Management of Nystagmus in Phenytoin Toxicity

Clinical Management

• The American College of Emergency Physicians notes that hypotension is a rare but potential complication of oral phenytoin, but more common with IV administration, and should be monitored 1, 2
• Fosphenytoin, a phenytoin pro-drug, has similar dose-related adverse effects, including nystagmus, but with fewer cardiovascular complications compared to IV phenytoin 1, 3