High Alert Medication
Anticonvulsant
CCP: Seizures refractory to midazolam
CCP: Seizures refractory to midazolam
CCP: Seizures refractory to midazolam
Stabilizes neuronal membranes and decreases seizure activity by lowering intracellular sodium levels in the motor cortex; prolongs effective refractory period and suppresses ventricular pacemaker automaticity, shortening action potential in the heart.
Following intravenous administration:
Cardiovascular: Cardiac arrhythmia, cardiac conduction disturbance (depression), circulatory shock, hypotension, ventricular fibrillation
Central nervous system: Ataxia, cerebral atrophy (elevated serum levels and/or long-term use), cerebral dysfunction (elevated serum levels and/or long-term use), confusion, dizziness, drowsiness, headache, insomnia, nervousness, paresthesia, peripheral neuropathy (associated with chronic treatment), slurred speech, suicidal ideation, suicidal tendencies, twitching, vertigo
Dermatologic: Bullous dermatitis, exfoliative dermatitis, morbilliform rash, scarlatiniform rash, skin or other tissue necrosis, skin rash
Endocrine & metabolic: Decreased T4, increased gamma-glutamyl transferase, vitamin D deficiency (associated with chronic treatment)
Gastrointestinal: Constipation, dysgeusia, gingival hyperplasia, nausea, swelling of lips, vomiting
Genitourinary: Peyronie's disease
Hematologic & oncologic: Macrocytosis, megaloblastic anemia, pseudolymphoma, purpuric dermatitis
Hepatic: Acute hepatic failure, hepatic injury, hepatitis, increased serum alkaline phosphatase, toxic hepatitis
Local: Injection site reaction ("purple glove syndrome;" edema, discoloration, and pain distal to injection site), local inflammation, local irritation, localized tenderness, local tissue necrosis
Neuromuscular & skeletal: Osteomalacia
Ophthalmic: Nystagmus
Miscellaneous: Fever, tissue sloughing
High Alert Medication
PhenyTOIN must be infused slowly. Do not exceed an infusion rate in adults of 50 mg/minute, and 1-3 mg/kg/minute (or 50 mg/minute, whichever is greater). Hypotension and severe cardiac arrhythmias may occur with rapid administration, and have been reported even when infused below recommended rate. Cardiovascular monitoring is mandatory during and after phenyTOIN administration.
PhenyTOIN is a vesicant and can cause significant tissue damage if extravasation occurs. Ensure line patency during infusion.
Ensure that an in-line micron filter is used during administration of diluted solution to prevent infusion of phenyTOIN crystals.
PhenyTOIN is incompatible with dextrose solutions and will precipitate very rapidly.
Do not attempt to administer phenyTOIN through PICC lines.