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Last Updated on May 3, 2024

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Phenytoin is a prescription medicine used to treat seizures, epilepsy and other neurological conditions. Because of its effectiveness, many people may wonder if it is possible to buy phenytoin over the counter in the UK. Unfortunately, the answer is no. Phenytoin is a controlled substance, which means that it cannot be purchased without a valid prescription from a licensed medical professional.

There are many reasons why phenytoin remains a prescription drug. Firstly, phenytoin can cause serious side effects such as liver and kidney problems. Also, the dose of phenytoin needs to be carefully monitored to make sure it stays within safe limits. Without proper medical supervision, taking too much or too little phenytoin can be dangerous and even life-threatening.

If you need phenytoin for your condition, it is important to get a prescription from a qualified healthcare professional. This will ensure that you receive the correct dose and the necessary medical monitoring to prevent any adverse reactions. Although it may be tempting to buy phenytoin over the counter, the risks of doing so outweigh any potential benefits. Always put your health first and seek appropriate medical advice.

What is phenytoin?

Phenytoin is used to treat epilepsy, heart rhythm disorders and nerve pain (neurogenic pain). Because it is essential for some conditions, the World Health Organisation has included phenytoin in its list of essential medicines. Read all about phenytoin: action, use and side effects.

How phenytoin works

In the heart, sodium ions are used to transmit signals. By blocking the sodium channels, phenytoin can stop arrhythmias caused by signals that are too fast, thus normalising the heart rhythm.

Experts believe that phenytoin relieves nerve pain (neurogenic pain) by blocking the sodium channel: This inhibits the transmission of pain signals.

After ingestion, the drug is absorbed in the intestine. As it is not readily soluble in water, it is carried in the blood by transport proteins (albumin). Phenytoin is metabolised in the liver and most of it is excreted in the bile. The time taken for half the dose to be excreted depends on the blood levels of the active ingredient, but is usually between 20 and 60 hours.

When is phenytoin used?

Phenytoin is an approved antiepileptic drug for the treatment of certain types of seizures. These include focal generalised and generalised tonic-clonic seizures, simple and complex partial seizures and combinations of these seizure types. Phenytoin can also be used for acute seizures and for status epilepticus, which is a prolonged seizure. It is also used to prevent and treat seizures during neurosurgery and in people with severe brain trauma.

As a second-line treatment, phenytoin may be used to relieve nerve pain.

The treatment of cardiac arrhythmias with phenytoin is an ‘off-label use’, i.e. use outside the scope of the marketing authorisation.

How phenytoin is taken?

To treat and prevent epileptic seizures, phenytoin is usually taken in one to three divided doses a day, with a total daily dose of 300 milligrams of phenytoin. At the start of treatment, the dosage is “gradual”, so a very low dose is given and then slowly increased. Higher doses may be needed for more severe forms of the disease. However, increasing the dose – especially if the dose is increased rapidly – should only be done under medical supervision. Swallow the tablets with a full glass of water. In case of prolonged use, the total daily dose may be divided into one or two doses.

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The duration of use depends on the reason for taking the tablets, and may be either short-term (for symptom control in epilepsy) or long-term (for neurosurgical operations).

What are the side effects of phenytoin?

Many side effects of phenytoin are dose-dependent. Therefore, the dosage is usually chosen by the doctor so that few or no side effects occur.

In one hundred to one thousand patients, excessive pigmentation and increased hair on the skin may occur. Gum overgrowth is also possible.

Rare side effects of phenytoin include blood disorders, severe irregular heartbeat, abnormal liver function and allergic reactions (swelling). If allergic reactions occur, phenytoin should be stopped and a doctor should be contacted.

What is to consider when taking this medicine?

Other drugs may also interact with phenytoin. This is often the case if both drugs are transported by the same route or are broken down in the body. As a result, the breakdown of phenytoin may be either accelerated or delayed.

To see an increased breakdown of phenytoin and thus reduce its effect, it can come by combining with certain antibiotics (ciprofloxacin, rifampicin), antiepileptics (vigabatrin, primidone), HIV drugs (lopinavir, ritonavir) and other active ingredients (dexamethasone, theophylline). Alcohol abuse and (vitamin B9) may reduce the effect of phenytoin.

If the breakdown of phenytoin is delayed, its blood levels may rise dangerously. This is possible as with concurrent use of certain antibiotics (chloramphenicol, erythromycin, sulfonamides), agents used to treat epilepsy (valproate, topiramate, oxcarbazepine), analgesics (aspirin, phenylbutazone, propyphenazone), antidepressants (fluoxetine, amitriptyline, imipramine) and agents to treat fungal infections (ketoconazole, fluconazole, amphotericin B).

Phenytoin inhibits the formation of the drug-degrading enzyme cytochrome P450 3A4. Drugs that are metabolised by this enzyme are broken down more quickly. This affects a number of different medicines, so the use of phenytoin with other medicines should always be discussed with your doctor or pharmacist.

The antiepileptic drug phenytoin must not be stopped suddenly, as this may lead to seizure clusters and other conditions.

Phenytoin may cause foetal abnormalities in the womb in a dose-dependent manner. Therefore, in pregnant women with epilepsy, the dose should be reduced to the maximum dose according to the severity of the disease in order to achieve seizure freedom as safely as possible. In addition, phenytoin should not be combined with other antiepileptic drugs during pregnancy.

Only small amounts of phenytoin are found in breast milk, so there is no need to stop taking it. However, the infant should always be monitored to ensure that it is gaining weight and is not too tired.

There is an increased risk of severe allergic skin reaction (Stevens-Johnson syndrome) in patients of Thai or Han Chinese descent.

Children and adolescents weighing less than 50 kg may be treated with an adjusted dose.

How to get medicines with phenytoin

The active ingredient phenytoin is available from pharmacies on prescription. Because of the many drug-drug interactions, your doctor or pharmacist should be consulted when you start treatment or change your medication.

How long has phenytoin been on the market?

Phenytoin was first produced in 1908 by the German chemist Heinrich Biltz, who sold his development to the pharmaceutical company Parke-Davis. It was not until 1938 that scientists discovered phenytoin’s good antispasmodic properties. Unlike the antiepileptic drug phenobarbital, phenytoin does not have a strong sedative side effect. It was approved in the United States in 1953. Since the patent has long expired, there are now many generic versions of phenytoin on the German pharmaceutical market.

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