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Phenytoin is effective in many forms of epilepsy, but not absence seizures. Its mode of action appears to be by blocking sodium ion channels. Phenytoin can be a difficult drug to use for the following reasons. Phenytoin is extensively bound to plasma albumin and other drugs such as salicylates and valproate displace it from its binding site.

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These drugs were known as dangerous drugs but are now referred to as controlled drugs. The use of controlled drugs for medicinal purposes is permitted by the Misuse of Drugs Regulations and subsequent amendments.

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This is essential not least because information about drugs and associated legislation is constantly changing. New drugs come on the market, and others are withdrawn or reclassified.

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Adverse effects of metformin are few, mainly gastrointestinal upsets and a rare but potentially fatal lactic acidosis, which is why other drugs in this class are unavailable. Metformin should never be prescribed for patients with renal disease or severe pulmonary or cardiac disease.

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Adjustment of the dose of oral terbinafine may be necessary if the two drugs are taken together.

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