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phenytoin PO

phenytoin PO

Drug Name	Form	Strength
Dilantin	CAPSULE, EXTENDED RELEASE, ORAL	100 mg
Dilantin	SUSPENSION, ORAL	100 mg/4 mL
Dilantin Infatab	TABLET, CHEWABLE, ORAL	50 mg

Display Class Ib Antiarrhythmics, Hydantoins Class : 24040408, 281212

Medication comments:

USP <800> Hazardous Drug Assessment of Risk (AOR)
Per policy, these drugs are exempt from USP <800> handling requirements under normal circumstances. The following outlines must be followed.
generic (Brand) Route [Packaging: Manufacturer ⇒ Dispense]	Activities
phenytoin (Dilantin, Phenytek) PO [UD ⇒ UD]	50 mg tablet (IMH) 100 mg ER capsule 100 mg/4 ml cup (IMH)	Stock @ IDBH? Y NIOSH Table 2^↑
Pharmacy: Receiving / Storage / Preparation Exposure Risk: minimal	• Handling/preparation PPE Requirements: n/a
	• Receiving from Distributor: Standard
	• Pharmacy Storage Area: Carousel
	• Packaging/Reconstitution Location: n/a
	• Compounding (Non-Sterile/Sterile) Location: n/a
	• Omnicell Load: Yes
Transport	• Transport (dose is placed inside a plastic sealable bag): Standard
Nursing: Storage / Administration Exposure Risk: low	• Handling/administration PPE Requirements: via Mouth- Single pair of CX approved gloves via Tube- double CX gloves and gown Wash hands after handling
	• Storage of Finished dose in Nursing Area/Procedural Area: Omnicell
	• Signage on Patient Door Required: No
	• Manipulation of Dosage Form: Standard
	• Special Manipulation for Administration: n/a
Disposal / Spills	• Disposal of Drug Waste: Full- black bin Trace/packaging- yellow bin
	• Disposol of Used PPE: yellow bin
	• Spill management: n/a
NIOSH Supplemental Information: IARC Group 1 carcinogen; NTP
Reason for exemption of USP<800> Containment Requirements: Purchased in final dosage form; packaged as unit dose. Does not require additional manipulation for dispensing.

2023 American Geriatrics Society Beers Criteria^® for potentially inappropriate medication use in older adults.
Medication:	phenytoin (Dilantin, Phenytek)
Criteria 2: Potentially inappropriate medication use in older adults due to drug–disease or drug–syndrome interactions that may exacerbate the disease or syndrome. (Table 3)
Drug(s) ⇆ disease or syndrome	antiepileptics ⇄ History of falls or fractures
Rationale	May cause ataxia, impaired psychomotor function, syncope, or additional falls. If one of the drugs must be used, consider reducing the use of other CNS-active medications that increase the risk of falls and fractures. (i.e., anticholinergics, selected antidepressants, antiepileptics, antipsychotics, sedative/hypnotics including benzodiazepines and, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids) and implement other strategies to reduce fall risk.
Recommendation	Avoid except for seizures and mood disorders.
Quality of evidence: High, Strength of Recommendation: Strong

Criteria 4: Potentially clinically important drug-drug interactions that should be avoided in older adults. (Table 5)
Interacting drug(s) or class(es)	antiepileptics (including gabapentinoids) ⇄ CNS-active agents
Risk Rationale	Increased risk of falls and of fracture with the concurrent use of ≥3 CNS-active agents (antiepileptics including gabapentinoids, antidepressants, antipsychotics, benzodiazepines, Nonbenzodiazepine benzodiazepine receptor agonist hypnotics, opioids, and skeletal muscle relaxants).
Recommendation	Avoid concurrent use of ≥3 CNS-active drugs Click for list; minimize the number of CNS-active drugs.
Quality of evidence: High, Strength of Recommendation: Strong

Interacting drug(s) or class(es)	phenytoin ⇄ trimethoprim-sulfamethoxazole
Risk Rationale	Increased risk of phenytoin toxicity
Recommendation	Avoid
Quality of evidence: Moderate, Strength of Recommendation: Strong

Last updated: Sep. 19, 2025

Hazard.Drug Handling(USP 800) USP<800> Hazardous Drug / Assessment of Risk

UpToDate Lexidrug

Pharmacy Contact Info:

Main Inpatient Pharmacy: ext 4599, 3503
Fax: 704-878-7283

Director of Pharmacy - Randi Raynor, PharmD: ext 4501
Clinical Coordinator - Laura Rollings, PharmD: ext 4597
Pharmacy Informaticist - Stephen Pringle, PharmD: ext 7645
Pharmacy Technician Supervisor - Amy Wingler, CPhT: ext 7385
Pharmacy Automation Coordinator (Omnicell) - Melissa Fulford, CPhT: ext 3556

This site is intended for the staff of Iredell Health System. While others may view accessible pages, Iredell Health System makes no warranty, express or implied, as to the use of this information outside of Iredell Health System. The content of this policy and procedure document serves as guidance to the delivery of quality patient care. Care providers are expected to exercise critical thinking and situational awareness skills, and in specific situations to take such action as is necessary for the delivery of quality patient care.