Phenytoin in the Elderly: Considerations and Precautions

17 Comments

• 

  Robert Andersen

  July 2, 2023 AT 18:52
  I've seen this play out in my dad's care team. Phenytoin was his go-to for years, but his neurologist finally switched him to levetiracetam after he started stumbling around like a drunk toddler at 3 a.m. The blood levels were fine, but the side effects? Nightmares. Elderly bodies aren't just small adults with gray hair.
• 

  Alexander Ståhlberg

  July 3, 2023 AT 20:40
  You think that's bad? My aunt was on phenytoin for 14 years. They didn't adjust her dose once, even after she lost 30 pounds and started hallucinating about her cat talking in Klingon. The doctor just said 'it's just aging.' I swear to god, if I had a dollar for every time a geriatrician blamed everything on 'old age' instead of checking drug levels, I'd own a private island. This isn't medicine, it's negligence dressed in lab coats.
• 

  Alexis Hernandez

  July 4, 2023 AT 03:25
  I work in a senior center and I've seen so many folks on this stuff. One guy would just sit in the corner muttering to himself, eyes glazed. We thought it was dementia. Turns out his phenytoin level was triple the max. Once they lowered it? He started telling jokes again. It's wild how a simple blood test can bring someone back to life. We need way more routine monitoring.
• 

  Michael Ferguson

  July 6, 2023 AT 00:52
  It's not just phenytoin. It's the entire system. Doctors treat the elderly like broken appliances that need a quick fix. They throw pills at them like confetti and call it 'care.' No one wants to admit that we're running out of time, so they just keep dosing until the body gives up. I've watched my grandmother become a ghost because no one had the guts to say 'maybe we should stop.' This isn't treatment-it's slow-motion euthanasia with a prescription pad.
• 

  Jackie R

  July 6, 2023 AT 21:52
  Americans are just too lazy to take care of themselves. If you're old and on 12 meds, maybe you shouldn't have eaten junk food your whole life. Stop blaming the drug and start blaming the person who chose to live like a sloth.
• 

  Eli Grinvald

  July 6, 2023 AT 22:00
  This is so important 💔 I had a neighbor on phenytoin who stopped walking for weeks. Turns out his levels were off. He cried when they fixed it. So many people are just... drifting.
• 

  Carly Smith

  July 8, 2023 AT 01:45
  Why are we even using phenytoin anymore? It's 2023. There are better options. Why are we still using 1950s drugs on old people like they're lab rats? Lazy doctors. Lazy system. Lazy us
• 

  Eric Donald

  July 8, 2023 AT 22:01
  I appreciate the thorough breakdown. The pharmacokinetic changes in the elderly-reduced hepatic metabolism, decreased renal clearance, increased fat-to-lean mass ratio-are well-documented in clinical pharmacology literature. The therapeutic window for phenytoin is narrow, and even minor deviations can precipitate neurotoxicity. Routine serum level monitoring, ideally every 3–6 months in stable elderly patients, is not optional-it's a standard of care. Many primary care providers overlook this, assuming 'if it's not broken, don't fix it.' But in geriatrics, the goal isn't stability-it's safety.
• 

  brajagopal debbarma

  July 9, 2023 AT 14:12
  So you're telling me old people can't handle a drug that's been around since Nixon was president? Maybe they just shouldn't be alive if they can't handle a little toxicity. I mean, what's the point of living to 80 if you can't even metabolize a seizure med?
• 

  Angie Creed

  July 9, 2023 AT 17:28
  This is the exact reason why we need to abolish the medical-industrial complex. They keep prescribing phenytoin because it's cheap, not because it's safe. They don't care about the elderly-they care about profit margins. The FDA approves drugs based on data from 30-year-olds. That's not science. That's corporate greed with a stethoscope.
• 

  Sebastian Brice

  July 11, 2023 AT 09:11
  I've had a lot of patients on this. One lady, 82, was on 300mg daily. Her level came back at 38. Normal is 10–20. She was barely walking. We cut it to 100mg. Within a week, she was knitting again. It's not about being old-it's about being treated like a person. A little attention goes a long way.
• 

  Kurt Stallings

  July 12, 2023 AT 20:30
  Phenytoin? Still using that? Pathetic. Real clinicians use lacosamide or perampanel. If your geriatric neurologist is prescribing phenytoin, you're being treated by someone who thinks a slide rule is cutting edge
• 

  Michael Schaller

  July 13, 2023 AT 02:46
  My grandfather was on phenytoin for 15 years. We never knew his levels were high until he started seeing spiders on the ceiling. He didn't complain-he just stopped eating. We thought he was depressed. Turned out he was neurotoxic. They lowered the dose. He lived three more years, clear-headed, happy. It wasn't magic. It was just a blood test.
• 

  Patrick Klepek

  July 13, 2023 AT 12:24
  Funny how we blame the drug when the real problem is that we don't have enough geriatric pharmacists. We treat old people like they're just broken-down versions of young people. We don't adjust for metabolism, we don't adjust for polypharmacy, we don't even adjust our attitude. Phenytoin isn't the villain. Our ignorance is.
• 

  Jim Aondongu

  July 14, 2023 AT 18:47
  In Nigeria we use phenytoin because its cheap and works. Old people here dont have access to fancy drugs. So you say its dangerous but what do you want them to do? Die faster? Maybe the problem is not the drug but the lack of access to better care
• 

  Brenda Flores

  July 15, 2023 AT 08:07
  Thank you for this thoughtful and much-needed overview. As a registered nurse with over two decades of experience in long-term care, I can attest that phenytoin toxicity is one of the most underdiagnosed conditions in our geriatric population. We must prioritize individualized care, therapeutic drug monitoring, and interdisciplinary collaboration. The elderly deserve more than a one-size-fits-all approach.
• 

  Josh Arce

  July 17, 2023 AT 02:24
  Phenytoin? That's the old school seizure med, right? Like, from the 70s? Why are we still giving this to grandmas? It's like using a typewriter when you got a laptop. I don't get it.