Variations within the CYP2C9 gene that result in decreased enzymatic activity have been associated with increased phenytoin concentrations, as well as reports of drug toxicities due to these increased concentrations. The U.S. Food and Drug Administration (FDA) notes on the phenytoin drug label that since strong evidence exists linking HLA-B*1502 with the risk of developing SJS or TEN in patients taking carbamazepine, consideration should be given to avoiding phenytoin as an alternative to carbamazepine in patients carrying this allele. Immune system
Phenytoin has been known to cause drug-induced lupus.Phenytoin is also associated with induction of reversible IgA deficiency. Psychological
Phenytoin may increase risk of suicidal thoughts or behavior. People on phenytoin should be monitored for any changes in mood, the development or worsening depression, and/or any thoughts or behavior of suicide. Some case reports of acute phenytoin psychosis were already described. Bones
Chronic phenytoin use has been associated with decreased bone density and increased bone fractures. Phenytoin induces metabolizing enzymes in the liver. This leads to increased metabolism of vitamin D, thus decreased vitamin D levels. Vitamin D deficiency, as well as low calcium and phosphate in the blood cause decreased bone mineral density. Interactions
Phenytoin is an inducer of the CYP3A4 and CYP2C9 families of the P450 enzyme responsible for the livers degradation of various drugs.A 1981 study by the National Institutes of Health showed that antacids administered concomitantly with phenytoin "altered not only the extent of absorption but also appeared to alter the rate of absorption.
However, the use of gold in other applications in electronic sliding contacts in highly humid or corrosive atmospheres, and in use for contacts with a very high failure cost (certain computers, communications equipment, spacecraft, jet aircraft engines) remains very common.Besides sliding electrical contacts, gold is also used in electrical contacts because of its resistance to corrosion, electrical conductivity, ductility and lack of toxicity. Switch contacts are generally subjected to more intense corrosion stress than are sliding contacts. Fine gold wires are used to connect semiconductor devices to their packages through a process known as wire bonding. The concentration of free electrons in gold metal is 5.91×1022 cm−3. Gold is highly conductive to electricity, and has been used for electrical wiring in some high-energy applications (only silver and copper are more conductive per volume, but gold has the advantage of corrosion resistance). For example, gold electrical wires were used during some of the Manhattan Projects atomic experiments, but large high-current silver wires were used in the calutron isotope separator magnets in the project. It is estimated that 16% of the worlds presently-accounted-for gold and 22% of the worlds silver is contained in electronic technology in Japan. Medicine
Metallic and gold compounds have long been used for medicinal purposes. Gold, usually as the metal, is perhaps the most anciently administered medicine (apparently by shamanic practitioners) and known to Dioscorides. In medieval times, gold was often seen as beneficial for the health, in the belief that something so rare and beautiful could not be anything but healthy.