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.

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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