Relation of in vivo drug metabolism to stereoselective fetal hydantoin toxicology in mouse: evaluation of mephenytoin and its metabolite, nirvanol.

Anticonvulsant therapy during pregnancy with the hydantoin phenytoin carries a risk of teratologic sequelae and developmental retardation known as the fetal hydantoin syndrome. The putative teratogen is a highly reactive arene oxide intermediate produced during phenytoin metabolism. By using two structurally similar hydantoins, mephenytoin and its in vivo demethylated metabolite nirvanol, we examined the possibility for a stereoselective dissociation of fetal hydantoin toxicity from maternal anticonvulsant activity. The d-isomers (S-enantiomers) of mephenytoin and nirvanol are p-hydroxylated via an arene oxide and hence were suspect teratogens. The l-isomers (R-enantiomers), being eliminated primarily via alternate pathways, were expected to be less toxic. Equimolar doses of the d- or l-isomers of mephenytoin or nirvanol were administered to pregnant Swiss ICR mice i.p. on gestational day 10. An 8-fold increase in fetal resorptions and a significant 11% decrease in fetal body weight was observed in the group treated with l-nirvanol, whereas no or minimal toxicity was observed in the other treatment groups. The blood clearance for d-nirvanol was double that for l-nirvanol, with correspondingly higher urinary concentrations of arene oxide-mediated metabolites. ANIH shift during metabolism supported the presence of an arene oxide intermediate. Contrary to our expectations, only l-nirvanol, the isomer producing less arene oxide, demonstrated fetal toxicity, thus raising some doubt concerning the arene oxide as the putative hydantoin teratogen. Further animal studies with the d-isomers of mephenytoin and nirvanol may lead to an anticonvulsant of choice during pregnancy.