Epanutin

How does it work?

Epanutin capsules, oral suspension and infatabs all contain the active ingredient phenytoin, which is a type of medicine called an anticonvulsant. (NB. Phenytoin is also available without a brand name, ie as the generic medicine.) Phenytoin is used to treat epilepsy and works by stabilising electrical activity in the brain.

The brain and nerves are made up of many nerve cells that communicate with each other through electrical signals. These signals must be carefully regulated for the brain and nerves to function properly. When abnormally rapid and repetitive electrical signals are released in the brain, the brain becomes over-stimulated and normal function is disturbed. This can result in fits or seizures.

Phenytoin prevents seizures by preventing the excessive electrical activity in the brain. It is thought to achieve this by preventing sodium from entering nerve cells when they begin to fire rapid and repetitive electrical signals. A build up of sodium in the nerve cells is necessary for the electrical signal to build up and be passed on to other nerve cells. As phenytoin prevents this, it helps stabilise the electrical activity in the brain.

As phenytoin stabilises electrical nerve activity, it can also be used to treat a condition called trigeminal neuralgia, in which the facial nerves spontaneously send messages of pain to the brain. Phenytoin prevents the nerve signals being sent inappropriately and relieves the pain of this condition. Phenytoin should only be used as second line therapy for this condition, in people who cannot take another medicine called carbamazepine, or for people in whom carbamazepine is ineffective.

What is it used for?

Generalised tonic-clonic seizures

Partial seizures

Seizures associated with brain surgery or head injury

Severe pain in the lips, gums, cheek, chin or eye caused by a disorder of the nerves in the face (trigeminal neuralgia)

Warning!

You should not suddenly stop taking this medicine unless your doctor tells you otherwise, as suddenly stopping treatment is likely to make your seizures return.

Different people can vary widely in the way their bodies respond to and metabolise phenytoin. This can also be affected by many other medicines. As a result, your phenytoin dose will need to be individualised. When you start treatment, your dose will be gradually increased and your doctor may need to take blood tests from time to time to check the amount of phenytoin in your blood. You should try not to miss any doses of your medicine, as this can cause a marked change in the level of phenytoin in your blood.

If the level of phenytoin in your blood gets too high, it can cause symptoms such as confusion, rapid involuntary eye movements, blurred vision, slurred speech or clumsy movements. You should tell your doctor if you experience any of these symptoms while taking phenytoin, so that your blood level of phenytoin can be measured and your dose reduced if necessary.

If you get a skin rash or other signs of allergic reaction while taking this medicine, such as a fever or swollen glands, you should inform your doctor immediately.

This medicine may rarely cause problems with your blood cells. For this reason you should have regular blood tests to monitor the levels of your blood cells. You should consult your doctor immediately if you experience any of the following symptoms, as these may signs of problems with your blood cells: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness.

Phenytoin can lower the amount of folic acid in your blood, which could cause folate-deficiency anaemia. It is recommended that you have a blood test every six months to check the amount of folate in your blood. Your doctor may prescribe folic acid supplements if your levels are too low.

Phenytoin can interfere with the way the body metabolises vitamin D. If you don't get enough vitamin D from your diet or from exposure to sunlight, this could cause bone pain, fractures, or a disease called ricketts. Ask your doctor or pharmacist for more information.

Phenytoin decreases the blood levels of hormonal contraceptives that contain oestrogen and/or progesterone. This can make these types of contraceptive ineffective, or cause breakthrough bleeding. Women taking phenytoin who need contraception should be prescribed hormonal contraceptives that contain a total of at least 50 micrograms of ethinylestradiol (oestrogen), or use non-hormonal methods of contraception, such as condoms. It is important for women of child-bearing age to discuss contraception and pregnancy with their doctor before starting treatment with this medicine.

Epanutin infatabs should be sucked or chewed. The tablets contain sucrose and may be harmful to the teeth when used long-term.

Use with caution in

Elderly people

Decreased liver function

Diabetes

High blood urea levels (uraemia)

Hereditary blood disorders called porphyrias

People who drink large amounts of alcohol

Not to be used in

Allergy to phenytoin or other medicines of this type (hydantoins).

Epanutin infatabs and Epanutin oral suspension contain sucrose and are not suitable for people with rare hereditary problems of fructose intolerance, glucose-galactose malabsorption or sucrase-isomaltase insufficiency.

This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and Breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

It is very important for women with epilepsy to talk to the doctor responsible for their epilepsy treatment before becoming pregnant. Antiepileptic medicines are associated with an increased risk of developmental disorders and malformations in the baby. However, stopping antiepileptic treatment during pregnancy runs the risk of the mother having seizures, which can harm both the mother and the foetus. This risk may be higher than that from continuing the medication. It is important that all the risks and benefits of treatment are weighed up. Seek medical advice from your doctor.

This medicine passes into breast milk. The manufacturer recommends that women taking this medicine should avoid breastfeeding their infants. Seek medical advice from your doctor.

Label warnings

Do not stop taking this medication except on your doctor's advice.

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