Abstract

PHENYTOIN TOXICITY AND IT’S MANAGEMENT - A SYSTEMATIC REVIEW

Shaik Ujefa*, Ede Sri Lakshmi, Golla Supriya, Dhanush Bellapu and Kantamaneni Padmalatha

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Abstract

Phenytoin toxicity occurs when serum levels exceed the therapeutic level, leading to symptoms such as nystagmus, slurred speech, and decreased coordination. This toxicity is sometimes caused by drug interactions. Phenytoin is one of the most commonly used anticonvulsants in the developing world, but lack of monitoring and concurrent medications can easily lead to toxicity. Phenytoin toxicity may be brought on by dosage variations, medication interactions, physiologic changes, or intentional overdose. In more severe situations, seizures, a depressed conscious state, and coma may also occur. Nevertheless, nausea and central nervous system dysfunction— particularly disorientation, nystagmus, and ataxia—are the most common symptoms of intoxication. Ingestion of phenytoin rarely results in cardiac problems such arrhythmias and hypotension, although parenteral administration of phenytoin or fosphenytoin may cause them. Intoxication with phenytoin alone is unlikely to result in death. Zero-order pharmacokinetics can cause a significantly lengthened half-life in overdoses, which can lead to prolonged symptom duration and, consequently, longer hospitalisation with its associated problems. Supportive care is the mainstay of treatment for a person suffering from phenytoin intoxication. No antidote exists, and there is no proof that gastrointestinal cleaning or increased excretion techniques improve outcomes. If a patient shows up early, activated charcoal should be taken into consideration; nevertheless, the use of multiple-dose activated charcoal is debatable. Increased clearance rates have been demonstrated in experimental trials, however this impact has not been converted into a therapeutic benefit. There is no proof that intrusive techniques for enhancing elimination, such plasmapheresis, hemodialysis, or hemoperfusion, are beneficial in any way. The pharmacokinetics of phenytoin and the clinical signs and symptoms of toxicity are briefly discussed in this article, followed by a thorough analysis of the various treatment options.

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