Fosphenytoin
Anticonvulsant
Fosphenytoin
Cerebyx
Experience
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Interactions
Pharmacogenomic + mechanism interactions
Pharmacogenomic guideline recommendationsCPIC and Dutch Pharmacogenetics Working Group clinical guidelines
CPIC rec 8094799 [Strong]: If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747] FDA labeling (Warnings and Precautions, Use in Specific Populations, Clinical Pharmacology)
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CPIC rec 8094799 [Strong]: If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094800 [Strong]: If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747] FDA labeling (Warnings and Precautions, Use in Specific Populations, Clinical Pharmacology)
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CPIC rec 8094802 [Strong]: If patient is phenytoin-naive, do not use phenytoin/fosphenytoin. Avoid carbamazepine and oxcarbazepine. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747] FDA labeling (Warnings and Precautions, Use in Specific Populations, Clinical Pharmacology)
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CPIC rec 8094796 [Strong]: For first dose, use typical initial or loading dose. For subsequent doses use approximately 50% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to a usual standard. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094793 [Strong]: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response, and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094795 [Moderate]: For first dose, use typical initial or loading dose. For subsequent doses, use approximately 25% less than typical maintenance dose. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN, and patients should be carefully monitored according to a usual standard. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094794 [Moderate]: No adjustments needed from typical dosing strategies. Subsequent doses should be adjusted according to therapeutic drug monitoring, response and side effects. An HLA-B*15:02 negative test does not eliminate the risk of phenytoin-induced SJS/TEN and patients should be carefully monitored according to a usual standard. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094819 [Optional]: If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. The latency period for drug-induced SJS/TEN is short with continuous dosing and adherence to therapy (4-28 days), and cases usually occur within three months of dosing. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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CPIC rec 8094819 [Optional]: If the patient has previously used phenytoin continuously for longer than three months without incidence of cutaneous adverse reactions, cautiously consider use of phenytoin in the future. The latency period for drug-induced SJS/TEN is short with continuous dosing and adherence to therapy (4-28 days), and cases usually occur within three months of dosing. CPIC pair-level A (CYP2C9, HLA-B and Phenytoin) [PMID 25099164, 32779747]
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Experience (1 a little, 5 a lot)
Outcome (-100 worst, +100 best)
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Summary
Classes
Anticonvulsant
Pharmacy
Pharmacology
Purported mechanism
Prodrug of phenytoin; sodium channel blocker