What are the possible affects of reducing Phenytoin?

Question

I've been taking 275mg of phenytoin for 22 years now. Since I started taking lamotragine alongside it, my seizures have reduced dramatically and the neurologist wants to get me off the phenytoin altogether. I'll be reducing it by 25mg each week. What side affects am I likely to notice - am I likely to feel more anxious, jittery or short-tempered for a while?

Answer 1

I switched from Dilantin (phenytoin) to Lamictal (lamotragine) 5 years ago taking both at the same time during the switch; reducing Dilantin and ramping up Lamictal. I don't recall having any side effects during the switch. Looking back, I was definitely more aware of the fact that I was taking Dilantin, I would feel "weird" if I missed a dose or took it late. I don't have any of that with the Lamictal. I haven't had a seizure in 7 years. I went in to get blood work during the switch so they could keep track of the levels in my system. It's not a bad idea to also keep track of how you're feeling too.

Answer 2

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What are the possible affects of reducing Phenytoin?
I've been taking 275mg of phenytoin for 22 years now. Since I started taking lamotragine alongside it, my seizures have reduced dramatically and the neurologist wants to get me off the phenytoin altogether. I'll be reducing it by 25mg each week. What side affects am I likely to notice -...

Answer 3

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Answer 4

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This is a complete interaction list, as you can see it does not interact with the pill. Interaction studies have only been performed in adults. Half-life: The long elimination half-lives of both fluoxetine and norfluoxetine should be borne in mind (see section 5.2) when considering pharmacodynamic or pharmacokinetic drug interactions (e.g., when switching from fluoxetine to other antidepressants). Monoamine oxidase inhibitors: See section 4.3. Not recommended combinations: MAOI-A (see section 4.3). Combinations requiring precautions for use: MAOI-B (selegeline): Risk of serotonin syndrome. Clinical monitoring is recommended. Phenytoin: Changes in blood levels have been observed when combined with fluoxetine. In some cases manifestations of toxicity have occurred. Consideration should be given to using conservative titration schedules of the concomitant drug and to monitoring clinical status. Serotonergic drugs: Co-administration with serotonergic drugs (e.g., tramadol, triptans) may increase the risk of serotonin syndrome. Use with triptans carries the additional risk of coronary vasoconstriction and hypertension. Lithium and tryptophan: There have been reports of serotonin syndrome when SSRIs have been given with lithium or tryptophan and, therefore, the concomitant use of fluoxetine with these drugs should be undertaken with caution. When fluoxetine is used in combination with lithium, closer and more frequent clinical monitoring is required. CYP2D6 isoenzyme: Because fluoxetine's metabolism (like tricyclic antidepressants and other selective serotonin antidepressants) involves the hepatic cytochrome CYP2D6 isoenzyme system, concomitant therapy with drugs also metabolised by this enzyme system may lead to drug interactions. Concomitant therapy with drugs predominantly metabolised by this isoenzyme, and which have a narrow therapeutic index (such as flecainide, encainide, carbamazepine and tricyclic antidepressants), should be initiated at or adjusted to the low end of their dose range. This will also apply if fluoxetine has been taken in the previous 5 weeks. Pharmacokinetic interaction between CYP2D6 inhibitors and tamoxifen, showing a 65-75% reduction in plasma levels of one of the more active forms of the tamoxifen, i.e. endoxifen, has been reported in the literature. Reduced efficacy of tamoxifen has been reported with concomitant usage of some SSRI antidepressants in some studies. As a reduced effect of tamoxifen cannot be excluded, co-administration with potent CYP2D6 inhibitors (including fluoxetine) should whenever possible be avoided (see section 4.4). Oral anticoagulants: Altered anticoagulant effects (laboratory values and/or clinical signs and symptoms), with no consistent pattern, but including increased bleeding, have been reported uncommonly when fluoxetine is co-administered with oral anticoagulants. Patients receiving warfarin therapy should receive careful coagulation monitoring when fluoxetine is initiated or stopped (see section 4.4, 'Haemorrhage'). Electroconvulsive therapy (ECT): There have been rare reports of prolonged seizures in patients on fluoxetine receiving ECT treatment; therefore, caution is advisable. Alcohol: In formal testing, fluoxetine did not raise blood alcohol levels or enhance the effects of alcohol. However, the combination of SSRI treatment and alcohol is not advisable. St John's Wort: In common with other SSRIs, pharmacodynamic interactions between fluoxetine and the herbal remedy St John's Wort (Hypericum perforatum) may occur, which may result in an increase of undesirable effects.

Answer 5

if they do it slowly you should be ok.you will be a bit nervious at first as you will be scared that you start fitting more than you did. dont worry if this does happen just go back to your doc and tell him or her. good luck