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Phenytoin Suspension and Ticlid

Determining the interaction of Phenytoin Suspension and Ticlid and the possibility of their joint administration.

Check result:

Phenytoin Suspension <> Ticlid

Relevance: 09.11.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using phenytoin together with ticlopidine may increase the effects of phenytoin. Contact your doctor if you experience twitching eye movements, slurred speech, loss of balance, tremor, muscle stiffness or weakness, nausea, vomiting, feeling light-headed, fainting, and slow or shallow breathing. If your doctor does prescribe these medications together, you may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: The coadministration with ticlopidine may increase the plasma concentrations and pharmacologic effects of phenytoin. The proposed mechanism is ticlopidine inhibition of CYP450 2C19, one of the isoenzymes responsible for the metabolic clearance of phenytoin. There have been case reports of patients stabilized on phenytoin therapy who developed central nervous system toxicity one to several weeks following the addition of ticlopidine, subsequently requiring discontinuation of ticlopidine or reductions of phenytoin dosage. A pharmacokinetic study conducted in six patients as well as a case report involving dechallenge and rechallenge with ticlopidine confirm an interaction. Data are lacking for other hydantoin anticonvulsants. However, based on their structural and pharmacologic similarities to phenytoin, the possibility of some of the same interactions should be considered.

MANAGEMENT: Given their narrow therapeutic index, caution is advised if phenytoin or other hydantoins must be used concomitantly with ticlopidine. Hydantoin levels and pharmacologic effects should be closely monitored and the dosage adjusted accordingly, particularly following initiation, discontinuation or change of dosage of ticlopidine in patients who are stabilized on their anticonvulsant regimen. Patients should be advised to contact their physician if they develop signs of phenytoin toxicity such as ataxia, dizziness, nausea, vomiting, and visual disturbances.

References

Riva R, Cerullo A, Albani F, Baruzzi A "Ticlopidine impairs phenytoin clearance: a case report." Neurology 46 (1996): 1172-3
Ko JW, Desta Z, Soukhova NV, Tracy T, Flockhart DA "In vitro inhibition of the cytochrome P450 (CYP450) system by the antiplatelet drug ticlopidine: potent effect on CYP2C19 and CYP2D6." Br J Clin Pharmacol 49 (2000): 343-51
Klaassen SL "Ticlopidine-induced phenytoin toxicity." Ann Pharmacother 32 (1998): 1295-8
Ha-Duong NT, Dijols S, Macherey AC, Goldstein JA, Dansette PM, Mansuy D "Ticlopidine as a selective mechanism-based inhibitor of human cytochrome P450 2C19." Biochemistry 40 (2001): 12112-22
Donahue S, Flockhart DA, Abernethy DR "Ticlopidine inhibits phenytoin clearance." Clin Pharmacol Ther 66 (1999): 563-8
Rindone JP, Bryan G "Phenytoin toxicity associated with ticlopidine administration." Arch Intern Med 156 (1996): 1113
Donahue SR, Flockhart DA, Abernathy DR, Jae-Wook Ko "Ticlopidine inhibition of phenytoin metabolism mediated by potent inhibition of CYP2C19." Clin Pharmacol Ther 62 (1997): 572-7
Giancarlo GM, Venkatakrishnan K, Granda BW, vonMoltke LL, Greenblatt DJ "Relative contributions of CYP2C9 and 2C19 to phenytoin 4-hydroxylation in vitro: inhibition by sulfaphenazole, omeprazole, and ticlopidine." Eur J Clin Pharmacol 57 (2001): 31-6
"Product Information. Ticlid (ticlopidine)." Syntex Laboratories Inc, Palo Alto, CA.
Privitera M, Welty TE "Acute phenytoin toxicity followed by seizure breakthrough from a ticlopidine-phenytoin interaction." Arch Neurol 53 (1996): 1191-2

Phenytoin Suspension

Generic Name: phenytoin

Brand name: Dilantin, Phenytek, Dilantin Infatabs, Phenytoin Sodium, Prompt

Synonyms: Phenytoin

What is Phenytoin Suspension?

Ticlid

Generic Name: ticlopidine

Brand name: Ticlid

Synonyms: n.a.

What is Ticlid?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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