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phenytoin IV

phenytoin IV
  • Restricted Medications IV Unit restrictions
Brand names: Dilantin, Dilantin IV
Form Strength
SOLUTION, INJECTABLE 50 mg/mL
Display Class Ib Antiarrhythmics, Hydantoins Class: 24040408, 281212
Medication comments:

Per policy, these medications require cardiac and/or special monitoring.
(KEY: "Y" = may be given as described on chart. "N" = may NOT be given except in Rapid Response/Code Blue situations or as otherwise described in Exceptions section of Policy.
generic (Brand) / Notes CCU, OR, PACU, CCL, ED PCU 2N (Tele) 1N (Tele), 3N (Tele) Med/Surg (1N w/o Tele, 3N w/o Tele, 4N, 5N) BirthPlace SNF ICS OPS
phenytoin (Dilantin)
IV Push,IV infusion		 Y Y Y Y N N N N N
Per policy, these hazardous drugs have special waste requirements. 
Generic (Brand) Waste Requirements
phenytoin (Dilantin) Injection ⇒  BLACK BUCKET 
Medications Requiring Filters   
Medication Preparation Filter Administration Filter
phenytoin sodium (Dilantin) Not required. Use a 0.22 to 0.55 micron inline filter.IMH: For IV infusions, use a 0.22 micron in-line filter.
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) IV
[n/a]		   Stock @ IDBH? N
NIOSH Table 2↑
Pharmacy:
Receiving / Storage / Preparation

Exposure Risk: low
 • Handling/preparation PPE Requirements: Single CX glove, gown
• Receiving from Distributor: Standard
• Pharmacy Storage Area: IV Area
• Packaging/Reconstitution Location: n/a
• Compounding (Non-Sterile/Sterile) Location: Positive pressure room
• Omnicell Load: No
Transport • Transport (dose is placed inside a plastic sealable bag): Standard
Nursing:
Storage / Administration

Exposure Risk: moderate
 • Handling/administration PPE Requirements: Single CX glove, gown
• Storage of Finished dose in Nursing Area/Procedural Area: Patient Med Drawer
• Signage on Patient Door Required: No
• Manipulation of Dosage Form: n/a
• Special Manipulation for Administration: n/a
Disposal / Spills • Disposal of Drug Waste: Full-  black bin 
Trace-  yellow bin 
• Disposol of Used PPE: trash bin (inside plastic bag)
• Spill management: n/a
NIOSH Supplemental Information: IARC Group 1 carcinogen; NTP
Reason for exemption of USP<800> Containment Requirements: Preg Category D. No NIOSH requirements but is highest Group for carcinogen to humans; likely only by systemic absorption. For skin contact, remove contaminated clothing, flush area with large amounts of water and soap. Per MSDS, "possible carcinogen"
Adult Extravasation Management
phenytoin (Dilantin,Phenytek)
Agent type: Non-Chemotherapeutic
Vesicant/Irritant: Vesicant
Local Care: Warm compress
Antidote: Hyaluronidase (200 units/mL),nitroglycerin topical 2%
Antidote link(s):
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
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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



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