weight.

[posted 08/16/1999]
Question: I had a hysterectomy on 7/22/99. I was taking Dilantin after my brain aneurism, but I hated the side effects. I stopped taking it in 1997. I hadn't had any seizures, until after surgery (the hysterectomy)
I had two that night. They put me on Dilantin, but now say I can't take the replacement hormones. I am now taking 12 Dilantin a day. I am trying to get an answer as to how those two things react with one
another. Please help me if you can. My doctor always seems to busy or hurried to have time to answer my questions.
Thank you.

Answer: For the life of me, I don't understand the logic. It does change the metabolism,but blood levels are all that one needs to follow this. By the way 12 Dilantin is a huge dosage. Have you had your blood levels checked?

Can OTC Headache Medications be Taken with Dilantin   [posted 12/10/98]
Question: My father is taking dilantin and sometimes having headaches and a fever. Is tylenol safe to take or is it contraindicated?

Answer: Tylenol is safe in small doses.

Getting Off Dilantin   [posted 12/08/98]
Question: Someone I know was put on 300 mg Dilantin daily and has been on it for approx 3 years. He had an aneurysm and they put him on it as as "just in case" he had no seizure. Now no doctor will help him discontinue the dilantin and he is attempting to discontinue it on his own, please give me any info you can to help, thank you

Answer: If his EEG is normal, then just decrease the dosage 100 mg a week or so. There should be no withdrawal syndrome, just a risk of seizure.

Dilantin for Insomnia  [posted 12/02/98]
Question: Have you ever heard of dilantin prescribed for chronic insomnia (insomnia characteristics are constant arousal from sleep, lack of deep sleep, and inability to return to sleep because of "over active" brain)?

Answer: Yes, but, uncommonly used-sometimes of help with restless leg syndrome.

Dilantin Levels [posted 11/11/98]
Question: When level is to low possible side effects?

Answer: Usally a serum level of 10 is the lowest that we like to achieve to keep seizures under control. The dosage to do this varies widely and one usually follows blood levels with this drug.

Can Dilantin Cause My Rash? [posted 10/9/98]
Question: I have been taking Dilantin for 5 months, for the second time. The first time, around 8 years ago, I developed a rash immediately and had to switch to another antiseizure medication: Depakote. Recently, I had to switch from Depakote due to low platelet count. I went on Dilantin, as Tegretol had not agreed with me either, and within six weeks had pancreatitis, not explained by any other physical problem. I now have an itchy rash and red hives all over me. I think it is the Dilantin but my doctor says it is not possible since I was on it for 3 months with no rash. She will not change me from it and has refered me to a dermatologist. What can I do and could it be the Dilantin, again? If so, what else could I take?

Answer: Get another doctor, it is probably the dilantin. Have you tried Neurontin?

Dilantin
Question: I have been on 250mg of dilantin daily for 17 years. Three years ago I started having some pain where my liver is, and the doctor found out that my enzymes were high-- sgot 53, sgpt 112, and ggt 1052. They gave me a MRI but found nothing. Hepatitis tests were negative. While they were doing all these tests the symptoms went away. I attributed it at the time to exercising and better eating habits. Now recently I just have had my bloodwork redone and the enzymes have gone up. The sgot 95, sgpt 142, ggt1098, and alk.phos is 258. I have no symptoms and feel really good. I have a hard time pinpointing a doctor. Should I go to a family doctor and a liver specialist? The liver specialist three years ago said not to worry about my enzymes, and if the symptoms come back to go back to him and he will possibly do a liver biopsy. What effect do you think dilantin has on this?

Answer: The only way to know is to either get the liver biopsy or to stop the dilantin and switch to another seizure drug. Unfortunately, almost every drug has potential liver toxicity listed as a side effect. I doubt that Dilantin would cause this problem several years out, but a drug vacation(using another seizure drug) might answer your question.

PSA Levels
Question: My father is 63 years old. He is on Dilantin 300mg daily since a brain surgery 8 years ago. During a routine blood test recently, his PSA level was 6.4ng/ml. He usually needs to get up twice a night to urinate. His physician performed a rectal examination and ultrasound and prescribed him Ofloxacin 200mg twice daily and Cardura 1mg daily for 1 month. After 1 month, the PSA level dropped to 6.08ng/ml. He was then prescribed Doxycycline 200mg twice a day and Cardura 1mg daily for another month. However, after 4 days, my father developed serious nausea and vomiting and was hospitalized. A gastroscopy was performed and subsequently found to be H Pylori positive. His PSA level dropped to 4.7ng/ml.

Answer: When there is mild elevation of the PSA it could either be due to hypertrophy, prostatitis or early cancer. Physicians will often treat men for prostatitis and if there is a subsequent drop in PSA, it obviates further testing including biopsy. I have done the same in my office on many occasions and it appears to have worked in your father with the continued drop in PSA, he probably had a mild infection in the prostate which was contributing to the elevated PSA. Doxycycline certainly can cause nausea, ofloxacin less commonly so. Hard to know if his was due to the doxycycline or not -certainly was time related. I would take Cardura based on his symptoms of outlet obstruction; not based on the PSA. If he is getting up several times or having trouble with a decreased stream then Cardura or Hytrin would be useful. If only to treat the PSA then it will have little effect.(PS Doxycycline is one of the treatment drugs for H. Pylori)



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