Home Drug Guide Ethotoin

Drug Guide

Generic Name

Ethotoin

Brand Names Peganone

Classification

Therapeutic: Anticonvulsant

Pharmacological: Sodium channel blocker

FDA Approved Indications

  • Epilepsy, particularly for focal seizures

Mechanism of Action

Ethotoin stabilizes neuronal membranes by inhibiting voltage-gated sodium channels, thereby reducing repetitive neuronal firing and seizure propagation.

Dosage and Administration

Adult: Initially 200 mg 2-3 times daily, titrating up based on response and tolerability.

Pediatric: Typically 10-15 mg/kg/day divided into 2-3 doses, titrated gradually.

Geriatric: Start at the lower end of dosing range; monitor closely due to potential sensitivity.

Renal Impairment: Dose adjustment may be necessary; consult specific guidelines.

Hepatic Impairment: Use with caution; no specific adjustment specified.

Pharmacokinetics

Absorption: Well absorbed from gastrointestinal tract.

Distribution: Extensive, protein-bound (~80%).

Metabolism: Primarily hepatic via oxidation.

Excretion: Urine mainly as metabolites; small amount as unchanged drug.

Half Life: Approximately 8-20 hours.

Contraindications

  • Hypersensitivity to ethotoin or other hydantoins.
  • History of hepatic disease.

Precautions

  • Use cautiously in patients with hepatic impairment, hematologic abnormalities, or history of blood dyscrasias. Regular blood counts recommended.

Adverse Reactions - Common

  • Drowsiness, dizziness (Common)
  • Nausea, vomiting (Uncommon)

Adverse Reactions - Serious

  • Blood dyscrasias (aplastic anemia, leukopenia, thrombocytopenia) (Rare)
  • Hepatotoxicity (Rare)
  • Stevens-Johnson syndrome (Very rare)

Drug-Drug Interactions

  • Other CNS depressants, phenytoin, phenobarbital, carbamazepine, valproic acid.
  • Drugs altering hepatic enzymes.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor seizure frequency, blood counts, liver function tests.

Diagnoses:

  • Risk for injury due to seizures.
  • Risk for bleeding due to hematologic side effects.

Implementation: Administer with food if GI upset occurs. Regular blood testing recommended.

Evaluation: Assess seizure control and monitor for adverse effects.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report signs of blood dyscrasias: easy bruising, bleeding, sore throat, fever.
  • Avoid alcohol and CNS depressants.
  • Report signs of hepatic dysfunction: jaundice, abdominal pain.

Special Considerations

Black Box Warnings:

  • Potential for serious blood dyscrasias and hepatotoxicity.

Genetic Factors: None well-established.

Lab Test Interference: May interfere with certain lab tests (e.g., blood counts).

Overdose Management

Signs/Symptoms: Drowsiness, ataxia, nystagmus, CNS depression.

Treatment: Supportive care, activated charcoal if recent ingestion, hemodialysis in severe cases.

Storage and Handling

Storage: Store at room temperature, protected from light and moisture.

Stability: Stable for 2-3 years under proper storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.