Seizures * Tonic-clonic seizures: Mainly used in the prophylactic management of tonic-clonic seizures with complex symptomatology (psychomotor seizures). A period of 5–10 days of dosing may be required to achieve anticonvulsant effects. * Focal seizures: Mainly used to protect against the development of focal seizures with complex symptomatology (psychomotor and temporal lobe seizures). Also effective in controlling focal seizures with autonomic symptoms. * Absence seizures: Not used in treatment of pure absence seizures due to risk for increasing frequency of seizures. However, can be used in combination with other anticonvulsants during combined absence and tonic-clonic seizures. * Seizures during surgery: A 2018 meta-analysis found that early antiepileptic treatment with either<unk>  or<unk> obarbital reduced the risk of seizure in the first week after neurosurgery for brain tumors. * Status epilepticus: Considered after failed treatment using a benzodiazepine due to slow onset of action. Other * Abnormal heart rhythms: may be used in the treatment of ventricular tachycardia and sudden episodes of atrial tachycardia after other antiarrhythmic medications or cardioversion has failed. It is a class 1b antiarrhythmic. * Digoxin toxicity: Intravenous formulation is drug of choice for arrhythmias caused by cardiac glycoside toxicity. * Trigeminal neuralgia: Second choice drug to carbamazepine. Special considerations *<unk>  has a narrow therapeutic index. Its therapeutic range for an anticonvulsant effect is 10–20 μg/mL and for an antiarrhythmic effect 10–20 μg/mL. *The most common cause of<unk>  intoxication is self‑medication, which accounts for more than thirty percent of the cases. * Avoid giving intramuscular formulation unless necessary due to skin cell death and local tissue destruction. * Elderly patients may show earlier signs of toxicity. * In the obese, ideal body weight should be used for dosing calculations. * Pregnancy: Pregnancy category D due to risk of fetal hydantoin syndrome and fetal bleeding. However, optimal seizure control is very important during pregnancy so drug may be continued if benefits outweigh the risks. Due to decreased drug concentrations as a result of plasma volume expansion during pregnancy, dose of<unk>  may need to be increased if only option for seizure control. * Breastfeeding: The manufacturer does not recommend breastfeeding since low concentrations of<unk>  are excreted in breast milk. * Liver disease: Do not use oral loading dose. Consider using decreased maintenance dose. * Kidney disease: Do not use oral loading dose. Can begin with standard maintenance dose and adjust as needed. * Intravenous use is contraindicated in patients with sinus bradycardia, sinoatrial block, second- or third-degree atrioventricular block, Stokes-Adams syndrome, or hypersensitivity to<unk> , other hydantoins or any ingredient in the respective formulation.
Phenytoin
Mephenytoin
Carbamazepine
Mesuximide
Propazepine
Levetiracetam
Phenobarbital
Oxcarbazepine