Fosphenytoin

Description

Fosphenytoin is an anticonvulsant used to treat severe epileptic seizures or fits (status epilepticus). It is also used to control and/or prevent seizures that may occur during or after brain surgeries or severe head injuries. It is also used in situations where the patient is not able to take oral antiepileptic medicines.

Side effects

Major & minor side effects for Fosphenytoin

  • Blurred vision
  • Dizziness and fainting
  • Confusion
  • Redness of the skin especially on the face and neck
  • Headache
  • Excessive sweating
  • Unusual tiredness or weakness
  • Anxiety
  • Burning, numbness, tingling in the arms and feet
  • Difficulty in speaking (dysphonia)
  • Dry mouth
  • Fast, pounding, or irregular heartbeat
  • Shaking and trembling of arms and feet
  • Sleep disturbances
  • Nausea or Vomiting
  • Abdominal pain
  • Black or tarry stools
  • Bluish discoloration of lips, fingernails, palm, or hands
  • Change in the frquency of urination
  • Joint pain
  • Heartburn and indigestion
  • Change in color, odor of vaginal discharge
  • Changes in weight

Uses of Fosphenytoin

What is it prescribed for?

  • Status Epilepticus
  • Epilepsy
Read More
Concerns

Commonly asked questions

  • Onset of action
    The amount of time taken by this medicine to show its effects is subject to variations based on the route of administration. It starts showing its effects immediately after an intravenous administration while the time taken is around 30 minutes upon intramuscular administration.
  • Duration of effect
    The amount of time for which this medicine remains active in the body is not clinically established.
  • Safe with alcohol?
    Consumption of alcohol is not recommended during treatment with this medicine due to the increased risk of serious adverse effects including slurred speech, loss of balance, lightheadedness, fainting, weakness, difficulties with breathing, etc.
  • Is it habit forming?
    No habit-forming tendencies were reported.
  • Usage in pregnancy?
    This medicine is not recommended for use in pregnant women unless absolutely necessary. Your doctor will determine the best course of treatment after evaluating the potential benefits and risks associated with the use of this medicine.
  • Usage while breast-feeding?
    This medicine is not recommended for use in breastfeeding women unless absolutely necessary. Your doctor will determine the best course of treatment after evaluating the potential benefits and risks associated with the use of this medicine.

Allergy

This medicine is not recommended for use in patients with a known allergy to fosphenytoin, phenytoin, any other medicines belonging to the hydantoin group, or any other inactive ingredients present in the formulation.

Heart rhythm disorders

This medicine is not recommended for use in patients suffering from heart rhythm disorders such as sinus bradycardia, sino-atrial block, second or third-degree AV-block, Adams-Stokes syndrome, etc. due to the increased risk of worsening of the patient's condition.

Acute intermittent porphyria

This medicine is not recommended for use in patients suffering from acute intermittent porphyria, a rare metabolic disorder that affects the formation of red blood cells in the body, since it may worsen the patient's condition.

Delavirdine

This medicine is not recommended for use in patients receiving delavirdine, an antiviral medicine used for the treatment of an HIV infection, since it may worsen the patient's condition.
Warnings for special population

Pregnancy

This medicine is not recommended for use in pregnant women unless absolutely necessary. Your doctor will determine the best course of treatment after evaluating the potential benefits and risks associated with the use of this medicine.

Breast-feeding

This medicine is not recommended for use in breastfeeding women unless absolutely necessary. Your doctor will determine the best course of treatment after evaluating the potential benefits and risks associated with the use of this medicine.
General warnings

Other medicines

This medicine may interact with many other medicines and may cause significant side effects. Hence, it is advised that you report all your current medicines to your doctor, including any herbs and supplements, before receiving this medicine.

Phenytoin equivalence

The dose of this medicine is always expressed in terms of phenytoin equivalence (PE) i.e., 1 mg PE is equivalent to 1 mg of phenytoin. Hence, dose adjustments are not recommended when switching from fosphenytoin to phenytoin or vice versa.

Liver diseases

This medicine should be used with caution in patients with a history of liver diseases due to the increased risk of worsening of the patient's condition. Close monitoring of liver function tests, appropriate dose adjustments, or replacement with a suitable alternative may be necessary based on the patient's clinical condition.

Kidney diseases

This medicine should be used with caution in patients with a history of kidney diseases due to the increased risk of worsening of the patient's condition. Close monitoring of kidney function tests, appropriate dose adjustments, or replacement with a suitable alternative may be necessary based on the patient's clinical condition.

Elevated blood glucose levels

This medicine should be used with caution in patients suffering from diabetes or patients predisposed to hyperglycemia due to the increased risk of elevated blood glucose levels. Close monitoring of blood sugar levels, appropriate dose adjustments, or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.

Abrupt withdrawal

Use of this medicine should not be discontinued abruptly since this may increase the frequency of seizures. It is advised to reduce the dose gradually except in the event of severe allergic reactions where an alternative therapy may be necessary.

Cardiovascular events

Use of this medicine has been associated with a severe fall in blood pressure and heart rhythm disorders. Hence, it is recommended to use this medicine only in cases where oral phenytoin cannot be administered. The patient should be switched to oral phenytoin as soon as possible (within 5 days).

CNS events

Use of this medicine may cause delirium, psychosis, encephalopathy, etc. in some patients. Close monitoring of serum concentrations of this medicine is advised during therapy. Appropriate corrective measures, dose adjustments, or replacement with a suitable alternative may be necessary based on the patient's clinical condition.

Severe allergic reactions

Use of this medicine may cause severe and potentially life-threatening allergic reactions such as Stevens-Jonhson syndrome or toxic epidermal necrolysis in some patients. Use of this medicine should be discontinued and alternative therapy should be initiated if signs and symptoms suggestive of a severe allergic reaction occur.

Local toxicity

Use of this medicine may cause edema, discoloration, and pain near the injection site (Purple glove syndrome). These symptoms may develop for up to several days after the last administration of this medicine. Report any such symptoms to the doctor immediately.

Missed Dose

Since this medicine is usually administered in a hospital/clinic, the likelihood of missing a dose is very low. However, if you miss a scheduled appointment for a dose of this medicine, contact your doctor immediately for further instructions.

Overdose

Since this medicine is usually administered in a hospital/clinic, the likelihood of an overdose is very low. However, emergency medical treatment will be instituted by your doctor if an overdose is suspected.
All drugs interact differently for person to person. You should check all the possible interactions with your doctor before starting any medicine.
Interaction with Alcohol

Description

N/A

Instructions

Consumption of alcohol is not recommended during treatment with this medicine due to the increased risk of serious adverse effects including slurred speech, loss of balance, lightheadedness, fainting, weakness, difficulties with breathing, etc.
Interaction with Medicine

Abiraterone

Caspofungin Acetate

Quetiapine

Dolutegravir

Artemether

Naloxegol

Dabigatran

Amlodipine

Fluconazole

Albendazole

Voriconazole

Carbamazepine

Betamethasone

Aminophylline

Ethinyl Estradiol

abemaciclib

Paracetamol

Atorvastatin

Everolimus

Apremilast

Desogestrel

Ticagrelor

Disease interactions

Liver Disease

This medicine should be used with caution in patients with a history of liver diseases due to the increased risk of severe adverse effects. Close monitoring of liver function tests, appropriate dose adjustments, or replacement with a suitable alternative may be necessary in some cases based on the patient's clinical condition.

Kidney Disease

This medicine should be used with caution in patients with a history of kidney diseases due to the increased risk of severe adverse effects. Close monitoring of kidney function tests and serum concentration of the medicine, appropriate dose adjustments, or replacement with a suitable alternative may be necessary based on the patient's clinical condition.

Depression

This medicine should be used with caution in patients with a history of depression or other psychiatric disorders since it may increase the risk of suicidal thoughts and behavior. Close monitoring of the patients for any changes in behavior and mood is advised. Appropriate dose adjustments or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.

Diabetes Mellitus

This medicine should be used with caution in patients suffering from diabetes mellitus due to the increased risk of elevated blood sugar levels. Close monitoring of blood sugar levels, appropriate dose adjustments, or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.

Megaloblastic anemia

This medicine should be used with caution in patients suffering from megaloblastic anemia or folate deficiency due to the increased risk of worsening of the patient's condition. Appropriate corrective measures, dose adjustments, or replacement with a suitable alternative may be necessary based on the clinical condition of the patient.
Food interactions
Information not available.
Lab interactions
Information not available.
This medicine is administered in the hospital/clinical setting by a qualified healthcare professional. Follow all the instructions given by your doctor. Inform the doctor if you have a known history of allergy to this medicine. Report to the doctor all your current medicines including any herbs and supplements as well as your medical history before receiving this medicine.
Miscelleneous

Usage does not depend on food timings

To be taken as instructed by doctor

May cause sleepiness

How it works
This medicine decreases the abnormal electrical activity in the brain and thus controls the seizures/fits.
Legal Status

Approved

Approved

Approved

Approved

Classification

Category

Hydantoin anticonvulsants

Schedule

Schedule H

[Internet]. Medicines.org.uk. 2018 [cited 12 September 2018]. Available from:

https://www.medicines.org.uk/emc/files/pil.2260.pdf

[Internet]. Accessdata.fda.gov. 2018 [cited 12 September 2018]. Available from:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2007/078052s000lbl.pdf

DailyMed - Fosphenytoin sodium injection, solution [Internet]. Dailymed.nlm.nih.gov. 2018 [cited 12 September 2018]. Available from:

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=b60c9c82-e5c7-4e05-98c7-5bbba4af04b2

Fosphenytoin [Internet]. Pubchem.ncbi.nlm.nih.gov. 2018 [cited 12 September 2018]. Available from:

https://pubchem.ncbi.nlm.nih.gov/compound/Fosphenytoin#section=Top

Fosphenytoin - DrugBank [Internet]. Drugbank.ca. 2018 [cited 12 September 2018]. Available from:

https://www.drugbank.ca/drugs/DB01320

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Information on this page was last updated on 12 Sep 2018

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