In 1908
phenytoin (5,5-diphenylhydantoin) was first synthesized as a
barbiturate derivative in Germany by professor Heinrich Biltz (1865-1943) and subsequently resynthesized by an American chemist of the
pharmaceutical company Parke-Davis in 1923 in Detroit. Screening
phenytoin did not reveal comparable
sedative side effects as
barbiturates and, thus, Parke-Davis discarded this compound as a useful
drug. In 1936,
phenytoin's anticonvulsive properties were identified via a new animal model for convulsive disorders, developed by Putnam and Merritt, who also evaluated its clinical value in a number of patients in the period 1937-1940. For many diseases, mechanism of action of
phenytoin remains obscure. The
voltage-gated sodium channel was and is generally regarded as the main target to explain
phenytoin's activity as an
anticonvulsant and an
anti-arrhythmic drug. This target, however, does not explain many of the other clinical properties of
phenytoin. We will explore a number of original articles on
phenytoin published in its 80 years history and give extra attention to the various hypothesis and experiments done to elucidate its mechanisms of action.
Phenytoin has been explored in over 100 different disorders; the last two promising indications tested in the clinic are
breast cancer and
optic neuritis. Most probably, there are multiple targets active for these various disorders, and the insight into which targets are relevant is still very incomplete. It is remarkable that many pharmacological studies tested one dose only, mostly 50 or 100 μM, doses which most probably are higher than the non-plasma bound
phenytoin plasma levels obtained during treatment.