M Toin 100mg

Description

M Toin 100mg: Comprehensive Overview

Product Overview: M Toin 100mg Tablet contains Phenytoin 100 mg as its active ingredient. Phenytoin belongs to the class of antiepileptic drugs known as hydantoins. It is a cornerstone medication for seizure control, having been used for many decades. M Toin is commonly manufactured by Medopharm Pvt Ltd. and is widely available in Nepal.

Mechanism of Action: Phenytoin primarily works by stabilizing hyperexcitable neuronal membranes in the brain. Its main action involves blocking voltage-gated sodium channels. By limiting the influx of sodium ions into nerve cells, it prevents the rapid, repetitive firing of neurons. This helps to reduce the abnormal and excessive electrical activity in the brain that causes seizures, thereby controlling their frequency and severity. It also decreases post-tetanic potentiation at synapses, further inhibiting the spread of seizure activity.

Therapeutic Uses (Indications): M Toin 100mg is primarily prescribed for:

1. Epilepsy (Seizures/Fits):
   • Tonic-clonic seizures (Grand Mal seizures): Characterized by generalized muscle stiffening followed by rhythmic jerking.
   • Partial seizures (Focal seizures): Seizures that begin in one part of the brain, including simple and complex partial seizures.
   • Prevention and control of seizures during and after brain surgery or following a severe head injury.
   • Note: Phenytoin is generally not effective for absence seizures and may sometimes worsen them.
2. Trigeminal Neuralgia: This is a severe, debilitating nerve pain condition affecting the face, characterized by intense, electric shock-like pain. Phenytoin is an effective treatment for this condition, though carbamazepine is often considered first-line.

Dosage and Administration:

• Oral Tablet: M Toin 100mg tablets are taken orally, usually with or without food, as directed by your doctor. It’s often recommended to take it with food if stomach upset occurs.
• Individualized Dose: The dosage is highly individualized. Your doctor will determine the appropriate dose based on your condition, age, weight, and response to treatment. Blood levels of phenytoin are often monitored to ensure that the drug concentration is within the therapeutic range (10-20 mcg/ml) and to minimize side effects.
• Frequency: It is typically taken once or twice daily, depending on the total daily dose and the specific formulation.
• Consistency is Key: It is crucial to take the medication regularly at the same time(s) each day to maintain consistent blood levels and maximize its effectiveness in preventing seizures.
• Do NOT stop suddenly: Never discontinue M Toin 100mg abruptly without consulting your doctor. Sudden cessation can lead to severe withdrawal seizures (status epilepticus), which can be life-threatening. The dose must always be tapered gradually under strict medical supervision.
• Missed Dose: If a dose is missed, take it as soon as remembered unless it’s almost time for the next scheduled dose. Do not double the dose.

Side Effects:

Phenytoin, including M Toin 100mg, can cause a variety of side effects. Many are common, especially at the beginning of treatment or if blood levels are too high. Some can be serious.

Common Side Effects (Dose-related, especially at higher doses or above therapeutic levels):

• Central Nervous System (CNS) effects: Dizziness, drowsiness, fatigue, unsteadiness (ataxia), nystagmus (involuntary eye movements), slurred speech, blurred vision, double vision (diplopia), confusion, headache.
• Gastrointestinal effects: Nausea, vomiting, constipation.
• Dental effects: Gingival hyperplasia (gum overgrowth) is a very common and characteristic side effect with long-term use. Maintaining excellent oral hygiene is crucial to minimize this.
• Hair growth: Hirsutism (excessive body hair growth), particularly noticeable in females.
• Skin reactions: Skin rashes (often a mild, measles-like rash, especially at initiation).

Serious (but less common) Side Effects (Seek immediate medical attention if you experience these):

• Severe Skin Reactions: Rare but life-threatening rashes such as Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). Symptoms include fever, flu-like symptoms, widespread, painful rash (red or purple) that blisters and peels, and sores in the mouth, throat, eyes, or genitals. Any new or worsening skin rash should be immediately reported to your doctor. Patients of Asian ancestry (especially with the HLA-B*1502 allele) have a higher risk, and genetic testing may be recommended.
• Blood Disorders: Serious, though rare, blood disorders like aplastic anemia (bone marrow failure) and agranulocytosis (severe reduction in white blood cells), increasing infection risk. Symptoms include persistent fever, sore throat, easy bruising, unusual bleeding, or extreme fatigue. Regular complete blood counts (CBC) are crucial, especially during the first few months of treatment.
• Liver Problems (Hepatotoxicity): Rare but potentially severe liver damage can occur. Symptoms might include yellowing of the skin or eyes (jaundice), dark urine, persistent nausea/vomiting, severe abdominal pain, or loss of appetite. Liver function tests should be monitored periodically.
• Hypersensitivity Syndrome (DRESS syndrome): A severe, multi-organ allergic reaction involving rash, fever, swollen lymph nodes, facial swelling, and involvement of internal organs.
• Suicidal Thoughts or Behavior: Antiepileptic drugs, including phenytoin, can increase the risk of suicidal thoughts or behavior in a small percentage of patients. Patients and caregivers should monitor for any new or worsening changes in mood, behavior, or the emergence of suicidal ideation and report them to the doctor immediately.
• Cardiac Effects: When administered intravenously, rapid infusion can cause hypotension and arrhythmias. Oral use typically has a lower risk, but caution is still advised in patients with pre-existing heart conditions.
• Lymphadenopathy: Swelling of lymph nodes.
• Bone issues: Long-term use can affect bone density (osteoporosis, osteomalacia), potentially due to effects on Vitamin D metabolism.

Precautions and Warnings:

Before taking M Toin 100mg, and throughout treatment, it is essential to be aware of certain precautions and inform your doctor about your complete medical history.

• Abrupt Discontinuation: DO NOT STOP TAKING M TOIN 100MG SUDDENLY. Abrupt withdrawal can precipitate or worsen seizures, potentially leading to status epilepticus. Any dose reduction or discontinuation must be done gradually under strict medical supervision.
• Allergies: Do not take M Toin 100mg if you are allergic to phenytoin or any other hydantoin derivatives.
• Severe Skin Reactions (HLA-B*1502 allele): Patients of Asian ancestry should ideally be screened for the HLA-B*1502 allele before starting phenytoin due to a significantly increased risk of SJS/TEN.
• Blood Disorders: Inform your doctor if you have a history of bone marrow suppression or any blood disorders. Regular complete blood counts (CBC) are essential, especially during the first few months, to monitor for potential blood abnormalities.
• Liver and Kidney Impairment: Use with caution in patients with liver or kidney disease. Dosage adjustments may be required, and regular monitoring of liver and kidney function is important. Phenytoin metabolism can be significantly affected by liver disease.
• Cardiac Conditions: Use with caution in patients with a history of heart problems, especially those with certain heart rhythm disorders (e.g., sinus bradycardia, heart block).
• Driving and Operating Machinery: M Toin 100mg can cause dizziness, drowsiness, blurred vision, and impaired coordination. Avoid driving, operating heavy machinery, or performing tasks requiring mental alertness until you know how the medication affects you.
• Alcohol Consumption: Avoid alcohol entirely while on M Toin 100mg, as it can significantly enhance central nervous system side effects (drowsiness, dizziness) and may interfere with phenytoin levels or lower the seizure threshold.
• Pregnancy: Phenytoin is generally NOT recommended during pregnancy due to a known risk of birth defects (fetal hydantoin syndrome, including craniofacial anomalies, limb defects, and cardiac defects) and developmental delays. If you are pregnant or planning to become pregnant, discuss this with your doctor immediately. They will weigh the risks and benefits, potentially consider alternative AEDs, and may recommend high-dose folic acid supplementation (5 mg daily) if continuing phenytoin is deemed necessary.
• Women of Childbearing Potential: Women of childbearing age should be counselled about the risks of phenytoin in pregnancy and use highly effective non-hormonal contraception or other reliable birth control methods, as phenytoin can reduce the effectiveness of hormonal contraceptives.
• Breastfeeding: Phenytoin passes into breast milk. While some sources suggest caution, others consider it probably unsafe. Monitor the infant for excessive drowsiness, poor feeding, or rash. Discuss with your doctor to weigh the benefits and risks of breastfeeding.
• Diabetes: Phenytoin can increase blood sugar levels. Diabetics should monitor their blood glucose closely.
• Porphyria: Contraindicated in patients with acute intermittent porphyria.
• Drug Interactions: Phenytoin has numerous and complex drug interactions. It is a potent inducer of liver enzymes (especially CYP450 enzymes), which can significantly reduce the blood levels and effectiveness of many other medications. It can also be affected by other drugs that inhibit its metabolism. Always inform your doctor about all prescription and over-the-counter medications, herbal supplements (especially St. John’s Wort), and vitamins you are taking. Key interactions include:
  • Hormonal Contraceptives: Significantly reduces their effectiveness, leading to potential contraceptive failure.
  • Other Antiepileptic Drugs: Can affect levels of carbamazepine, valproate, lamotrigine, etc., and be affected by them.
  • Warfarin (Blood Thinner): Can alter warfarin’s effect, requiring close INR monitoring.
  • Certain Antibiotics (e.g., chloramphenicol, sulfonamides, ciprofloxacin, macrolides like erythromycin).
  • Antifungals (e.g., fluconazole, itraconazole, ketoconazole).
  • Corticosteroids.
  • Certain HIV medications (e.g., delavirdine is contraindicated).
  • Theophylline.
  • Cimetidine, Omeprazole.
• Regular Monitoring: Your doctor will likely order regular blood tests to monitor phenytoin serum levels, complete blood counts, and liver function, especially during the initial treatment phase and periodically thereafter.

Prescription Information:

M Toin 100mg Tablet is a prescription-only medication (POM). This means:

• It cannot be purchased over-the-counter without a valid prescription from a licensed medical professional (e.g., neurologist).
• A doctor will determine the appropriate starting dose, titration schedule, and maintenance dose based on the patient’s individual needs, condition, and response.
• Regular follow-up appointments are crucial for monitoring efficacy, managing side effects, and performing necessary laboratory tests to ensure safe and effective use.