Pills for warts

A common dermatological lesion in the form of warts is caused by the human papillomavirus (HPV), which infects the epithelial cells of the skin. In the complex treatment of papillomatosis, agents that stimulate the immune system are used. Patients often define drugs of this pharmacological group as antiviral tablets for warts.

Indications Pills for warts

It should be borne in mind that there are no special pills for the  human papillomavirus  and warts, just as there is no single therapeutic method that is effective in all cases. And this is a rather serious problem due to the fact that after the introduction of the HPV genome into epithelial cells, the virus is able to evade innate immune reactions, suppress cellular immunity and not show its presence for a long time. And it is still unknown how this happens, that is, what is the specific immunosuppressive mechanism of papillomavirus. Obviously, HPV can uniquely influence the differentiation of the immune cells themselves (macrophages, neutrophils, T-helpers, killer cells, etc.), recognizing foreign pathogenic structures. [1]

Indications for the use of tablets against warts and papillomas - auxiliary treatment of common skin warts (Verruca vulgaris), plantar warts (Verruca plantaris),  genital warts  or condyloma acuminata -  genital warts , often recurrent and not amenable to other treatment.

In such cases, the goal of immunomodulation is to enhance the adaptive immune response. Although the spontaneous disappearance of warts and papillomas, experts explain not by humoral, but by cell-mediated immunity. [2]

Release form

Names of immunostimulating drugs that can be prescribed for warts:  Isoprinosine  (other trade names are Inosine pranobex, Inosiplex, Groprinosine, Metizoprinol, Dimepranol, Imunovir, Novirin); Alpizarin; Likopid (Glycopin); Cycloferon; Levamisole (Levazol, Levotetramizol, Decaris, Ergamizol, Levoripercol).

In fact, they are all analogues, the mode of action of which is nonspecific, that is, it leads to an increased immune response to a number of infectious agents. But the antiviral drug Acyclovir is used only for the defeat of the herpes simplex virus, as well as for herpes zoster caused by the Herpes zoster virus.

Pharmacodynamics

As indicated in the description of the drug Isoprinosine, its pharmacological action is due to the alkylamino-alcohol complex of nitrogen-containing glycosylamine inosine, 4-acetamidobenzoic acid and N, N-dimethylamino-isopropanol. Although the exact mechanism of action of inosine pranobex is unknown, it can induce T-cell differentiation, enhance the lymphoproliferative response against virus-transformed or infected cells, and induce cytokine (IL-1 and IL-2) production, chemotaxis, and phagocytosis of neutrophils, monocytes, and macrophages.

The active substance of the drug Alpizarin is 2-С-β-D - (glucopyranosyl) -1,3,6,7-tetraoxyxanthone - polyphenol mangiferin of the roots of plants of the legume family Hedisarum flavescens (yellowing hedysarum or licorice) and Hedysarum alpinum (Altai hedysarum). This polyphenol inhibits the growth and reproduction of bacteria and the replication of viral DNA, enhances humoral and cellular immune function, increasing the rate of proliferation of lymphocytes and macrophages and the synthesis of γ-interferon by T cells.

The effect of Likopid on immunocompetent cells is exerted by glucosaminyl muramyl dipeptide of bacterial cell membranes, which binds to the NOD2 cytoplasmic receptor expressed in phagocytic blood monocytes. This activates macrophages and neutrophilic granulocytes, stimulates the division of T- and B-lymphocytes, the production of γ-interferon, IL-1, IL-6 and IL-12.

Pharmacodynamics of Cycloferon is based on the action of its active substance - meglumine acridone acetate or N-methylglucamine 2- (9-oxoacridin-10 (9H) -yl) acetate, which is a derivative of monocarboxylic acridoneacetic acid. The use of this immunostimulating agent, according to the official instructions, leads to the stimulation of T-lymphocytes, an increase in α- and β-interferon. But how this happens is not explained.

As an immunomodulator, the anthelmintic drug Levamisole acts due to levamisole hydrochloride, a derivative of the nitrogen-containing heterocyclic compound imidazole, which restores the activity of phagocytes, macrophages and T-lymphocytes, which provide immune cell protection. [3]

Pharmacokinetics

With almost 100% bioavailability, the maximum plasma level of Isoprinosine is noted after about 60 minutes. After ingestion of a standard dose, but after two hours, the concentration decreases - due to the high rate of its transformation by liver enzymes. Excretion from the body occurs in the urine partly unchanged, as well as in the form of uric acid and other metabolites.

Absorbed in the gastrointestinal tract, Likopid also enters the systemic circulation, but its bioavailability does not exceed 13% with the highest plasma concentration 90 minutes after taking the tablet. The elimination half-life by the kidneys is just over four hours.

The active component of the drug Cycloferon within three hours after oral administration reaches the highest concentration in plasma, the average duration of its half-life is 4.5 hours; renal excretion.

Levamisole reaches its highest plasma level after an average of two hours; metabolism occurs in the liver; metabolites are excreted by the kidneys and to a lesser extent by the intestines - with a half-life of about six hours.

Dosing and administration

In the treatment of recurrent warts, adults are recommended to take two tablets (0.5 g each) of Isoprinosine orally three times a day; I calculate the daily dose for children based on body weight - 0.5 g of the drug per 10 kg, and is divided into three doses. The course of treatment can last from two to weeks to a month.

The dosage of Alpizarin is determined by the doctor, but the maximum allowable daily dose should not exceed eight tablets, that is, 800 mg (for children - 300 mg). Duration of application - from five days to two weeks.

Likopid tablets can be taken orally (half an hour before meals) or placed under the tongue (for gradual resorption). The exact dosage and duration of use of this remedy is individually determined by the attending physician.

Cycloferon should be taken one tablet (0.15 g) once a day half an hour before meals

Levamisole (tablets of 50 and 150 mg) is prescribed at 150 mg (daily dose for children - 1 mg per kg of body weight) - for three days with a week break; the course of treatment consists of two or three cycles.

• Wart pills for children

Contraindicated in children under 3 years old - Isoprinosine, Alpizarin and Likopid; children under 5 years old - Cycloferon; up to 7 years (according to other sources - up to 14 years) - Levamisole.

Use Pills for warts during pregnancy

Any pharmacological agents that directly or indirectly affect the immune system should not be used during pregnancy.

Contraindications

Contraindications to the use of Isoprinosine include gout, the presence of bladder stones, chronic kidney failure and cardiac arrhythmias.

It is contraindicated to use:

• Likopid - with fever and autoimmune thyroiditis;
• Cycloferon - with decompensated cirrhosis of the liver;
• Levamisole - with a low level of leukocytes in the blood.

Side effects Pills for warts

Taking Isoprinosine can cause side effects in the form of: feelings of general malaise, headaches and dizziness, abdominal pain, intestinal disorders, sleep problems, skin itching, increased urine volume, joint pain.

Side effects of Alpizarin include headache and dizziness, nausea and weakness, indigestion, and immediate allergic reactions.

Likopid can cause a short-term increase in body temperature, and Cycloferon - an allergic reaction.

The use of Levamisole may be accompanied by skin rashes, nausea, vomiting, diarrhea, changes in the perception of smells and tastes, weakness and fever, as well as muscle and joint pain.

Overdose

There is no information on overdose of Isoprinose, Alpizarin, Likopid and Cycloferon.

In case of an overdose of Levamisole, convulsions and cardiac arrhythmias may occur; it is necessary to carry out a gastric lavage and take an enterosorbent (activated charcoal). Treatment is symptomatic.

Interactions with other drugs

Isoprinosine is not taken with drugs used to treat gout and diuretics.

Alpizarin is not used simultaneously with enterosorbents, and Likopid is used with antibiotics of the tetracycline group and sulfanilamide preparations.

Consideration should be given to the ability of Likopid to enhance the effect of antibacterial drugs and polyene antimycotics.

Levamisole hydrochloride is not compatible with ethanol and oil-based preparations; it potentiates the action of anticonvulsants and drugs of the group of indirect anticoagulants.

Storage conditions

All of the listed drugs in the form of tablets should be stored at room temperature (not higher than + 22-25 ° C).

Shelf life

The shelf life of Isoprinosine, Alpizarin and Likopid is 5 years; Levamisole - 3 years; Cycloferon - 2 years.

Immunotherapy has become one of the most important therapeutic options for treating warts, but clinically proven evidence of their effectiveness is often lacking. Given the feedback from experts, it should be borne in mind that there is no single absolutely effective treatment, and various types of treatment - surgical excision, cryo- and laser surgery, topical agents and immunotherapy - can be combined. The possibility of spontaneous regression of papillomas, especially in children, must also be taken into account, so an overly aggressive approach to their treatment should be avoided.