Ethotoin(eth’ i toe in)
Peganone
PREGNANCY CATEGORY D
Drug Classes
Antiepileptic
Hydantoin
Therapeutic Actions
Has antiepileptic activity without causing general CNS depression; stabilizes neuronal membranes and prevents hyperexcitability caused by excessive stimulation; limits the spread of seizure activity from an active focus.
Indications
Control of tonic-clonic and complex partial (psychomotor) seizures; may be combined with other antiepileptics
Contraindications and Cautions
Contraindicated with hypersensitivity to hydantoins, pregnancy, lactation, hepatic abnormalities, hematologic disorders.
Use cautiously with acute intermittent porphyria; hypotension, severe myocardial insufficiency; diabetes mellitus, hyperglycemia.
Available Forms
Tablets—250 mg
Dosages
Administer in four to six divided doses daily. Take after eating; space as evenly as possible.
Adults
Initial dose should be 1 g/day PO in four to six divided doses. Increase gradually over several days; usual maintenance dose is 2–3 g/day PO in four to six divided doses; less than 2 g/day is ineffective in most adults. If replacing another drug, reduce the dose of the other drug gradually as ethotoin dose is increased.
Pediatric patients 1 yr and older
Initial dose should not exceed 750 mg/day PO in four to six divided doses; maintenance doses range from 500 mg/day to 1 g/day PO in four to six divided doses.
Pharmacokinetics
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Metabolism: Hepatic; T1/2: 3–9 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine
Adverse Effects
CNS: Nystagmus, ataxia, dysarthria, slurred speech, mental confusion, dizziness, drowsiness, insomnia, transient nervousness, motor twitchings, fatigue, irritability, depression, numbness, tremor, headache, photophobia, diplopia, conjunctivitis
Dermatologic: Scarlatiniform, morbilliform, maculopapular, urticarial and nonspecific rashes, also serious and sometimes fatal dermatologic reactions: Bullous, exfoliative, or purpuric dermatitis, lupus erythematosus, and Stevens-Johnson syndrome, toxic epidermal necrolysis, hirsutism, alopecia, coarsening of the facial features, enlargement of the lips, Peyronie disease
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