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 BRAND NAMES
 MECHANISM OF ACTION
Ethotoin exerts an antiepileptic effect without causing general central nervous system depression. The mechanism of action is probably very similar to that of phenytoin, but it is less effective. Ethotoin lacks phenytoin's side effects of gingival hyperplasia and hirsutism.
- Tonic-clonic (grand mal)
- Complex partial (psychomotor) seizures.
Ethotoin is administered orally in 4 to 6 divided doses daily. The drug should be taken after food.
For adults, the initial daily dose should be 1 g or less, with subsequent gradual dosage increases over a period of several days. The optimum dosage must be determined on the basis of individual response. The usual adult maintenance dose is 2 to 3 g daily. Less than 2 g daily has been found ineffective in most adults.
Pediatric dosage depends upon the age and weight of the patient. The initial dose should not exceed 750 mg daily. The usual maintenance dose in children ranges from 500 mg to 1 g daily, although occasionally 2 or (rarely) 3 g daily may be necessary.
If a patient is receiving another antiepileptic drug, it should not be discontinued when Ethotoin therapy is begun. The dosage of the other drug should be reduced gradually as that of Ethotoin is increased. Ethotoin may eventually replace the other drug or the optimal dosage of both antiepileptics may be established.
In tonic-clonic (grand mal) seizures, use of the drug with phenobarbital may be beneficial.
Ethotoin is contraindicated in patients with hepatic abnormalities or hematologic disorders
 PREGNANCY AND LACTATION
 SIDE EFFECTS
Adverse reactions associated with Ethotoin, in decreasing order of severity, are:
- Isolated cases of lymphadenopathy and systemic lupus erythematosus have been reported in patients taking hydantoin compounds, and lymphadenopathy has occurred with Ethotoin. Withdrawal of therapy has resulted in remission of the clinical and pathological findings. Therefore, if a lymphomalike syndrome develops, the drug should be withdrawn and the patient should be closely observed for regression of signs and symptoms before treatment is resumed.
- Ataxia and gum hypertrophy have occurred only rarely— usually only in patients receiving an additional hydantoin derivative. It is of interest to note that ataxia and gum hypertrophy have subsided in patients receiving other hydantoins when Ethotoin was given as a substitute antiepileptic.
- Occasionally, vomiting or nausea after ingestion of Ethotoin has been reported, but if the drug is administered after meals, the incidence of gastric distress is reduced. Other side effects have included chest pain, nystagmus, diplopia, fever, dizziness, diarrhea, headache, insomnia, fatigue, numbness, skin rash, and Stevens-Johnson syndrome.