Modulation of antiepileptic effect of phenytoin and carbamazepine by melatonin in mice

The pharmacokinetic and pharmacodynamic interaction of phenytoin and carbamazepine with melatonin was studied in a maximal electroshock seizure (MES) model in mice. The anticonvulsant ED(20), ED(33), ED(50) and ED(100) of phenytoin and carbamazepine, and ED(50) of melatonin were determined. Thereafter, the subanticonvulsant doses of phenytoin and carbamazepine were combined with ED(50) dose of melatonin. In combination with melatonin, 100% protection against seizures was achieved with phenytoin and carbamazepine in doses as low as ED(50) and ED(33), respectively. Serum levels of phenytoin and carbamazepine in animals that received ED(50) dose of phenytoin and carbamazepine per se, were not significantly different to those of the groups that received melatonin also. The study suggests that the synergistic antiepileptic effect is most likely a pharmacodynamic interaction, and not due to pharmacokinetic changes. Melatonin, thus, can be a potential adjunct to antiepileptic drugs, achieving a therapeutic effect at lower concentrations, hence limiting their dose-related toxicities.