ethotoin (Rx)

Brand and Other Names:Peganone
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Dosing & Uses

AdultPediatric

Tonic Clonic & Complex Partial Seizures

Initial: Up to 1 g/d PO in 4-6 divided doses;

Maint: 2-3 g/d

Administration

Take after food

Other Information

Monitor: CBC, LFTs

Other Indications & Uses

Tonic clonic (grand mal) & complex partial seizures

Tonic Clonic & Complex Partial Seizures

Initial: Up to 750 mg/d PO in 4-6 divided doses;

Maint: Usual 500 mg-1 g/d PO; rarely 2 g/d or more

Administration

Take after food

Other Information

Monitor: CBC, LFTs

Next:

Interactions

Interaction Checker

and ethotoin

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (1)

            • dofetilide

              ethotoin, dofetilide. Either increases effects of the other by pharmacodynamic synergism. Contraindicated. Additive cardiac effects.

            Serious - Use Alternative (7)

            • cyclosporine

              ethotoin decreases levels of cyclosporine by increasing metabolism. Avoid or Use Alternate Drug.

            • dopamine

              ethotoin, dopamine. Mechanism: pharmacodynamic synergism. Avoid or Use Alternate Drug. Increased risk of hypotension.

            • efavirenz

              efavirenz will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug.

            • mebendazole

              ethotoin decreases levels of mebendazole by increasing metabolism. Contraindicated.

            • mestranol

              ethotoin decreases levels of mestranol by increasing metabolism. Avoid or Use Alternate Drug. May result in contraceptive failure.

            • methadone

              ethotoin decreases levels of methadone by increasing metabolism. Contraindicated.

            • metoclopramide intranasal

              ethotoin, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            Monitor Closely (87)

            • amiodarone

              amiodarone will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • amobarbital

              amobarbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • antithrombin alfa

              antithrombin alfa increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, antithrombin alfa. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • antithrombin III

              antithrombin III increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, antithrombin III. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • argatroban

              argatroban increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, argatroban. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • bemiparin

              bemiparin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, bemiparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • bivalirudin

              bivalirudin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, bivalirudin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • bleomycin

              bleomycin decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • bosentan

              bosentan will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • brexanolone

              brexanolone, ethotoin. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • busulfan

              ethotoin decreases levels of busulfan by increasing hepatic clearance. Use Caution/Monitor.

            • butabarbital

              butabarbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • butalbital

              butalbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • capecitabine

              capecitabine increases levels of ethotoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

            • carbamazepine

              carbamazepine will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • carboplatin

              carboplatin decreases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

            • carmustine

              carmustine decreases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

            • cenobamate

              cenobamate, ethotoin. Either increases effects of the other by sedation. Use Caution/Monitor.

            • cimetidine

              cimetidine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • cisplatin

              cisplatin decreases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

            • dabigatran

              dabigatran increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, dabigatran. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • dalteparin

              dalteparin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, dalteparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • decitabine

              decitabine increases levels of ethotoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

            • deutetrabenazine

              ethotoin and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • disopyramide

              ethotoin increases toxicity of disopyramide by increasing metabolism. Use Caution/Monitor. Hydantoins decreases the level, but increases the toxicity, of disopyramide.

            • disulfiram

              disulfiram will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • docetaxel

              docetaxel decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              docetaxel decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • doxorubicin

              doxorubicin decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • doxorubicin liposomal

              doxorubicin liposomal decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • enoxaparin

              enoxaparin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, enoxaparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • esketamine intranasal

              esketamine intranasal, ethotoin. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • eslicarbazepine acetate

              ethotoin decreases levels of eslicarbazepine acetate by increasing metabolism. Modify Therapy/Monitor Closely.

            • etravirine

              etravirine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • felbamate

              felbamate will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • felodipine

              ethotoin decreases levels of felodipine by increasing metabolism. Use Caution/Monitor.

            • fleroxacin

              fleroxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

            • floxuridine

              floxuridine increases levels of ethotoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

            • fluconazole

              fluconazole will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • fluorouracil

              fluorouracil increases levels of ethotoin by unknown mechanism. Use Caution/Monitor. Based on case reports.

            • fluoxetine

              fluoxetine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • fluvoxamine

              fluvoxamine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • fondaparinux

              fondaparinux increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, fondaparinux. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • gemifloxacin

              gemifloxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

            • heparin

              heparin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, heparin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • imatinib

              imatinib will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • ketoconazole

              ketoconazole will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • lamotrigine

              ethotoin decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

            • leflunomide

              leflunomide will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • lemborexant

              ethotoin, lemborexant. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levofloxacin

              levofloxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

            • lurasidone

              lurasidone, ethotoin. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • mestranol

              mestranol decreases effects of ethotoin by decreasing metabolism. Use Caution/Monitor.

            • metronidazole

              metronidazole will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • metyrapone

              ethotoin decreases levels of metyrapone by increasing metabolism. Use Caution/Monitor.

            • mexiletine

              ethotoin decreases levels of mexiletine by increasing metabolism. Use Caution/Monitor.

            • miconazole vaginal

              miconazole vaginal will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, ethotoin. Either increases levels of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • mitoxantrone

              mitoxantrone decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • moxifloxacin

              moxifloxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

            • nateglinide

              nateglinide will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • ofloxacin

              ofloxacin decreases effects of ethotoin by unknown mechanism. Use Caution/Monitor. There are also case reports of quinolones increasing phenytoin levels.

            • orlistat

              orlistat decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

            • paclitaxel

              paclitaxel decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              paclitaxel decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • paclitaxel protein bound

              paclitaxel protein bound decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              paclitaxel protein bound decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • pentobarbital

              pentobarbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • phenindione

              phenindione increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, phenindione. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • phenobarbital

              phenobarbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • posaconazole

              ethotoin decreases levels of posaconazole by increasing metabolism. Use Caution/Monitor.

            • primidone

              primidone will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

              ethotoin increases effects of primidone by increasing metabolism. Use Caution/Monitor. Phenytoin enhances the conversion of primidone to phenobarbital.

            • protamine

              protamine increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, protamine. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • quinidine

              ethotoin decreases levels of quinidine by increasing metabolism. Use Caution/Monitor.

            • rifampin

              rifampin will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • rifapentine

              rifapentine will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • secobarbital

              secobarbital will decrease the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • sorafenib

              ethotoin decreases levels of sorafenib by increasing metabolism. Use Caution/Monitor.

            • sulfamethoxazole

              sulfamethoxazole will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • ticlopidine

              ticlopidine will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • treosulfan

              treosulfan decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              treosulfan decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • valproic acid

              valproic acid will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • vinblastine

              vinblastine decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vinblastine decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • vincristine

              vincristine decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vincristine decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • vincristine liposomal

              vincristine liposomal decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vincristine liposomal decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • vindesine

              vindesine decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vindesine decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • vinorelbine

              vinorelbine decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.

              vinorelbine decreases levels of ethotoin by increasing metabolism. Use Caution/Monitor.

            • voriconazole

              voriconazole will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            • warfarin

              warfarin increases levels of ethotoin by unknown mechanism. Use Caution/Monitor.

              ethotoin, warfarin. Other (see comment). Use Caution/Monitor. Comment: Hydantoin anticonvulsants increase anticoagulant effects at first, then decrease those effects with continued use (2+ wks). There are multiple mechanisms involved, including enzyme induction, plasma protein binding site competition, and additive effects on prothrombin time.

            • zafirlukast

              zafirlukast will increase the level or effect of ethotoin by affecting hepatic enzyme CYP2C9/10 metabolism. Use Caution/Monitor.

            Minor (52)

            • acetazolamide

              acetazolamide, ethotoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.

            • auranofin

              auranofin increases levels of ethotoin by unspecified interaction mechanism. Minor/Significance Unknown.

            • brinzolamide

              brinzolamide, ethotoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.

            • carbamazepine

              carbamazepine, ethotoin. Mechanism: unspecified interaction mechanism. Minor/Significance Unknown. Carbamazepine may increase or decrease phenytoin levels.

            • caspofungin

              ethotoin decreases levels of caspofungin by increasing metabolism. Minor/Significance Unknown.

            • chloramphenicol

              chloramphenicol increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • clopidogrel

              clopidogrel increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • diazoxide

              diazoxide decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

            • disulfiram

              disulfiram increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • doxycycline

              ethotoin decreases levels of doxycycline by increasing metabolism. Minor/Significance Unknown.

            • ethanol

              ethanol decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

            • ethosuximide

              ethosuximide increases effects of ethotoin by pharmacodynamic synergism. Minor/Significance Unknown.

            • felbamate

              ethotoin decreases levels of felbamate by increasing metabolism. Minor/Significance Unknown. Toxicity increased with combination.

            • folic acid

              folic acid decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. Large doses of folic acid (>10 mg/day).

            • furosemide

              ethotoin decreases levels of furosemide by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • immune globulin IM (IGIM)

              ethotoin, immune globulin IM (IGIM). Mechanism: unknown. Minor/Significance Unknown. Risk of hypersensitivity myocarditis.

            • immune globulin IV (IGIV)

              ethotoin, immune globulin IV (IGIV). Mechanism: unknown. Minor/Significance Unknown. Risk of hypersensitivity myocarditis.

            • immune globulin SC

              ethotoin, immune globulin SC. Mechanism: unknown. Minor/Significance Unknown. Risk of hypersensitivity myocarditis (theoretical interaction, based on IM and IV immune globulin).

            • influenza virus vaccine quadrivalent

              influenza virus vaccine quadrivalent, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

            • influenza virus vaccine quadrivalent, cell-cultured

              influenza virus vaccine quadrivalent, cell-cultured, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

            • influenza virus vaccine trivalent

              influenza virus vaccine trivalent, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

            • influenza virus vaccine trivalent, recombinant

              influenza virus vaccine trivalent, recombinant, ethotoin. Mechanism: unknown. Minor/Significance Unknown. Vaccine administration may incr or decr phenytoin levels.

            • isoniazid

              isoniazid increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • L-methylfolate

              L-methylfolate decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

            • levothyroxine

              ethotoin decreases levels of levothyroxine by increasing metabolism. Minor/Significance Unknown.

              ethotoin decreases levels of levothyroxine by plasma protein binding competition. Minor/Significance Unknown.

            • liothyronine

              ethotoin decreases levels of liothyronine by increasing metabolism. Minor/Significance Unknown.

              ethotoin decreases levels of liothyronine by plasma protein binding competition. Minor/Significance Unknown.

            • lithium

              ethotoin increases toxicity of lithium by unknown mechanism. Minor/Significance Unknown.

            • meperidine

              ethotoin decreases levels of meperidine by increasing metabolism. Minor/Significance Unknown.

            • methazolamide

              methazolamide, ethotoin. Mechanism: pharmacodynamic synergism. Minor/Significance Unknown. Increased risk of anticonvulsant induced osteomalacia.

            • methsuximide

              methsuximide increases effects of ethotoin by pharmacodynamic synergism. Minor/Significance Unknown.

            • oxcarbazepine

              ethotoin decreases levels of oxcarbazepine by increasing metabolism. Minor/Significance Unknown.

            • phenobarbital

              phenobarbital decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. Phenobarbital may occasionally not change or even increase (via competitive inhibition) phenytoin levels.

            • pyridoxine

              pyridoxine decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

            • pyridoxine (Antidote)

              pyridoxine (Antidote) decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown. High dose of pyridoxine (vitamin B6), >=200 mg/day.

            • pyrimethamine

              pyrimethamine decreases effects of ethotoin by pharmacodynamic antagonism. Minor/Significance Unknown.

            • rifabutin

              rifabutin decreases levels of ethotoin by increasing metabolism. Minor/Significance Unknown.

            • sucralfate

              sucralfate decreases levels of ethotoin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • sulfadiazine

              sulfadiazine increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • sulfamethoxazole

              sulfamethoxazole increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • sulfisoxazole

              sulfisoxazole increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

            • thyroid desiccated

              ethotoin decreases levels of thyroid desiccated by increasing metabolism. Minor/Significance Unknown.

              ethotoin decreases levels of thyroid desiccated by plasma protein binding competition. Minor/Significance Unknown.

            • tiagabine

              ethotoin decreases levels of tiagabine by increasing metabolism. Minor/Significance Unknown.

            • tibolone

              ethotoin decreases levels of tibolone by increasing metabolism. Minor/Significance Unknown. Theoretical interaction.

            • tolazamide

              tolazamide increases levels of ethotoin by plasma protein binding competition. Minor/Significance Unknown.

            • tolbutamide

              tolbutamide increases levels of ethotoin by plasma protein binding competition. Minor/Significance Unknown.

              ethotoin decreases effects of tolbutamide by pharmacodynamic antagonism. Minor/Significance Unknown.

            • topiramate

              topiramate increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

              ethotoin decreases levels of topiramate by increasing metabolism. Minor/Significance Unknown.

            • trazodone

              trazodone increases levels of ethotoin by unspecified interaction mechanism. Minor/Significance Unknown.

            • typhoid polysaccharide vaccine

              ethotoin decreases levels of typhoid polysaccharide vaccine by increasing metabolism. Minor/Significance Unknown.

            • typhoid vaccine live

              ethotoin decreases levels of typhoid vaccine live by increasing metabolism. Minor/Significance Unknown.

            • valproic acid

              valproic acid, ethotoin. Mechanism: plasma protein binding competition. Minor/Significance Unknown. Valproic acid may increase or decrease phenytoin levels.

              ethotoin decreases levels of valproic acid by increasing metabolism. Minor/Significance Unknown.

            • vigabatrin

              vigabatrin decreases levels of ethotoin by unknown mechanism. Minor/Significance Unknown.

            • voriconazole

              voriconazole increases levels of ethotoin by decreasing metabolism. Minor/Significance Unknown.

              ethotoin decreases levels of voriconazole by increasing metabolism. Minor/Significance Unknown.

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            Adverse Effects

            Frequency Not Defined

            Dizziness

            Fatigue

            Headache

            Insomnia

            Numbness

            Rash

            Diarrhea

            Mild nausea

            Vomiting

            Chest pain

            Diplopia

            Nystagmus

            Rare

            • Ataxia
            • Stevens-Johnson syndrome
            • Gum hypertrophy
            • Lymphadenopathy
            • Megaloblastic anemia
            • Systemic lupus erythematosus
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            Warnings

            Contraindications

            Hepatic abnormalities

            Blood dyscrasias

            Cautions

            Use during pregnancy may result in incr incidence of birth defects in offspring (fetal hydantoin syndrome); do not discontinue in pts with major seizures due to risk of status epilepticus with hypoxia & risk to mother & fetus

            Possible risk of blood dyscrasias & lymphadenopathy

            May interfere with folic acid metabolism, causing megaloblastic anemia

            Check LFT's if indicated; monitor blood counts & UA at initiation & monthly for several months

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            Pregnancy & Lactation

            Pregnancy Category: D

            Lactation: enters breast milk/not recommended

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

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            Pharmacology

            Half-Life: 3-9 hr

            Metabolism: by liver to p-hydroxylated & m-hydroxylated derivatives following N-deethylation; these metabolites are conjugated with glucuronic acid

            Excretion: urine, feces

            Mechanism of Action

            Exerts an antiepileptic effect w/o causing general CNS depression. Mechanism of action probably similar to phenytoin but less effective & less toxic than phenytoin

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            Images

            No images available for this drug.
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            Patient Handout

            A Patient Handout is not currently available for this monograph.
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            Formulary

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            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
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            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.