| Tonic-Clonic Epilepsy
Dilantin vs Fycompa
Side-by-side clinical, coverage, and cost comparison for tonic-clonic epilepsy.Deep comparison between: Dilantin vs Fycompa with Prescriber.AI
AI compares prescribing info and payer-specific access barriers across 1,200+ formularies. Here's a preview of what prescribers are already asking.Safety signalsFycompa has a higher rate of injection site reactions vs Dilantin based on FDA-approved prescribing information
Coverage gaps3 major payers require step therapy for Fycompa but not Dilantin, including UnitedHealthcare
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Category
Dilantin
Fycompa
At A Glance
Oral
1-4 times daily
Sodium channel blocker (antiepileptic)
Oral
Once daily
AMPA receptor antagonist
Indications
- Tonic-Clonic Epilepsy
- Epilepsy, Temporal Lobe
- Seizures, Focal
- Tonic-Clonic Epilepsy
Dosing
Tonic-Clonic Epilepsy, Epilepsy, Temporal Lobe (Adults) Starting dose 100 mg orally 3 times daily; maintenance 300-400 mg/day; once-daily 300 mg may be considered when seizure control is established on divided doses of 300 mg/day. Loading dose (clinic/hospital setting): 1 g in 3 divided doses (400 mg, 300 mg, 300 mg) at 2-hour intervals, followed by maintenance dosing 24 hours later.
Tonic-Clonic Epilepsy, Epilepsy, Temporal Lobe (Pediatric) Starting dose 5 mg/kg/day orally in 2-3 equally divided doses; maintenance 4-8 mg/kg/day; maximum 300 mg/day.
Seizures, Focal Start at 2 mg once daily at bedtime; increase by 2 mg no more frequently than weekly; recommended maintenance 8-12 mg once daily at bedtime (monotherapy or adjunctive). With concomitant moderate or strong CYP3A4 inducers, start at 4 mg once daily.
Tonic-Clonic Epilepsy Start at 2 mg once daily at bedtime; increase by 2 mg no more frequently than weekly; recommended maintenance 8 mg once daily at bedtime (adjunctive). With concomitant moderate or strong CYP3A4 inducers, start at 4 mg once daily.
Contraindications
- History of hypersensitivity to phenytoin, its inactive ingredients, or other hydantoins (reactions have included angioedema)
- History of prior acute hepatotoxicity attributable to phenytoin
- Coadministration with delavirdine due to potential for loss of virologic response and possible resistance to delavirdine or non-nucleoside reverse transcriptase inhibitors
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Adverse Reactions
Most common Nystagmus, ataxia, slurred speech, decreased coordination, somnolence, mental confusion (dose-related nervous system reactions)
Serious Withdrawal-precipitated seizures/status epilepticus, suicidal behavior and ideation, serious dermatologic reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis, bullous/exfoliative dermatitis), DRESS/multiorgan hypersensitivity, angioedema, acute hepatic failure, hematopoietic complications (thrombocytopenia, agranulocytosis, pancytopenia), exacerbation of porphyria, teratogenicity, hyperglycemia
Most common (>=4%) dizziness, somnolence, fatigue, irritability, falls, nausea, ataxia, balance disorder, gait disturbance, vertigo, weight gain
Serious serious psychiatric and behavioral reactions, suicidal behavior and ideation, neurologic effects, falls, DRESS/multiorgan hypersensitivity
Postmarketing DRESS, acute psychosis, hallucinations, delusions, paranoia, delirium, confusional state, disorientation, memory impairment
Pharmacology
Phenytoin is an antiepileptic agent thought to act through voltage-dependent blockade of membrane sodium channels, reducing sustained high-frequency neuronal discharges. It is primarily metabolized by CYP2C9 and to a lesser extent CYP2C19 via a saturable hepatic enzyme system, such that small dose increases at high serum levels may produce disproportionately large increases in serum concentrations.
Perampanel is a non-competitive antagonist of the ionotropic AMPA glutamate receptor on post-synaptic neurons, reducing neuronal over-excitation caused by glutamate, the primary excitatory neurotransmitter in the CNS; the precise mechanism by which it exerts antiepileptic effects in humans is unknown.
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Most Common Insurance
Anthem BCBS
Dilantin
- Covered on 5 commercial plans
- PA (11/12) · Step Therapy (0/12) · Qty limit (0/12)
Fycompa
- Covered on 5 commercial plans
- PA (10/12) · Step Therapy (1/12) · Qty limit (9/12)
UnitedHealthcare
Dilantin
- Covered on 4 commercial plans
- PA (0/8) · Step Therapy (0/8) · Qty limit (0/8)
Fycompa
- Covered on 4 commercial plans
- PA (4/8) · Step Therapy (0/8) · Qty limit (2/8)
Humana
Dilantin
- Covered on 0 commercial plans
- PA (1/3) · Step Therapy (0/3) · Qty limit (0/3)
Fycompa
- Covered on 0 commercial plans
- PA (3/3) · Step Therapy (3/3) · Qty limit (3/3)
Coverage data sourced from MMIT. Updated monthly.
Savings
No savings programs available for Dilantin.
$5/momo
Fycompa Instant Savings Card - Covered benefitCommercial or private insurance
Medicare, Medicaid, VA, TRICARE
Final cost depends on formulary coverage
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DilantinView full Dilantin profile
FycompaView full Fycompa profile
Clinical data sourced from FDA-approved labeling. Coverage data via MMIT. Updated monthly.