Drug Interaction Report

MONITOR: Succinimides may increase serum hydantoin levels. The pharmacologic and toxic effects of hydantoins may be increased. The mechanism is not fully understood, but may be related to inhibition of the hepatic metabolism of hydantoins. In addition, phenytoin has been associated with reductions in succinimide levels.

MANAGEMENT: If a succinimide and a hydantoin must be used together, close observation for evidence of altered hydantoin effect is recommended. Patients should be advised to notify their physician if they experience symptoms of possible hydantoin toxicity, including drowsiness, visual disturbances, change in mental status, seizures, nausea, or ataxia.

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.