Phenytoin Cisplatin

Drugs that may interact with zalcitabine include antacids, chloramphenicol, cisplatin, dapsone, didanosine, disulfiram, ethionamide, glutethimide, gold, hydralazine, iodoquinol, isoniazid, metronidazole, nitrofurantoin, phenytoin, ribavirin, vincristine, cimetidine, metoclopramide, amphotericin, aminoglycosides, foscarnet, antiretroviral nucleoside analogs, pentamidine, and probenecid. 

Drugs that may affect tacrolimus include nephrotoxic agents (aminoglycosides, amphotericin B, cisplatin, cyclosporine), antifungals, bromocriptine, calcium channel blockers, cimetidine, clarithromycin, danazol, diltiazem, erythromycin, methylprednisolone, metoclopramide, carbamazepine, phenobarbital, phenytoin, rifamycins, cisapride, chloramphenicol, metronidazole, nefazodone, omeprazole, protease inhibitors, macrolide antibiotics, fosphenytoin, and St. John s wort. 

Uses Edema, HTN, CHF, h atic cirrhosis Action Loop diuretic -1- reabsorption of Na Cr in ascending loop of Henle distal tubule Dose 5-20 mg/d PO or IV 200 mg/d max Caution [B, ] Contra Sulfonylurea sensitivity Disp Tabs, inj SE Orthostatic -1- BP, HA, dizziness, photosens, electrolyte imbalance, blurred vision, renal impair Notes 20 mg torsemide = 40 mg furosemide Interactions t Risk of ototox W/ aminoglycosides, cisplatin t effects W/ thiazides t effects OF anticoagulants, antih5rpCTtensives, Li, salicylates X effects IT/barbiturates, carbamaz ine, cholestyramine, NSAIDs, phenytoin, phenobarbital, probenecid, dandehon EMS t Effects of anticoagulants monitor for S/Sxs tinnitus, monitor ECG for hypokalemia (flattened T waves) OD May cause HA, hypotension, hypovolemia, and hypokalemia give IV fluids symptomatic and supportive... 

Incompatibilities of metoclopramide depend on drug concentration, pH, and temperature. It is incompatible with cephalosporins, chloramphenicol, sodium bicarbonate, doxorubicin, cisplatin, and cyclophosphamide. Caution should be exercised with simultaneous administration of metoclopramide with lithium, sym-pathomimetics, antidepressants, bromocriptine, and carbamazepine. Omperazole interacts with tolbutamide, clarithromycin, and phenytoin. Coadministration of rantidine and cisapride increases the plasma concentration of rantidine. Abuse of senna laxative has been reported and may cause hepatitis.176-178... 

Amiodarone Chloroquine Cisplatin Colchicine Dapsone Disulfiram Glutethimide Gold compounds Hydralazine Isoniazid Misonidazole Nitrous oxide Nitrofuratoin Nucleoside analogs (antiretrovirals) Paclitaxel (taxanes) Phenytoin... 

Cisplatin Carbamazepine Phenytoin Valproate Reduced effect of phenytoin interaction poorly documented Unknown... 

Plasma concentrations of antiepileptic drugs (for example carbamazepine, valproic acid, phenytoin) should be measured more frequently during cisplatin-containing cancer chemotherapy (266,267). 

Nephrotoxicity may be prevented or diminished by prehydration with 21 of normal saline administered over a 6-8 h period, followed by continued hydration during and after the cisplatin infusion. Nausea and vomiting may be managed with antiemetics. Electrolyte concentration should be monitored and supplemented as needed. Treatment for an anaphylactic reaction would include antihistamines, administered with or without epinephrine. If accidental exposure to the eyes or skin occurs, the affected skin area should be washed thoroughly with soap and water, and eyes should be flushed with copious amounts of tepid water for at least 15 min. Seizures should be treated with diazepam, lorazepan, phenobarbital, or phenytoin. 

Increased effects (P450 3A4 inhibitors) cimetidine, danazol, diltiazem, erythromycin, troleandomycin, clarithromycin, fluoxetine, isoniazid, niacinamide, nicotinamide, propoxyphene, ketoconazole, itraconazole, verapamil,and valproate Decreased effects (P450 3A4 inducers) cisplatin, doxorubicin, felbamate, rifampin, phenobarbital, phenytoin, primidone, theophylline... 

Phenytoin Cisplatin Carmustine Brain tumours A retrospective study reviewed the effects of 3 or more cycles of 72 hours of carmustine and cispiatin chemotherapy in 19 patients who did not vomit. A phenytoin dose increase was required in three-quarters of patients, which was, on average, 40% of the originai dose (range 20 to 100%). The effect on phenytoin levek persisted after the chemotherapy had finished, with levels returning to normal 2 to 3 weeks later. 1... 

Phenytoin Cisplatin Vinblastine Bleomycin Metastatic germ cell tumour Estimated phenytoin level 15 micrograms/mL, but level only reached 2 micrograms/mL Patient fitted. 2... 

Phenytoin Primidone Cisplatin Vinblastine Bleomycin Metastatic embryonal cell cancer Phenytoin 800 mg daiiy gave a ievei of i 5 micrograms/mL whilst receiving chemotherapy. After chemotherapy the same dose produced a toxic level of 42.8 micrograms/mL Phenobarbitai ieveis unaffected. 3... 

Phenytoin Carbamazepine Sodium valproate Doxorubicin Cisplatin Cyclophosphamide Altretamine Papillary adenocarcinoma of the ovaries Seizures occurred 2 to 3 days after starting chemotherapy. All drug levels dropped to one-third or iower. Doses increased to compensate, which led to phenytoin toxicity when the chemotherapy finished. 5... 

Phenytoin Dacarbazine Carmustine Cisplatin Tamoxifen Maiignant meianoma with brain metastases Phenytoin level of only 2.5 micrograms/mL despite a loading 1 -g dose and a daily dose of 500 mg phenytoin. 7... 

Phenytoin Cisplatin Carmustine Etoposide CNS tumours Dose of phenytoin had to be increased by 50 to 300% in 10 patients to maintain phenytoin levels in the therapeutic range. 10... 

Sodium valproate Phenytoin Cisplatin Etoposide Bleomycin Testicular cancer Serum valproate levels reduced by 50% after the first cycle and generalised tonic-clonic seizures occurred. There was no effect on phenytoin levels. 13... 

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