BENZODIAZEPINES AND PHENYTOIN - OTHER BENZODIAZEPINES

Reports are inconsistent: benzodiazepines can cause serum phenytoin levels to rise (chlordiazepoxide, clobazam, clonazepam, diazepam), occasionally resulting in tox- icity; or fall (clonazepam, diazepam); or remain unaltered (alprazolam, clonazepam). In addition phenytoin may cause a fall in the serum levels of clobazam, clonazepam, diazepam, midazolam (see above) and oxazepam.
Warn the patient to monitor for indicators of phenytoin toxicity (blurred vision, nystagmus, ataxia or drowsiness). Take phenytoin levels as necessary. Be aware that the benzodiazepine may be less effective than expected.
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