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Chemistry

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Also known as: Methoin, Mesantoin, Phenantoin, Methylphenetoin, 50-12-4, Epiazin
Molecular Formula
C12H14N2O2
Molecular Weight
218.25  g/mol
InChI Key
GMHKMTDVRCWUDX-UHFFFAOYSA-N
FDA UNII
R420KW629U

Mephenytoin
An anticonvulsant effective in tonic-clonic epilepsy (EPILEPSY, TONIC-CLONIC). It may cause blood dyscrasias.
Mephenytoin is an Anti-epileptic Agent. The physiologic effect of mephenytoin is by means of Decreased Central Nervous System Disorganized Electrical Activity.
1 2D Structure

Mephenytoin

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
5-ethyl-3-methyl-5-phenylimidazolidine-2,4-dione
2.1.2 InChI
InChI=1S/C12H14N2O2/c1-3-12(9-7-5-4-6-8-9)10(15)14(2)11(16)13-12/h4-8H,3H2,1-2H3,(H,13,16)
2.1.3 InChI Key
GMHKMTDVRCWUDX-UHFFFAOYSA-N
2.1.4 Canonical SMILES
CCC1(C(=O)N(C(=O)N1)C)C2=CC=CC=C2
2.2 Other Identifiers
2.2.1 UNII
R420KW629U
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 5 Ethyl 3 Methyl 5 Phenylhydantoin

2. 5-ethyl-3-methyl-5-phenylhydantoin

3. Mefenetoin

4. Mesantoin

5. Methoin

6. Methyl Phenetoin

7. Phenantoin

8. Phenetoin, Methyl

2.3.2 Depositor-Supplied Synonyms

1. Methoin

2. Mesantoin

3. Phenantoin

4. Methylphenetoin

5. 50-12-4

6. Epiazin

7. Methyl Hydantoin

8. Fenantoin

9. Sedantoin

10. Sedantoinal

11. Triantoin

12. Insulton

13. Metydan

14. Sacerno

15. 5-ethyl-3-methyl-5-phenylimidazolidine-2,4-dione

16. Epilan

17. Phenylethylmethylhydantoin

18. Mesontoin

19. (+/-)-mephenytoin

20. Mephentoin

21. Mephenytoinum

22. 3-ethylnirvanol

23. Mephenytoine

24. Mefenitoina

25. 5-ethyl-3-methyl-5-phenylhydantoin

26. 3-methyl-5,5-phenylethylhydantoin

27. 3-methyl-5-ethyl-5-phenylhydantoin

28. Nsc-34652

29. 5-ethyl-3-methyl-5-phenyl-2,4-imidazolidinedione

30. Hydantoin, 5-ethyl-3-methyl-5-phenyl-

31. 5-ethyl-3-methyl-5-phenylimidazolidin-2,4-dione

32. 2,4-imidazolidinedione, 5-ethyl-3-methyl-5-phenyl-

33. 5-ethyl-5-fenyl-3-methylhydantoin

34. 5-ethyl-3-methyl-5-phenyl-2,4(3h,5h)-imidazoledione

35. L-mephenytoin

36. 3-methyl-5,5-ethylphenylhydantoin

37. 50-12-4 (racemic)

38. Mephenetoinum

39. Mesdontoin

40. R420kw629u

41. Nsc34652

42. Sedantional

43. Gerot-epilan

44. Mefenitoina [inn-spanish]

45. Mephenytoine [inn-french]

46. Mephenytoinum [inn-latin]

47. Mesantoin (tn)

48. (-)-5-ethyl-3-methyl-5-phenylhydantoin

49. Hsdb 3581

50. 5-ethyl-5-fenyl-3-methylhydantoin [czech]

51. Sr-05000001478

52. Mephenytoin (usp/inn)

53. Einecs 200-012-8

54. Nsc 34652

55. Brn 0017282

56. Rac-mephenytoin

57. Unii-r420kw629u

58. (+-)-5-ethyl-3-methyl-5-phenylhydantoin

59. Mephenytoin [usan:usp:inn:ban]

60. 3-methyl-5, 5-ethylphenylhydantoin

61. L-3-methyl-5-ethyl-5-phenylhydantoin

62. Spectrum_001494

63. Mephenytoin [mi]

64. Prestwick0_001108

65. Prestwick1_001108

66. Prestwick2_001108

67. Prestwick3_001108

68. Spectrum4_001094

69. Mephenytoin [inn]

70. (+/-)-5-ethyl-3-methyl-5-phenylhydantoin

71. Ethylmethylhydantoin

72. Mephenytoin [hsdb]

73. Mephenytoin [usan]

74. Chembl861

75. Mephenytoin [vandf]

76. Mephenytoin [mart.]

77. Oprea1_289074

78. Schembl21766

79. Bspbio_001216

80. Kbiogr_001508

81. Kbioss_001974

82. Mephenytoin [who-dd]

83. Mls002154157

84. Divk1c_000937

85. Spbio_003088

86. Bpbio1_001338

87. Chebi:6757

88. Gtpl7223

89. Dtxsid9023257

90. Niosh/mu2276000

91. Hms502o19

92. Kbio1_000937

93. Kbio2_001974

94. Kbio2_004542

95. Kbio2_007110

96. (+/-)-5-ethyl-3-methyl-5-phenyl-2,4-imidazolidinedione

97. Mephenytoin [orange Book]

98. Ninds_000937

99. 2,4-imidazolidinedione, 5-ethyl-3-methyl-5-phenyl-, (+-)-

100. Hms1571m18

101. Hms2089j22

102. Hms2098m18

103. Hms2230e21

104. Hms3369f15

105. Hms3715m18

106. Mephenytoin [usp Impurity]

107. 2, 5-ethyl-3-methyl-5-phenyl-

108. Hy-b1184

109. Mephenytoin 1.0 Mg/ml In Methanol

110. Bdbm50103593

111. Wln: T5mvnv Ehj C1 E2 Er

112. Akos015962176

113. Ccg-213191

114. Cs-4793

115. Db00532

116. Idi1_000937

117. Ncgc00165924-01

118. Ncgc00165924-02

119. (?)-5-ethyl-3-methyl-5-phenylhydantoin

120. Ac-15964

121. As-56694

122. Smr001233457

123. Db-055496

124. Ab00052368

125. Ft-0605165

126. Ft-0605333

127. Ft-0671015

128. Ft-0671016

129. Mu22760000

130. (.+/-.)-5-ethyl-3-methyl-5-phenylhydantoin

131. Bim-0051837.0001

132. D00375

133. Ab00052368-07

134. Ab00052368_08

135. Hydantoin, 5-ethyl-3-methyl-5-phenyl-, (-)-

136. 5-ethyl-3-methyl-5-phenyl-2,5h)-imidazoledione

137. 5-ethyl-3-methyl-5-phenyl-imidazolidine-2,4-dione

138. Q1175385

139. Sr-05000001478-1

140. Sr-05000001478-3

141. 2, 4-imidazolidinedione, 5-ethyl-3-methyl-5-phenyl-

142. Brd-a83937277-001-03-0

143. 4-ethyl-2-hydroxy-1-methyl-4-phenyl-4,5-dihydro-1h-imidazol-5-one

144. Mephenytoin, United States Pharmacopeia (usp) Reference Standard

145. 2,4-imidazolidinedione, 5-ethyl-3-methyl-5-phenyl-, (+/-)-

2.4 Create Date
2005-03-25
3 Chemical and Physical Properties
Molecular Weight 218.25 g/mol
Molecular Formula C12H14N2O2
XLogP31.5
Hydrogen Bond Donor Count1
Hydrogen Bond Acceptor Count2
Rotatable Bond Count2
Exact Mass218.105527694 g/mol
Monoisotopic Mass218.105527694 g/mol
Topological Polar Surface Area49.4 Ų
Heavy Atom Count16
Formal Charge0
Complexity310
Isotope Atom Count0
Defined Atom Stereocenter Count0
Undefined Atom Stereocenter Count1
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Therapeutic Uses

Anticonvulsants

National Library of Medicine's Medical Subject Headings online file (MeSH, 1999)


Hydantoin anticonvulsants are indicated in the suppression and control of tonic-clonic (grand mal) and simple or complex partial (psychomotor or temporal lobe) seizures. ... Mephenytoin is also used in the treatment of simple partial (focal and Jacksonian) seizures in patients who have not responded to less toxic anticonvulsants. /Hydantoin anticonvulsants; Included in US product labeling./

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 259


Hydantoin anticonvulsants are not indicated in the treatment of absence (petit mal) seizures, or as first-line treatment of febrile, hypoglycemic, or other metabolic seizures. When tonic-clonic (grand mal) seizures coexist with absence seizures, combined therapy may be necessary. /Hydantoin anticonvulsants;NOT included in the US product label/

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 259


4.2 Drug Warning

Leukopenia, neutropenia, agranulocytosis, thrombocytopenia, and pancytopenia have occurred. Eosinophilia, monocytosis, and leukocytosis have been described. Simple anemia, hemolytic anemia, megaloblastic anemia, and aplastic anemia have occurred but are uncommon.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.2006 (1996)


Maculopapular, morbilliform, scarlatiniform, urticarial, purpuric (associated with thrombocytopenia), and nonspecific skin rashes have been reported. Exfoliative dermatitis, erythema multiform (Stevens-Johnson syndrome), and toxic epidermal neurolysis and fatal dermatitides have been described on rare occaisions. Skin pigmentation and rashes associated with a lupus erythematosis syndrome have also been reported.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.2006 (1996)


Drowsiness is dose-related and may be reduced by a reduction in dose. Ataxia, diplopia, nystagmus, dysarthria, fatigue, irritability, choreiform movements, depression, and tremor have been encountered. Nervousness, nausea, vomiting, insomnia, and dizziness may occur during the initial stages of therapy. Generally, these symptoms are transient, often disappearing with continued treatment. Mental confusion and psychotic disturbances and increased seizures have been reported but a definite causal relationship with the drug is uncertain.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.2006 (1996)


Hepatitis, jaundice, and nephrosis have been reported but a definite cause and effect relationship between the drug and these effects has not been established. Alopecia, weight gain, edema, photophobia, and conjunctivitis have been encountered. Polyarthropathy, pulmonary fibrosis, lupus erythematosis syndrome, and lymphadenopathy which simulates Hodgkin's disease have also been observed.

Medical Economics Co; Physicians Desk Reference: Generics 2nd ed p.2006 (1996)


For more Drug Warnings (Complete) data for MEPHENYTOIN (15 total), please visit the HSDB record page.


4.3 Drug Indication

For the treatment of refractory partial epilepsy.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Mephenytoin is an antiepileptic drug which can be useful in the treatment of epilepsy. The primary site of action appears to be the motor cortex where spread of seizure activity is inhibited. Possibly by promoting sodium efflux from neurons, mephenytoin tends to stabilize the threshold against hyperexcitability caused by excessive stimulation or environmental changes capable of reducing membrane sodium gradient. This includes the reduction of posttetanic potentiation at synapses. Loss of posttetanic potentiation prevents cortical seizure foci from detonating adjacent cortical areas. Mephenytoin reduces the maximal activity of brain stem centers responsible for the tonic phase of tonic-clonic (grand mal) seizures.


5.2 MeSH Pharmacological Classification

Anticonvulsants

Drugs used to prevent SEIZURES or reduce their severity. (See all compounds classified as Anticonvulsants.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
MEPHENYTOIN
5.3.2 FDA UNII
R420KW629U
5.3.3 Pharmacological Classes
Physiologic Effects [PE] - Decreased Central Nervous System Disorganized Electrical Activity
5.4 ATC Code

N - Nervous system

N03 - Antiepileptics

N03A - Antiepileptics

N03AB - Hydantoin derivatives

N03AB04 - Mephenytoin


5.5 Absorption, Distribution and Excretion

Volume of Distribution

1.4 L/kg


Mephenytoin is absorbed from the GI tract. Following oral administration, the drug has an onset of action of 30 minutes and a duration of action of 24-48 hours. Plasma concentrations required for therapeutic effects are not known; however, total serum concentrations of mephenytoin and its major metabolite of 25-40 ug/mL are reportedly associated with good seizure control without clinical intoxication.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 97. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1997 (Plus Supplements)., p. 1638


Therapeutic serum concentrations range from 25 to 40 ug/mL (115 to 183 umol/L) for mephenytoin in combination with nirvanol /SRP: its active metabolite/. Time to peak concentration ranges from 45 minutes to 4 hours for mephenytoin and from 16 to 36 hours for nirvanol.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 260


... /A/ single-dose study of mephenytoin (Mesantoin) ... was performed in adult inpatients on stable regimens of other anticonvulsants. Five patients received mephenytoin, 7 mg per kilogram of body weight. Serial blood sampling was performed rigorously. The time to peak concentration (Tmax) for mephenytoin was 1 hour, with a half-life (T 1/2) of 7 hours; the T 1/2 of its metabolite, 5-ethyl-5-phenylhydantion, was 96 hours. ... Saliva accurately represented the unbound fraction for /both/ agents. Mean salivary levels (as percentage of total levels) were 61% for mephenytoin, 73% for its metabolite ... . The implications for therapy are that following mephenytoin administration, the metabolite 5-ethyl-5-phenylhydantoin will provide anticonvulsant effectiveness, with its long half-life producing stable blood levels on simple dose schedules.

PMID:42344 Troupin A et al; Ann Neurol 6 (5): 410-4 (1979)


5.6 Metabolism/Metabolites

The rate of hepatic biotransformation is increased in younger children, in pregnant women, in women during menses, and in patients with acute trauma; rate decreases with advancing age. ... Mephenytoin has an active metabolite, nirvanol (5-ethyl-5-phenylhydantoin). /Hydantoin anticonvulsants/

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 260


Mephenytoin is N-demethylated by the liver to form a highly toxic compound, 5,5-ethylphenylhydantoin. It is probably that this metabolite at least partly accounts for both the therapeutic and toxic effects of mephenytoin. The N-demethylated /metabolite/ may be excreted in the urine or further metabolized via p-hydroxylation of the phenyl group, conjugated with glucuronic acid, and excreted in the urine.

McEvoy, G.K. (ed.). American Hospital Formulary Service - Drug Information 97. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 1997 (Plus Supplements)., p. 1638


Human liver was used in investigations of mephenytoin p-hydroxylase, the enzyme presumably responsible for the genetic polymorphism in mephenytoin metabolism. A gas chromatographic assay method was developed to measure p-hydroxylation and N-demethylation which is the other major metabolic pathway. Both reactions were localized in the microsomal fraction and required NADPH. Inhibition of p-hydroxylation by CO, SKF 525-A, and metyrapone was demonstrated. It was concluded that a form of cytochrome P-450 catalyzes the reaction. The velocity of N-demethylation in human liver did not show saturation even at 500 microM substrate concentration. The p-hydroxylation, however, followed Michaelis-Menten kinetics. The Km, determined in five different livers, ranged from 59 to 143 microM. The linearity in Eadie-Hofstee plots was consistent with the involvement of a single catalytic site.

PMID:2859161 Jurima M et al; Drug Metab Dispos 13 (2): 151-5 (1985)


A major metabolite of the antiepileptic drug mephenytoin (3-methyl-5-ethyl-5-phenylhydantoin) has been identified in urine after a single oral dose of 100 mg of mephenytoin in man. Using chemical synthesis, gas chromatography-mass spectrometry, and nuclear magnetic resonance spectroscopy, /investigators/ established its chemical structure as 3-methyl-5-ethyl-5-(4-hydroxyphenyl)hydantoin (4-OH-M) which is a product of aromatic hydroxylation of mephenytoin in man. Quantitative determinations of 4-OH-M in urine of 10 volunteers showed that 43 +/- 7% (SD) of a single oral dose of 100 mg of mephenytoin were eliminated as the glucuronide of this metabolite. Urinary elimination of the demethylated metabolite, 5-ethyl-5-phenylhydantoin (Nirvanol), was low (1% of the dose per 24 hr) emphasizing the importance of 4-OH-M as the major metabolite after a single oral dose of mephenytoin. Other products of mephenytoin hydroxylation (2-OH-M, E-OH-M, or aliphatically hydroxylated 2-OH-ethyl-M) were not detectable under the conditions selected (less than 1 umol/24 hr).

PMID:6102023 Kupfer A et al; Drug Metab Dispos 8 (1): 1-4 (1980)


For more Metabolism/Metabolites (Complete) data for MEPHENYTOIN (6 total), please visit the HSDB record page.


5.7 Biological Half-Life

Approximately 7 hours


... /A/ single-dose study of mephenytoin (Mesantoin) ... was performed in adult inpatients on stable regimens of other anticonvulsants. ... The time to peak concentration (Tmax) for mephenytoin was 1 hour, with a half-life (T 1/2) of 7 hours; the T 1/2 of its metabolite, 5-ethyl-5-phenylhydantion, was 96 hours. ...

PMID:42344 Troupin A et al; Ann Neurol 6 (5): 410-4 (1979)


About 7 hours, but for active metabolite, nirvanol, about 95 to 144 hours.

Thomson/Micromedex. Drug Information for the Health Care Professional. Volume 1, Greenwood Village, CO. 2007., p. 260


5.8 Mechanism of Action

The mechanism of action of mephenytoin is not definitely known, but extensive research strongly suggests that its main mechanism is to block frequency-, use- and voltage-dependent neuronal sodium channels, and therefore limit repetitive firing of action potentials.


The mechanism of action is not completely known, but it is thought to involve stabilization of neuronal membranes at the cell body, axon, and synapse and limitation of the spread of neuronal or seizure activity. ... Hydantoin anticonvulsants have an excitatory effect on the cerebellum, activating inhibitory pathways that extend to the cerebral cortex. This effect may also produce a reduction in seizure activity that is assoc with an increased cerebellar Purkinje cell discharge. /Hydantoin anticonvulsants/

USP Convention. USPDI - Drug Information for the Health Care Professional. 17th ed. Volume I. Rockville, MD: Convention, Inc., 1997. (Plus Updates)., p. 246


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