Originally synthesized by a German chemist in 1908 and effectively ignored as an epilepsy treatment until 1937, Dilantin is now one of the most commonly prescribed anti-epileptic medications. However it also has a known association with Stevens Johnson Syndrome, a painful and potentially deadly skin condition.

Dilantin is approved by the FDA to control tonic-clonic and psychomotor seizures and to prevent and treat seizures that happen during or after brain surgery. It appears to work by inhibiting the spread of seizure activity in the motor cortex.

Despite its success as an anti-seizure medication, Dilantin is one of several different kinds of medication that can cause Stevens Johnson Syndrome, or SJS. Other such drugs include sulfa antibiotics, barbiturates, certain nonsteroidal anti-inflammatory drugs, and carbamazepine, another anti-epileptic drug. SJS is rare, but when it does occur it’s almost always caused by medication.

Dilantin SJS usually begins within 28 days, but can occur later. The condition mainly affects the skin and causes symptoms similar to those of severe burns. Symptoms typically begin with headache, fever, cough, or body aches – the condition is often initially misdiagnosed as the flu.

Within a few days, areas of skin turn red like a rash and may begin to blister. Similar blisters may appear on the mucous membranes of the mouth, eyes and genitals.

These blisters may coalesce into large areas of skin that may slough off. Once these lesions cover more than 30 percent of the body’s surface area, the condition may be referred to as toxic epidermal necrolysis, a similar though more advanced condition.

The condition can also cause severe symptoms in the eyes. The eyes may become swollen and purulent enough to seal shut, and the corneas may be scarred.

Treatment of SJS generally requires several weeks of hospitalization, driving up medical expenses while requiring time away from work. Whatever medication is causing the SJS must be discontinued immediately. After that, treatment is directed mainly at alleviating symptoms and preventing infection.

FDA Warnings

Studies show that patients with Asian ancestry may be at particular risk for developing Dilantin SJS. In a November 2008 alert, the FDA announced an investigation into the possibility of an increased risk of SJS and TEN related to phenytoin treatment in patients of certain Asian ancestry.

The increased risk appeared to be connected to the presence of a particular genetic trait, the HLA-B*1502 allele. That allele is found almost exclusively in persons with ancestry from all over Asia, including Han Chinese, Filipinos, Malaysian, South Asian Indians, and Thais.

The FDA alert noted the same warning applied to the similar drug fosphenytoin, sold under the brand name Cerebyx.

Dilantin SJS Lawsuits

Dilantin lawsuits typically allege a failure to properly warn patients and doctors about the risks of Dilantin side effects. Although the current FDA-approved label for Dilantin includes a warning about SJS and TEN, the presence of such a warning does not necessarily preclude the plaintiff in a Dilantin lawsuit from arguing that the warning is not effective. Successful plaintiffs may be able to recover medical expenses, lost wages, compensation for pain and suffering, and other damages.