title: Contraindications - Neonatal Intensive Care Drug Manual
text: Contraindications
  Known hypersensitivity to phenytoin, severe sinus bradycardia, and sinoatrial block, second and third degree AV block or Stokes - Adams syndrome.
  Precautions
  If patient is hypotensive prior to starting phenytoin, consult the treating neonatologist. If impaired hepatic or renal function, may require decreased dosage. Phenytoin is highly protein bound. Concentration of free phenytoin is higher in infants with hypoalbuminaemia and may cause toxicity even if the total phenytoin serum concentration is within therapeutic range. Increased free fraction of phenytoin can also occur in infants with hyperbilirubinaemia, renal impairment, or uraemia.
  Consider weaning instead of abrupt cessation of the drug (see special comments section).
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