Glycyram

Glycyram, also known as ammonium glycyrrhizinate, is a derivative of glycyrrhizic acid, the active component of licorice root (Glycyrrhiza glabra). This compound has a pronounced anti-inflammatory and anti-allergic effect, similar to the action of corticosteroids. Glycyrrhizic acid and its derivatives are widely used in medicine due to their pharmacological properties.

Ammonium glycyrrhizinate can be used to treat inflammatory skin conditions and other conditions associated with inflammation and allergies. It is also used as an adjuvant in medications to improve their taste and as a potential treatment for some viral infections.

Recent studies show that ammonium glycyrrhizinate administered in the form of ultra-deformable liposomes effectively reduces cutaneous inflammation in healthy volunteers, making it a potential vehicle for topical delivery of anti-inflammatory drugs (Barone et al., 2020).

Indications Glycyram

1. Cough of various etiologies, including cough associated with acute respiratory viral infections and influenza.
2. Diseases of the upper respiratory tract, such as bronchitis, tracheitis, laryngitis.
3. Nasal congestion that accompanies colds or allergic rhinitis.
4. Prevention and treatment of acute and chronic rhinosinusitis.
5. Rhinitis of various origins, including allergic and vasomotor rhinitis.
6. Rhinitis in smokers and occupational risk groups.

Release form

Glycyram (ammonium glycyrrhizinate) is commonly available in several forms, including tablets, syrups, and injection solutions.

Pharmacodynamics

1. Anti-inflammatory action:

   • Ammonium glycyrrhizinate has an anti-inflammatory effect by suppressing the activity of enzymes responsible for the formation of inflammatory cytokines such as interleukin-1 and interleukin-6, as well as inhibiting the activity of phospholipase A2, which leads to a decrease in the formation of prostaglandin E2.
   • These mechanisms may result in a reduction in inflammation and associated symptoms such as pain, swelling and redness.

2. Antiviral action:

   • Ammonium glycyrrhizinate also has antiviral activity. It helps inhibit viral replication, including the herpes virus, by affecting various stages of the viral cycle, including cell entry, replication, and assembly of viral particles.

3. Antiulcer action:

   • Ammonium glycyrrhizinate also has an antiulcer effect due to the stimulation of mucus secretion and its protective effect on the gastric mucosa.

4. Immunomodulatory action:

   • Some studies suggest that ammonium glycyrrhizinate may modulate the immune system, enhancing its defense functions and anti-inflammatory responses.

Pharmacokinetics

1. Absorption: After oral administration of ammonium glycyrrhizinate, it can be partially absorbed from the gastrointestinal tract. However, a significant portion of the drug usually remains in the gastrointestinal tract and exerts a local effect on the mucous membrane of the respiratory tract.
2. Metabolism: Ammonium glycyrrhizinate can be metabolized in the liver to form active metabolites. However, most of the drug is not metabolized and is excreted unchanged.
3. Excretion: Ammonium glycyrrhizinate is excreted from the body primarily through the kidneys in the form of metabolites and unchanged.
4. Peak Blood Concentration and Duration of Action: Due to local application as syrup or lozenges, peak blood concentration and duration of action of ammonium glycyrrhizinate are not usually considered as its action is directed at the respiratory mucosa.
5. Interactions with other drugs: Information on the interactions of ammonium glycyrrhizinate with other drugs is limited. However, interactions with other drugs are possible, especially when several drugs are used simultaneously.
6. Side effects: When using ammonium glycyrrhizinate, various side effects may occur, such as hypertension, fluid and sodium retention, hypokalemia, suppression of adrenal cortex function, and others.

Dosing and administration

1. Pills:

   • Glycyram tablets are usually taken orally, i.e. through the mouth.
   • They are usually taken after meals.
   • The dosage usually depends on the severity of the condition and the doctor's recommendations. Usually, adults are prescribed 100-200 mg 3-4 times a day.

2. Syrup:

   • Glycyram syrup is also taken orally, often after meals.
   • For adults, it is usually recommended to take 5-10 ml of syrup 3-4 times a day.

3. Injection solutions:

   • Injectable forms can be used to treat acute conditions when oral administration is not possible or not effective.
   • The dosage of injections is usually determined by the doctor depending on the patient's condition.

Use Glycyram during pregnancy

Use of ammonium glycyrrhizinate (Glycyram) during pregnancy may pose risks to the fetus. In a study in rats, ammonium glycyrrhizinate was shown to cause an increase in embryonic lethality and external hemorrhage in the fetus. An increase in minor skeletal abnormalities, particularly thoracic vertebral changes, and a significant increase in renal ectopia were also noted at the highest dose (Mantovani et al., 1988).

These results indicate possible embryotoxicity of ammonium glycyrrhizinate, especially at high doses, which should be taken into account when using it during pregnancy. It is necessary to consult a doctor before starting to use this substance, considering the potential risks.

Contraindications

1. Hypersensitivity: People with known hypersensitivity to ammonium glycyrrhizinate or other components of the drug should not use Glycyram.
2. Hypertension: It is known that glycyrrhizic acid contained in ammonium glycyrrhizinate can increase the level of glucocorticoids in the body, which can lead to sodium and water retention in the body, causing an increase in blood pressure. Therefore, the use of Glycyram may be contraindicated in high blood pressure.
3. Heart disease: In patients with serious heart conditions such as heart failure, arrhythmias or previous myocardial infarction, the use of Glycyram may be contraindicated due to the risk of worsening these conditions.
4. Kidney disease: In patients with severe renal impairment, the use of Glycyram may be limited due to possible accumulation of metabolites and deterioration of renal function.
5. Pregnancy and breastfeeding: Data on the safety of Glyciram during pregnancy and breastfeeding are limited, so its use during this period should be carried out only on the recommendation of a doctor.
6. Paediatric population: The safety and efficacy of Glycyram in children may not be fully understood, so its use in children may require consultation with a physician.
7. Acute liver disease: Glycyram may be contraindicated in acute liver disease due to the risk of deterioration of liver function.

Side effects Glycyram

1. Changes in taste sensations.
2. Vomiting and nausea.
3. Bloating and discomfort in the epigastric region.
4. Allergic reactions such as skin rash, itching and hives.
5. Increase in pressure.
6. Increased mucus secretion.
7. Headache.
8. Rarely, the level of potassium in the blood may increase.

Overdose

1. Hypertension and Edema: Ammonium glycyrrhizinate may cause fluid and sodium retention, which in turn may lead to increased blood pressure and edema.
2. Hypokalemia: Long-term use of ammonium glycyrrhizinate may cause potassium loss and hypokalemia, which may result in muscle weakness, abnormal heart rhythms, and other symptoms.
3. Hypernatremia: Overdose may lead to increased sodium levels in the blood, which may cause various disorders such as headache, seizures, insomnia, etc.
4. Poisoning and intoxication: In case of significant overdose, poisoning and intoxication may develop, which may manifest itself in the form of nausea, vomiting, abdominal pain, dizziness, drowsiness and other symptoms.

Interactions with other drugs

1. Medicines that increase the risk of side effects:

   • Drugs that may also cause fluid and sodium retention or increase kalemia (eg, diuretics) may increase these side effects when used concomitantly with ammonium glycyrrhizinate.

2. Medicines that affect electrolyte balance:

   • Drugs that can also increase or decrease potassium levels in the body (eg, antiarrhythmic drugs) may interact with ammonium glycyrrhizinate, possibly leading to electrolyte imbalances.

3. Drugs that affect the central nervous system:

   • Drugs that cause central nervous system depression (eg, hypnotics, analgesics) may enhance the sedative effect of ammonium glycyrrhizinate, which may lead to increased drowsiness and decreased reaction time.

4. Drugs that affect kidney and liver function:

   • Drugs that may have negative effects on kidney or liver function may interact with ammonium glycyrrhizinate, since its metabolism and excretion are largely dependent on these organs.

5. Anticoagulants and drugs that affect blood clotting:

   • Concomitant use of ammonium glycyrrhizinate with anticoagulants or drugs that affect blood clotting may increase the risk of bleeding.

6. Drugs that increase the pH of the gastrointestinal tract:

   • Taking antacids or drugs that increase gastrointestinal pH may decrease the absorption of ammonium glycyrrhizinate.