title: Is phenytoin contraindicated in patients receiving cranial irradiation?
abstract: Three recent publications have reported the development of erythema multiforme and Stevens-Johnson syndrome in patients receiving cranial irradiation and sodium phenytoin. Some authors have recommended that patients receiving whole brain radiation therapy and who have had seizures should not be prescribed phenytoin but an alternative anti-convulsant. This article reviews the current literature pertaining to the development of this potentially lethal complication in patients receiving whole brain radiation and phenytoin, with reference to the single recorded case of Stevens-Johnson syndrome in a patient receiving cranial irradiation and phenytoin in Auckland, New Zealand. While the clinical picture in the 16 patients reported in the literature and the current case report differed from the classical form of erythema multiforme, a similar pattern of presentation and outcome appeared in all patients reviewed, suggesting that the combination of phenytoin, cranial irradiation and the gradual reduction of concomitant steroids seem to lead to the development of erythema multiforme and/or Stevens-Johnson syndrome. The data presented, although sparse, suggest that phenytoin should not be prescribed in patients receiving cranial irradiation.
authors.affiliation: Department of Radiation Oncology, Royal Adelaide Hospital, South Australia.
authors.forename: M F
authors.initials: MF
authors.lastname: Borg
authors.forename: J C
authors.initials: JC
authors.lastname: Probert
authors.forename: L J
authors.initials: LJ
authors.lastname: Zwi
mesh_terms: D001706:Biopsy; D001859:Bone Neoplasms / Q000556:secondary; D001932:Brain Neoplasms / Q000556:secondary; D001943:Breast Neoplasms / Q000150:complications / Q000628:therapy; D002277:Carcinoma / Q000150:complications / Q000628:therapy; D003131:Combined Modality Therapy; D000075202:Contraindications; D016371:Cranial Irradiation / Q000009:adverse effects; D004892:Erythema Multiforme / Q000209:etiology / Q000473:pathology; D005260:Female; D006801:Humans; D008875:Middle Aged; D010672:Phenytoin / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012867:Skin / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000209:etiology
chemical_list: D010672:Phenytoin