Ethotoin

Aka: Ethotoin, Peganone

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II. Mechanism

  1. Hydantoin Anticonvulsant similar to Phenytoin
  2. Alters Sodium and Calcium Ion influx (repolarization, depolarization) and presynaptic Calcium uptake
  3. Stabilizes Neuronal membranes by inhibiting Neuronal firing and prevents the propagation of Seizure activity within the motor cortex

III. Indications

  1. Generalized Tonic Clonic Seizures
  2. Complex Partial Seizures

IV. Contraindications

  1. Pregnancy
  2. Hepatic dysfunction
  3. Hematologic disorders

V. Dosing

  1. Therapeutic Level: 15 to 50 mcg/ml
  2. Adults
    1. Start up to 1000 mg/day divided in 4 to 6 doses after meals
    2. Target: 2000 to 3000 mg/day in divided doses
  3. Children
    1. Start up to 750 mg/day divided in 4 to 6 doses after meals
    2. Target: 500 to 1000 mg/day in divided doses
    3. Maximum: 2000 to 3000 mg/day in divided doses

VI. Metabolism

  1. Hepatic Metabolism

VII. Safety

  1. Pregnancy Category X (Known Teratogen)
    1. See Fetal Hydantoin Syndrome
  2. Unknown Safety in Lactation
    1. Secreted into Breast Milk
  3. Monitoring (periodic recheck)
    1. Complete Blood Count (CBC)
    2. Liver Function Tests
    3. Urinalysis

VIII. Resources

  1. Ethotoin (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=afcb9d60-3668-3890-5fed-f0794a12509d

IX. References

  1. Hamilton (2020) Tarascon Pocket Pharmacopoeia

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