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This is to be the day when I continue all of my old posts. After searching for some time I found that I really only had one that I had not finished completely; my post of Fosphenytoin. I feel as though I did a thorough job of explaining the med - at least as far as the confines of this blog go - but I did not do a good job of explaining possible side effects.
Discussion of side-effects seems somewhat relevant to me right now because I spent most of my day on Thursday keeping an eye on a patient who had come into the ED (Emergency Department) for a 3+ hour long seizure.
I am not certain about this, but would be rather surprised if the patient was not given Fosphenytoin in an attempt to stop the seizure and restore normal function as quickly as possible. I had to sit with this patient as a consequence of being so loaded up with anti-seizure medication that they did not no what they were doing most of the time and needed someone to make sure the didn't hurt themselves.
The chart that I posted in the original Fosphenytoin post that compared seizure length to mortality rate should be a compelling enough reason for my thought-process.
Without further ado, the 'Drug of the Week' feature is (drum-roll please): FOSPHENYTOIN - PART 2!
As I have already discussed the basics of this med and shown the organic molecule, I will skip right to the continuation.
I did not give adequate time to side-effects. In fact, not much time has been spent talking about the secondary effects of the meds that have been featured. However - especially due to my experience this last week at the hospital, and the fact that I MUST finish the 'to be contined...' - I will now give a description of Fosphenytoins side effects.
This link: http://version2-6.blogspot.com/2009/05/well-we-are-nearing-end-of-our-journey.html will put you at the original post so that any questions as to the mechanism and etc. will be answered. I won't re-post it because of length, time and laziness.
Like all medicines Fosphenytoin has both common and uncommon side effects (actually it is quite funny to list off the less-common side effects to someone who is taking that medicine; they kind of freak out now that they know all of the things that 'could go wrong' but most likely will not). Common side-effects of Fosphenytoin are: confusion, dizziness, drowsiness, vomiting, nausea. The less common list is a bit longer, so I am going to block quote it:
Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); abnormal muscle movements; back and forth eye movements; blurred or double vision; chest pain; clumsiness or unsteadiness; fever or sore throat; irregular heartbeat; joint pain; pain, swelling, or tenderness of the lymph nodes; rash; severe burning, itching, or numbness of the skin; severe stomach pain; shaky movements; slurred speech; staggering walk; swollen or tender gums; unusual bruising or bleeding; yellowing of the skin or eyes.
(http://www.drugs.com/sfx/fosphenytoin-side-effects.html)
www.rateadrug.com (this link will send you straight to the survey for Fosphenytoin Sodium if you doubt that www.rateadrug.com has a more extensive list) has a good list of side-effects associated with all meds. They list the common and less-common side-effects of Fosphenytoin as being: abdominal cramping, allergic reaction, anemia, blurred-vision, coordination/ balance problems, depression, concentration/ focus problems and lastly: diziness, drowsiness, fatigue and nausea. The less common side effects are as follows: mood swings, apathy/ indifference, hair growth, sore/ swollen gums, impaired thinking/ judgment, lethargy, osteoporosis/ loss of bone mass, infection, liver failure, skin rash, fever, aplastic anemia, bleeding, blistering, decrease in platlet count, decrease in white blood cell count, sore, thinning/ loss of hair, liver damage, mouth sores and pancreas problems.
If I was on a med and knew all of that stuff could go wrong, I might kind of freak out too.
http://www.drugs.com/sfx/fosphenytoin-side-effects.html has some statistics that help explain what percentage of people experience side-effects; and what percentage of the time that they experience them. I am trying to get some interviews at local neurological clinics so I can get some serious survey work and questions answered about side effects and etc. The information is found on two different tables.
| (Events in at Least 2% of Patients Treated with Fosphenytoin Sodium Injection, USP) | ||
| BODY SYSTEM Adverse Event | IV Fosphenytoin Sodium Injection, USP N = 90 | IV Phenytoin N = 22 |
| BODY AS A WHOLE | ||
| Pelvic Pain | 4.4 | 0.0 |
| Asthenia | 2.2 | 0.0 |
| Back Pain | 2.2 | 0.0 |
| Headache | 2.2 | 4.5 |
| CARDIOVASCULAR | ||
| Hypotension | 7.7 | 9.1 |
| Vasodilatation | 5.6 | 4.5 |
| Tachycardia | 2.2 | 0.0 |
| DIGESTIVE | ||
| Nausea | 8.9 | 13.6 |
| Tongue Disorder | 4.4 | 0.0 |
| Dry Mouth | 4.4 | 4.5 |
| Vomiting | 2.2 | 9.1 |
| NERVOUS | ||
| Nystagmus | 44.4 | 59.1 |
| Dizziness | 31.1 | 27.3 |
| Somnolence | 20.0 | 27.3 |
| Ataxia | 11.1 | 18.2 |
| Stupor | 7.7 | 4.5 |
| Incoordination | 4.4 | 4.5 |
| Paresthesia | 4.4 | 0.0 |
| Extrapyramidal Syndrome | 4.4 | 0.0 |
| Tremor | 3.3 | 9.1 |
| Agitation | 3.3 | 0.0 |
| Hypesthesia | 2.2 | 9.1 |
| Dysarthria | 2.2 | 0.0 |
| Vertigo | 2.2 | 0.0 |
| Brain Edema | 2.2 | 4.5 |
| SKIN AND APPENDAGES | ||
| Pruritus | 48.9 | 4.5 |
| SPECIAL SENSES | ||
| Tinnitus | 8.9 | 9.1 |
| Diplopia | 3.3 | 0.0 |
| Taste Perversion | 3.3 | 0.0 |
| Amblyopia | 2.2 | 9.1 |
| Deafness | 2.2 | 0.0 |
| (Events in at Least 2% of Patients Treated with Fosphenytoin Sodium Injection, USP) | ||
| BODY SYSTEM Adverse Event | IM Fosphenytoin Sodium Injection, USP N = 179 | Oral Dilantin N = 61 |
| BODY AS A WHOLE | ||
| Headache | 8.9 | 4.9 |
| Asthenia | 3.9 | 3.3 |
| Accidental Injury | 3.4 | 6.6 |
| DIGESTIVE | ||
| Nausea | 4.5 | 0.0 |
| Vomiting | 2.8 | 0.0 |
| HEMATOLOGIC AND LYMPHATIC | ||
| Ecchymosis | 7.3 | 4.9 |
| NERVOUS | ||
| Nystagmus | 15.1 | 8.2 |
| Tremor | 9.5 | 13.1 |
| Ataxia | 8.4 | 8.2 |
| Incoordination | 7.8 | 4.9 |
| Somnolence | 6.7 | 9.8 |
| Dizziness | 5.0 | 3.3 |
| Paresthesia | 3.9 | 3.3 |
| Reflexes Decreased | 2.8 | 4.9 |
| SKIN AND APPENDAGES | ||
| Pruritus | 2.8 | 0.0 |
As you can no doubt see this table has the side-effect and the body system seperated into different categories. Fosphenytoin - like all drugs - has different effects on different parts of the body. http://www.drugs.com/sfx/fosphenytoin-side-effects.html#system_7389 explains the commonly associated side effects and the relevant body systems in more detail. I was going to write the information as part of this post, but decided it might be a bit redundant with the two tables explaining the information already.
All medicines have side-effects. It is impossible to introduce a foreign body into the human anatomy and not have it cause several different consequences. Generally the medicines that we commonly use or have prescribed to us are those that have been found to be safe. There are of course the extreme examples. The television screen often blares messages about users of medications and the latest class-action lawsuit taking place against the makers thereof (don't even get me started on tort law and the necessary reforms).
Clinical trials and studies have been done and done and redone to find out the long and short term effects on medicines. Those studies are effective, interesting and helpful. However, they are under controlled circumstances that do not always catch all problems. Thus, www.rateadrug.com has come along. Now there is a database where people can check on their meds or see what others have to say about them.
Drug surveys for the drug user is what I always say.
Be sure to tune in next time, as we are nearing the end of our run, as I discuss yet another interesting and compelling medication!
Until then faithful readers!
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