Melatonin anticonvulsant

Among the recently evaluated treatments for BZD withdrawal are anticonvulsants (carbamazepine and VPA) ( 256), melatonin (257), and ondansetron (258). Of these, odansetron had no significant effects on severity of withdrawal symptoms melatonin was found to effectively facilitate discontinuation of BZD therapy while maintaining good sleep and carbamazepine and VPA may be beneficial in the management of BZD discontinuation but not in decreasing the severity of BZD withdrawal (259, 260). 

Lapin I. P., Mirzaev S. M., Ryzov I. V., and Oxenkrug G. F. (1998). Anticonvulsant activity of melatonin against seizures induced by quinolinate, kainate, glutamate, NMDA, and pentylenete-trazole in mice. J. Pineal Res. 24 215-218. 

Ramelteon is a melatonin receptor agonist selective for the MTj and MT2 receptors. The dose is 8 mg at bedtime. It is well tolerated, but side effects include headache, dizziness, and somnolence. It is not a controlled substance. Zolpidem, chemically unrelated to benzodiazepines or barbiturates, acts selectively at the y-aminobutyric acid (GABA )-receptor and has minimal anxiolytic and no muscle relaxant or anticonvulsant effects. It is comparable in effectiveness to benzodiazepine hypnotics, and it has htde effect on sleep stages. Its duration is approximately 6 to 8 hours, and it is metabolized to inactive metabolites. Common side effects are drowsiness, amnesia, dizziness, headache, and GI complaints. Rebound effects when discontinued and tolerance with prolonged use are minimal, but theoretical concerns about abuse exist. It appears to have minimal effects on next-day psychomotor performance. The usual dose is 10 mg (5 mg in the elderly or those with liver impairment), which can be increased up to 20 mg nightly. Cases of psychotic reactions and sleep-eating have been reported. 

Among other preparations which have been reported as being effective in small open studies are benzodiazepine hypnotics the anticonvulsant compound topiramate melatonin leptin. 

Further five-membered ring fragmentations are known for imidazolines such as vasoconstrictor naphazoline (Sortino et al., 1999b) and anticonvulsant phenyltoin (Parman et al., 1998) thiazoles as vitamin thiamine (van Dort et al., 1984) isoin-dolines as diuretic chlorthalidone (Vargas and Mendez, 1999) and sydnones as vasodilator molsidomide (Carney, 1987). The indole derivative melatonin is oxidized to a 2-acylformanilide (Andrisano et al., 2000). 

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