Ethotoin

Uses

Ethotoin is a hydantoin antiepileptic used to control tonic-clonic and complex partial seizures.

For the control of tonic-clonic (grand mal) and complex partial (psychomotor) seizures.

Ethotoin is also used to associated treatment for these conditions: Complex Partial Seizures, Grand mal Generalized tonic-clonic seizure

How Ethotoin works

The mechanism of action is probably very similar to that of phenytoin. The latter drug appears to stabilize rather than to raise the normal seizure threshold, and to prevent the spread of seizure activity rather than to abolish the primary focus of seizure discharges. Ethotoin inhibits nerve impulses in the motor cortex by lowering sodium ion influx, limiting tetanic stimulation.

Toxicity

Symptoms of overdose include drowsiness, loss of or impaired muscle coordination, nausea, visual disturbance, and, at very high doses, coma.

Food Interaction

• Take after a meal. This may reduce gastrointestinal upset.

[Moderate] ADJUST DOSING INTERVAL: Phenytoin bioavailability may decrease to subtherapeutic levels when the suspension is given concomitantly with enteral feedings.

The mechanism may be related to phenytoin binding to substances in the enteral formula (e.g., calcium, protein) and

Data have been conflicting and some studies have reported no changes in phenytoin levels, while others have reported significant reductions.

MONITOR: Acute consumption of alcohol may increase plasma phenytoin levels.

Chronic consumption of alcohol may decrease plasma phenytoin levels.

The mechanism of this interaction is related to induction of phenytoin metabolism by ethanol during chronic administration.

Other hydantoin derivatives may be similarly affected by ethanol.

MANAGEMENT: Some experts have recommended interrupting the feeding for 2 hours before and after the phenytoin dose, giving the phenytoin suspension diluted in water, and flushing the tube with water after administration; however, this method may not entirely avoid the interaction and is not always clinically feasible.

Patients should be closely monitored for clinical and laboratory evidence of altered phenytoin efficacy and levels upon initiation and discontinuation of enteral feedings.

Dosage adjustments or intravenous administration may be required until therapeutic serum levels are obtained.

In addition, patients receiving phenytoin therapy should be warned about the interaction between phenytoin and ethanol and they should be advised to notify their physician if they experience worsening of seizure control or symptoms of toxicity, including drowsiness, visual disturbances, change in mental status, nausea, or ataxia.

Ethotoin Disease Interaction

Major: blood dyscrasias, liver disease, porphyriaModerate: suicidal tendency, hyperglycemia, megaloblastic anemia, osteomalacia

Elimination Route

Fairly rapidly absorbed, however, the extent of oral absorption is not known.

Half Life

3 to 9 hours

Innovators Monograph

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