Aerosols from a sore throat

One of the most popular and sufficiently effective means of local treatment of inflammatory diseases of the throat and larynx is an aerosol from the pain in the throat.

In addition to the anesthetic effect, all preparations of this category have anti-inflammatory and antiseptic properties (bacteriostatic and bactericidal), and some help against fungal infections.

Indications for the use of aerosol for the throat include: acute tonsillitis (tonsillitis), chronic tonsillitis, acute and chronic pharyngitis, glossitis, chronic laryngitis, tracheitis, laryngotracheitis, as well as stomatitis (including aphthous) and gingivitis.

[1], [2]

Pharmacodynamics

The pharmacological action of the aerosol, Angilex (Givalex), is based on its composition, which includes the local antiseptics hexetidine and chlorobutanol hemihydrate, as well as the derivative of salicylic acid (nonsteroidal anti-inflammatory drug), choline salicylate.

Hexetidine (5-methyl-hexahydropyrimidinamine) acts on pathogenic microorganisms bacteriostatically, disrupting their metabolism. Chlorobutanol hemihydrate (1-trichloro-2-methylpropan-2-ol) is a chlorinated butyl alcohol used as a chemical preservative, a sedative and a weak analgesic topical agent. A choline salicylate, like any NSAID, removes inflammation, reducing the activity of cyclooxygenase and, thereby, reducing the production of prostaglandins (inflammatory mediators).

Aerosol from sore throat Hexoral also contains hexetidine. And in the preparation of Stopangin, except hexetidine, contains a derivative of salicylic acid methylsalicylate (has anti-inflammatory properties) and essential oils: eucalyptus, menthol, clove and sassafras. About the last oil in the official instruction there is no detailed information, therefore it is necessary to say a few words about it. Oil from the roots of the tree Sassafras officinale contains safrole - phenylpropanoid, which is the precursor (precursor) of psychotropic and narcotic drugs.

The pharmacodynamics of the aerosol of Septolete plus is based on two components: the cationic surfactant ammonium derivative cetylpyridinium chloride and the local anesthetic benzocaine (with benzocaine in the preparation 5 times greater than the antiseptic). The antiseptic is cetylpyridinium chloride, which, when bound to the membrane of a bacterial cell, breaks its integrity and enters the cytoplasm of bacteria, causing their death. And benzocaine relieves pain by blocking the passage of painful impulses along axons.

Anti-inflammatory and analgesic action of the Tantum Verde means provides NSAIDs for topical use - benzidamine hydrochloride, which reduces the permeability of capillaries of the mucous membrane, promotes the stabilization of cell membranes of epithelial cells, and also reduces the production of tissue mediators of inflammation (Pg). The analgesic effect of this drug is due to a reduction in the synthesis of neurotransmitters at the site of inflammation.

The mechanism of pharmacological action of the aerosol TeraFlu Lar is similar to the drug Sepotlet plus, since its active substance - antiseptic benzoxonium chloride - also refers to ammonium derivatives, and the lidocaine hydrochloride anesthetic inhibits the occurrence and conduct of pain impulses.

Aerosol from the throat with antibiotic Bioparox has in its composition an antibiotic fusafungin - cyclohexadechipptide, obtained from fusarium lateritium fungi (Fusarium lateritium or Gibberella baccata). On bacteria, the drug acts bacteriostatically, embedded in the protein shells of microbial cells, disrupting the water-electrolyte balance and the ability to divide cells of microorganisms causing inflammation.

Another aerosol from the throat with antibiotic - Anginovag - contains just four active substances. First, it is a polypeptide antibiotic for topical application of tirotricin (obtained from gram-positive spore-forming bacteria of the genus Brevibacillus). Antibacterial, antiviral and antifungal (Candida albicans) properties are characterized by the antiseptic of the ammonium group of dequalinium chloride, which also removes inflammation. The active substance enoxolone, which is a complex of triterpene glycosides of glycyrrhizic acid of licorice roots, also contributes to the reduction of inflammatory processes (including herpesvirus etiology). Enoxalon not only prevents the penetration of viruses into the cells of the mucosal epithelium, but also stops the replication of their RNA.

Aerosol Anginovag contains glucocorticosteroid hydrocortisone, which suppresses all inflammation processes and inhibits oxidative processes in cells and the development of allergic reactions. So it can be used as an aerosol from an allergy in the throat. Anesthesia occurs due to the presence in the aerosol of the lidocaine mentioned above.

Farmakodinamiku aerosol for the throat Kameton provide such components: camphor (stimulates blood circulation, disinfects the mucous membrane); eucalyptus oil (contains monocyclic terpene cineole, which is a strong antiseptic); chlorobutanol (see above) and levomenthol. Levomenthol is an isomer of menthol, and its local anesthetic effect is caused by the expansion of the capillaries of the mucous membrane, in which there is a feeling of "mint cold".

Pharmacokinetics

As noted in the official instructions, the aerosol from the pain in the throat Angilex (Givalex) after spraying is well absorbed by the mucous membranes and continues to act for some time. But the producers do not give any more information, although chlorobutanol gets into the bloodstream (in small amounts).

Therapeutic effect of aerosol Geksoral after one spraying lasts more than 10 hours, although, as noted, this drug is almost not absorbed. Nevertheless, the traces of hexetidine are fairly firmly "deposited" in the tissue structures, but the process of biotransformation of this substance is not explained.

The pharmacokinetics of TeraFlu Lar and Anginovag preparations are not represented by manufacturers.

The active substances of the Stopangin aerosol do not enter the blood, but fall into the saliva. The further way of its components (hexetidine, methyl salicylate and essential oils) is not traced.

Benzocaine, which is part of the drug Sepotlet Plus, is absorbed into the blood in small amounts and there it undergoes hydrolysis. Some metabolites are formed in the liver and excreted by the kidneys.

Benzidamine hydrochloride in the aerosol of Tantum Verde is absorbed by the mucous membranes and enters the underlying tissues. Further, the instruction informs that elimination of biotransformation products is carried out through the kidneys and intestines.

Aerosol from the throat with antibiotic Bioparox after application remains on the mucous membrane of the oral cavity and throat, but does not enter the systemic bloodstream (since fusafungin poorly dissolves). From the body the drug is excreted in the process of breathing - along with the tracheobronchial secret.

But chlorobutanol and camphor in the Cameton aerosol get into the blood, and their metabolites (glucuronides) leave the body with urine.

Names of aerosols from pain in the throat

The names of aerosols from the pain in the throat of various manufacturers presented in this review: Angilex (Ukraine) and its synonym Givalex (Norgine Pharma, France), Stopangin (Ivax Pharmaceuticals, Czech Republic), Hexoral (Famar Orleans, France), Septolete plus (KRKA, Slovenia ), Tantum Verde (ACRAF SpA, Italy) and its synonym Tanflex (Turkey), TerraFlu Lar (Novartis, Switzerland), Bioparox (Egis Pharmaceuticals, Hungary), Anginovag (Ferrer Internacional, Spain), Cameton (Ukraine).

If angina is caused not by rhinoviruses but by bacterial infection (staphylococci, streptococci, pneumococci, etc.), an aerosol from the throat with an antibiotic is necessary. Of the above mentioned means, such include aerosols Bioparox and Anginovag.

It should be noted that it is useless to look for a special aerosol from the throat for children: this simply is not. Moreover, otolaryngologists warn that a child who has not reached 2.5-3 years of age, in general, can not use any aerosol because of the increased risk of spasm of the muscles of the larynx, which can lead to convulsions, fainting and stopping breathing. As noted by the specialists of the American Academy of Pediatrics, containing local anesthetics, aerosols (sprays) are no more effective than lozenges and lozenges from sore throat, and do not recommend them for children.

Aerosol for pain in the throat Angilex should not be used to treat children younger than 2.5 years, and the instructions for the Givalex spray, which has an identical composition, indicate that it is only permitted to use it after 12 years.

According to the instructions, a child younger than 2.5 years old is not prescribed a Bioparox preparation. Aerosols Geksoral and Tantum Verde are contraindicated in children under the age of three. Spray TeraFlu Lar can be used after 4 years; Cameton - after five; Sepptolet Plus - after six; Stopangin - after 8, and aerosol from the throat with antibiotic Anginovag - only after 13 years.

Method of application and dose of aerosols from pain in the throat

Aerugol Angilex (Givalex) is recommended for use: adults - one irrigation of the throat 4-5 times during the day (after eating); children under 15 years - no more than three times; the maximum duration of application is 5 days.

Doses of aerosols from pain in the throat Stopangin and Geksoral: spray the mucous throat 2-3 times a day (2 seconds at a time), apply no more than a week.

Septotelet: two pressures on the nebulizer constitute a single dose for adults and one-touch - for children from 6 to 12 years; can be used 7-8 times during the day. The course of treatment is 7 days.

Tantum Verde: for adults, the minimum single dose is 4 pulses per sprayer, the maximum is 8 strokes; for children the maximum dose is 4 strokes. The drug is used every 2-3 hours. For children under the age of 6, one push is allowed for every 4 kg of their weight.

TeraFlu Lar: 4 sprayings (pressure on the nebulizer) up to 6 times a day - for adults; twice less for children after 4 years. The maximum duration of treatment is 5 days.

Aerosol from the throat with antibiotic Bioparox should be applied to 4 sprays every 4 hours; for children, the dosage is reduced to one spray every 6 hours. This remedy can not be used for more than 5-6 days.

Aerosol from the throat with antibiotic Anginovag is used for 1-2 injections up to 4 times a day for a week. The method of application and dose of Cameton aerosol are similar.

Use of aerosols from pain in the throat during pregnancy

According to the information provided in the official instructions for the preparations Angiolix, Geksoral, Tantum Verde, Anginovag and Cameton, the use of aerosols from pain in the throat during pregnancy and during lactation is allowed: only according to the doctor's testimony, with the standard wording "in case the expected benefit for the mother is higher than the possible risks for the child. "

With regard to Angeline (Givalex) and Hexoral, which contain hexetidine, you should be aware that, according to the decision of the European Agency for the Evaluation of Medicines (EAEMP), pregnant women should not use drugs that contain hexetidine.

By the way, hexetidine is also a part of Stopangin, but manufacturers have limited the ban on its use by pregnant women only the first 14 weeks. But methylsalicylate in the composition of this drug (according to the instructions to most methylsalicylate) during pregnancy is contraindicated!

Aerosols from the pain in the throat Sepotlet plus and Bioparox during pregnancy and lactation are not recommended, and TeraFlu Lar is contraindicated.

In the instructions to the preparation Anginovag indicated that during pregnancy, only a doctor can prescribe it. However, this medication contains a hormone of the adrenal cortex hydrocortisone, which is contraindicated for pregnant women.

Contraindications for use

Presented aerosols from pain in the throat have the following contraindications to the application:

Angilex (Givalex), Geksoral, Tantum Verde, Bioparox and Anginovag - individual intolerance of the components of the drug.

Stopangin - individual sensitivity to the components of the drug, age to 8 years, atrophic pharyngitis, the first trimester of pregnancy.

Septhotlet Plus - individual hypersensitivity to local anesthetics, alcohol abuse, blood disease, methaemoglobinaemia.

TeraFlu Lar - hypersensitivity to derivatives and compounds of ammonia, pregnancy.

Cameton - bronchial asthma; because of the presence of camphor - epilepsy.

[3], [4], [5]

Side effects

The use of these aerosols from pain in the throat can cause the following side effects:

• Angilex - irritation of the mucous membranes in the mouth and pharynx.
• Hexoral - allergic reactions, a violation of taste and color of tooth enamel.
• Stopangin - an allergy, burning in the throat, if swallowed, there may be vomiting.
• Septhotlet Plus - allergic reactions in the form of skin rashes and swelling, as well as shortness of breath.
• Tantum Verde - dryness and numbness in the oral cavity, hives and insomnia.
• TeraFlu Lar - irritation of mucous membranes, color of tooth enamel and tongue (reversible), rashes on the skin, swelling of the larynx. Because of lidocaine, a decrease in blood pressure and bradycardia is possible.
• Bioparox - irritation of the mucous membranes in the mouth and nasopharynx, cough, bronchospasm or spasm of the larynx, taste in the mouth, nausea, urticaria, development of superinfection, anaphylactic shock.

Aerosol from the throat with antibiotic Anginovag can cause dryness and numbness in the mouth, allergic reactions, swelling on the face, dyspnea. Similar side effects are noted in the instruction to the drug Cameton.

Overdose

Information on the overdose of drugs Angilex, Stopangin, Bioparox and Anginovag at the moment is missing.

Overdosage of the spray Hexoral occurs if the sprayed drug is swallowed, which can cause nausea and vomiting, as the ethyl alcohol contained in the aerosol contributes to absorption.

Exceeding the recommended dosage of Septolet plus, containing benzocaine, can lead to the development of methemoglobinemia, which manifests itself as headache, cyanosis of the skin, dyspnea, general weakness. In such situations, an oxygen cushion, gastric lavage and the use of methylene blue as an antidote are needed.

An overdose of Tantoum Verde's drug containing benzidamine hydrochloride causes CNS stimulation and hallucinations.

In case of an overdose of an aerosol from a pain in a throat TeraFlyu Lar nausea and vomiting are noted. In addition, lidocaine inhibits the electrical conductivity of the myocardium and lowers the heart rate, but the manufacturers claim that the aerosol content is small.

And an overdose of the drug Kameton is expressed in the intensification of its side effects (dryness and numbness in the mouth, allergic reactions, puffiness of the face and dyspnea).

Interactions with other drugs

Clinically important interactions with other drugs have not been identified in such drugs as Hexoral, Stopangin, Sepptole plus, Tantum Verde, Bioparox and Cameton.

Aerosol from sore throat Angilex (Givalex) can not be used in combination with other antiseptics. The drug TeraFlu Lar is not used with alcohol-containing products, so as not to increase the absorption of benzoxonium chloride.

Aerosol from the throat with antibiotic Anginovag is not used in combination with soothing and anesthetizing drugs.

Storage conditions and shelf life

The storage conditions of the listed drugs: in a shaded place at normal room temperature. Shelf life of aerosols Geksoral, Stopangin, Bioparox, Cameton - 2 years; Angilex (Givalex), Septolete plus - 3 years; Tantoum Verde, Anginovag - 4 years; TerraFlu Lar - 5 years.