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Nonsteroidal anti-inflammatory drugs (standard or coxibs) - prescribing issues - Management
What should I do for a person who requires phenytoin and an NSAID?
- Avoid concomitant use of phenytoin with azapropazone because serum phenytoin levels can be markedly increased and phenytoin toxicity can develop rapidly.
- Other nonsteroidal anti-inflammatory drugs (NSAIDs) vary in the degree to which they enhance the effects of phenytoin.
- Advise anyone taking an NSAID with phenytoin to seek immediate medical attention if such symptoms as lethargy, confusion, muscular twitching, fever, sore throat, rash, blistering, mouth ulcers, bruising, or bleeding develop.
- If an interaction occurs, discontinue the NSAID or reduce the phenytoin dose as necessary.
Basis for recommendation
- These recommendations are based on an authoritative reference manual on drug interactions and the British National Formulary [Baxter, 2006; BNF 55, 2008].
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