Antiarrhythmic drug therapy. Recent advances and current status

Phenytoin - An anti-seizure drug: Overview of its chemistry, pharmacology and toxicology

Phenytoin is a long-standing, anti-seizure drug widely used in clinical practice. It has also been evaluated in the context of many other illnesses in addition to its original epilepsy indication. The narrow therapeutic index of phenytoin and its ubiquitous daily use pose a high risk of poisoning. This review article focuses on the chemistry, pharmacokinetics, and toxicology of phenytoin, with a special focus on its mutagenicity, carcinogenicity, and teratogenicity. The side effects on human health associated with phenytoin use are thoroughly described. In particular, DRESS syndrome and cerebellar atrophy are addressed. This review will help in further understanding the benefits phenytoin use in the treatment of epilepsy.

Theoretical study of mexiletine and its interaction with cationic and anionic receptor sites

Theoretical methods are applied to study the antiarrhythmic (AA) mexiletine (1-(2,6-dimethylphenoxy)-2-aminopropane). The AM1 method is used to construct a three-centre binding model for this drug. This model consists of an amine nitrogen atom that is protonated to a higher degree at physiological pH, flat hydrophobic regions of aromatic rings and additional functional groups with lone electron pairs of oxygen. Based on these ideas, a model for the binding of mexiletine at the transmembrane protein was constructed. An ab initio SCF method was used to study the two-component mexiletine-receptor binding site composed of acetate (Glu-, Asp-) and protonated methylamine (Lys+, Arg+). The binding of mexiletine to the receptor may be understood by considering a two-step process of recognition and binding of AA to its receptor. Within this model the mexiletine cation is recognised in the first step and bonded to the negatively-charged part of the receptor. In a subsequent step, the interaction between the amide oxygen and cationic amine group of the membrane protein may follow.