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Saturday, February 14, 2004

Phenytoin Toxicity


216. Granulocytopenia, gingival hyperplasia and facila hirsutism are all possible side effects of one of the following anticonvulsant drugs.

1. Phenytoin.

2. Valproate.

3. Carbamazepine.

4. Phenobarbitone.


1. Phenytoin.


Katzung, 7th Edition Pages 391

KDT 5th Edition Page 372 & 4th Edition Page 385


Spotter – First Clinical




All books!!


The adverse effects of Phenytoin are

1. Gum Hyperplasia

2. Hirsutism, acne

3. Hypersensiticity reactions – rashes, DLE, Lymphadenopathy, neutropaenia which requires discontinuation of therapy

4. Megaloblastic Anemia due to Decreased Absorbtion and Increased Excretion of Folic Acid

5. Granulocytopaenia and even Pancytopaenia

6. Osteomalacia

7. Hyperglycaemia due to inhibition of Insulin release

8. Foetal Hydantoin Syndrome

a. Hypoplastic Phalanges

b. Cleft Palate

c. Hare Lip

d. Microcephaly


1. Phenytoin causes all the fetures given above.

2. Valproate causes Fulminant hepatitis and during pregnancy Neural Tube defects in Off Spring.

3. Carbamazepine produces dose related neurotoxicity and hepatitis, lupus like syndrome, rarely agranulocytosis and aplastic anaemia.

4. Phenobarbitone causes rashes, megaloblastic anaemia and osteomalacia.


Side effects of the drugs are best read from the Table in Harrison


Note the 5 H in the adverse effects

н Hyperplasia of Gums,

н Hirsutism,

н Hypersensiticity reactions

н Hyperglycaemia

н Hydantoin Syndrome

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