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The neurotoxicity of misonidazole: potential modifying role of dexamethasone.

Recent reports have generated some interest in the potential use of phenytoin, phenobarbitone and dexamethasone to reduce the incidence and severity of neurotoxicity caused by misonidazole (Workman, 1979; Wasserman et al., 1980). Pretreatment with phenobarbitone (100 mg/kg/day) or phenytoin (40 mg/kg/day) for four to five days increased the acute LD50 for misonidazole in mice (Workman, 1979). The mechanism appears to involve a reduction in half-life and area under the curve for misonidazole in blood and brain through induction of the demethylation pathway. Phenobarbitone had no effect on either the pharmacokinetics or the acute LD50 of the demethylation product desmethylmisonidazole (Ro 05–9963) (unpublished data).