Severe osteomalacia and rickets have been seen in a few patients taking phenytoin with acetazolamide. Rises in phenytoin levels have also been described in a very small number of patients. Fosphenytoin, a prodrug of phenytoin, may interact similarly.
The clinical importance of this interaction is unknown, but bear it in mind in case of an unexpected response to treatment. Indicators of phenytoin toxicity include blurred vision, nystagmus, ataxia or drowsiness.
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