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Hydantoins: Phenytoin and Fosphenytoin

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Critical Care Toxicology

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Abstract

Greater than two million Americans suffer from epilepsy, and 10 % of the population has at least one convulsion in their lifetime. Phenytoin has been commercially available in the United States since 1938 and had been a first-step anticonvulsant for all types of epilepsy, with the exception of absence seizures. In conjunction with benzodiazepines, phenytoin is efficacious in the acute treatment of status epilepticus [1] and has been used prophylactically after head injury [2]. Phenytoin was used as a class 1B antidysrhythmic agent, particularly in the setting of digoxin toxicity, but it no longer is considered a first-line agent for that indication.

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Author information

Authors and Affiliations

  1. Medical Toxicology, Banner Poison and Drug Information Center, Phoenix, AZ, USA

    Frank LoVecchio

Authors
  1. Frank LoVecchio
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Correspondence to Frank LoVecchio .

Editor information

Editors and Affiliations

  1. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Jeffrey Brent

  2. Office of New Drugs Drug Evaluation and Research, FDA, Silver Spring, Maryland, USA

    Keith Burkhart

  3. Clinical Toxicology, St Thomas' Hospital, London, United Kingdom

    Paul Dargan

  4. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Benjamin Hatten

  5. Med & Toxicological Intensive Care Unit, Lariboisière Hospital Paris-Diderot University, Paris, France

    Bruno Megarbane

  6. University of Colorado School of Medicine, Toxicology Associates, Denver, Colorado, USA

    Robert Palmer

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

Grading System for Levels of Evidence Supporting Recommendations in Critical Care Toxicology, 2nd Edition

  1. I

    Evidence obtained from at least one properly randomized controlled trial.

  2. II-1

    Evidence obtained from well-designed controlled trials without randomization.

  3. II-2

    Evidence obtained from well-designed cohort or case–control analytic studies, preferably from more than one center or research group.

  4. II-3

    Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments (such as the results of the introduction of penicillin treatment in the 1940s) could also be regarded as this type of evidence.

  5. III

    Opinions of respected authorities, based on clinical experience, descriptive studies and case reports, or reports of expert committees.

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LoVecchio, F. (2016). Hydantoins: Phenytoin and Fosphenytoin. In: Brent, J., Burkhart, K., Dargan, P., Hatten, B., Megarbane, B., Palmer, R. (eds) Critical Care Toxicology. Springer, Cham. https://doi.org/10.1007/978-3-319-20790-2_24-1

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  • DOI: https://doi.org/10.1007/978-3-319-20790-2_24-1

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  • Publisher Name: Springer, Cham

  • Online ISBN: 978-3-319-20790-2

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