Phenytoin as the first option in female epileptic patients?

Abstract

-Objective: Phenytoin (PHT) is one of the first-choice drugs in several epileptic syndromes, mostly in partial epilepsies, in which case it is effective as carbamazepine and phenobarbital. However, like any other anti-epileptic drug (AED), unpleasant side-effects are not rare. The aim of this study is the evaluation of dermatological troubles related to chronic PHT usage in female patients. Method: Between 1990-93, 731 new patients underwent investigation for epilepsy at the Multidisciplinary Clinic for Epilepsy in our State. In this sample 283 were AED users at the time of the first assessment. Sixty one female patients taking PHT were identified. They were taking PHT in a dosage ranging from 100 to 300 mg daily, in mono or polytherapy regimen, during 1-5 previous years. Results: More than 50% of the sample showed coarse facial features made by the combination of several degrees of acne, hirsutism and gingival hyperplasia. Conclusion: Except in emergency situations, PHT should not be prescribed as the first option to the treatment of female epileptic patients, because not uncommonly the cosmetic side-effects are more socially handicapping than the epileptic syndrome by itself.KEY WORDS: epilepsy, phenytoin, gingival hyperplasia, hirsutism. Fenitoína como primeira opção em mulheres com epilepsia ?RESUMO -Objetivo: Fenitoína (PHT) é uma das principais drogas no tratamento de epilepsias diversas, principalmente as parciais, para a qual ela é tão eficaz quanto carbamazepina e fenobarbital. Entretanto, como qualquer outra droga anti-epiléptica (DAE) da atualidade, efeitos desagradáveis não são raros. O alvo deste estudo é a avaliação dos efeitos dermatológicos relacionados com o uso prolongado de PHT em pacientes femininas. Método: Entre 1990-93, foram admitidos para avaliação 731 novos pacientes na Clínica Multidisciplinar de Epilepsia/SUS, Florianópolis/SC. Destes, 238 já estavam em uso de DAE, sendo que 61 eram mulheres usuárias de fenitoína, numa dosagem que variava de 100-300 mg/dia, em mono ou politerapia, por um período prévio de 1-5 anos. Resultados: Mais de 50 % das pacientes exibiam alterações faciais grosseiras, decorrentes da combinação em diferentes níveis de severidade de acne, hirsutismo e hiperplasia gengival,. Conclusão: Exceto em situações de emergência, PHT não deveria ser usada como primeira escolha no tratamento de mulheres com epilepsia; seus frequentes efeitos colaterais dermatológicos causam mais transtornos médico-sociais que a epilepsia por si própria. PALAVRAS-CHAVE: epilepsia, fenitoína, hiperplasia gengival, hirsutismo.Overall, phenytoin (PHT) is known to be effective in the treatment of several epileptic syndromes, specially in partial epilepsies 1 . However it has been associated with a lot of undesirable bad effects and cosmetic-dermatological troubles are quite common. Since Kimball, 1939, first reported gingival hiperplasia (GH) as a side-effect of PHT, many efforts have been done to approach this manifestation. The pathogenesis of the GH is still debatable and several theo...

Efficacy, tolerability, and safety of rapid initiation of topiramate versus phenytoin in patients with new‐onset epilepsy: A randomized double‐blind clinical trial

“…In addition to the tolerability issues associated with the use of PHT observed in this and other studies (rash, CNS side effects, nausea), long‐term use of PHT may be associated with peripheral neuropathy (including absent patellar or Achilles reflex, decreased conduction velocity, and sensory impairment) and impaired neuromuscular transmission (increased neuromuscular fatigability following repetitive stimulation) (So & Penry, 1981), gingival hyperplasia, coarsening of the facial features, and hirsutism (Trevisol‐Bittencourt et al., 1999). Patients with new‐onset epilepsy are often prescribed PHT as initial treatment in the emergency department (Huff et al., 2001), and it is common practice for this treatment to continue when patients consult a neurologist (Ortho‐McNeil Neurology Consultant Surveys, 2003–2004) despite the possibility of these long‐term safety concerns.…”

Phenytoin Toxicity: A Case Report

“…3,4,6 Our patient presented with ataxia, nystagmus, gingival hypertrophy, nodular skin lesions and hirsutism. Likewise there are reports of phenytoin induced ataxia, nystagmus, 2,3 gingival hypertrophy, 1,10 nodular skin lesions 10,11 and hirsutism 10 on phenytoin ingestion. Chronic phenytoin ingestion leads to its accumulation in the cerebral cortex, resulting in atrophy of cerebellum, causing ataxia and nystagmus.…”

Phenytoin Induced Erythema Multiforme

“…In higher plasma concentrations it affects the central nervous system. 15 The dermatological adverse effects are due to hypersensitivity reaction which is caused by toxic dose of the drug associated with aromatic anticonvulsants. Anticonvulsants are converted to reactive metabolites and induce cytochrome P450 3A which produce oxidative reactive intermediate resulting hypersensitivity reactions.…”