Phenytoin-induced isolated chronic, nocturnal dry cough

Abstract

We report a 72-year-old man with a four-year history of dyscognitive seizures (with occasional secondary generalization) who developed isolated, nocturnal dry cough immediately after being started on PO phenytoin. The cough was not accompanied by any other symptom or sign as his physical exam was completely normal. Further investigation with chest CT and spirometry was unremarkable. This symptom persisted for six months and did not resolve until we weaned him off of phenytoin. According to the Naranjo Adverse Drug Reaction Probability Scale, his cough was classified as being probably (score + 6) related to the use of this antiepileptic drug. To our knowledge, there has been only one study that reported phenytoin-triggered cough. It described a postoperative patient who developed cough and bronchospasm after receiving IV phenytoin. By reporting our case and discussing the literature on this specific topic, we have essentially two goals. First, we intend to remind clinicians that isolated persistent cough can be an adverse reaction to phenytoin. Second, we hope to encourage further studies that will be able to elucidate the association presented herein.

Drug-Induced Cough

“…A case was reported of an immediate occurrence of nocturnal dry cough after oral phenytoin administration (Nascimento et al 2016). In this case, the symptom lasted for 6 months and disappeared after phenytoin was discontinued.…”