Wart pills

A common dermatologic 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, immune stimulating agents are used. Preparations of this pharmacological group, patients often define as antiviral pills from warts.

Indications Wart pills

It should be borne in mind that there are no special pills for human papillomavirus and warts, nor is there a single therapeutic method effective in all cases. And this is quite a serious problem due to the fact that after the introduction of the HPV genome into the epithelial cells, the virus is able to evade innate immune reactions, suppress cellular immunity and not manifest its presence for a long time. And it is not yet known how this occurs, that is, what is the specific immunosuppressive mechanism of papillomavirus. Apparently, HPV can uniquely affect the differentiation of immune cells themselves (macrophages, neutrophils, T-helper cells, killer cells, etc.) that recognize foreign pathogenic structures. [1]

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

In such cases, the goal of immunomodulation is to enhance the adaptive immune response. Although experts explain the spontaneous disappearance of warts and papillomas by cell-mediated immunity rather than humoral immunity. [2]

Release form

Names of immunostimulant drugs that may be prescribed for warts: Isoprinosin (other trade names are Inosin pranobex, Inoziplex, Groprinosin, Metizoprinol, Dimepranol, Imunovir, Novirin); Alpizarin; Lycopid (Glycopene); Cycloferon; Levamisole (Levazole, Levotetramisole, Decaris, Ergamisole, Levoripercol).

In fact, they are all analogs, 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 in the case of herpes simplex virus lesions, as well as in shingles caused by the Herpes zoster virus.

Pharmacodynamics

As stated in the description of the drug Isoprinosin, its pharmacological action is due to an alkylamino-alcohol complex of the 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 lymphoproliferative response against transformed or virus-infected cells, and induce cytokine production (IL-1 and IL-2), chemotaxis and phagocytosis of neutrophils, monocytes and macrophages.

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

The effect of Lycopid on immunocompetent cells is exerted by glucosaminyl muramyl dipeptide of bacterial cell membranes, which binds to the cytoplasmic receptor NOD2 expressed in phagocytic blood monocytes. This activates macrophages and neutrophilic granulocytes, stimulates T- and B-lymphocyte division, and 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 acridonacetate or N-methylglucamine 2-(9-oxoacridin-10(9H)-yl)acetate, which is a derivative of monocarbon acridonacetic acid. The use of this immunostimulant, according to the official instructions, leads to stimulation of T-lymphocytes, increase of α- and β-interferon. But how this happens is not explained.

As an immunomodulator, the antihelminthic 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 that provide immune cell defense. [3]

Pharmacokinetics

With practically 100% bioavailability, the maximum plasma level of Isoprinosin is observed approximately 60 min after ingestion of a standard dose, but after two hours the concentration decreases due to its high rate of transformation by liver enzymes. Excretion from the body occurs with urine partially unchanged, as well as in the form of uric acid and other metabolites.

Absorbed in the gastrointestinal tract, Lycopid also enters the systemic bloodstream, but its bioavailability does not exceed 13% with the highest concentration in plasma 90 minutes after taking the tablet. The renal elimination half-life 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 - 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 intestine, with a half-life of about six hours.

Dosing and administration

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

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

Lycopid tablets can be taken orally (half an hour after a meal) or placed under the tongue (for gradual resorption). The exact dosage and duration of use of this drug 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 (50 and 150 mg tablets) is administered at 150 mg (daily dose to children - 1 mg per kg of body weight) - for three days with a one-week break; the course of treatment consists of two to three cycles.

• Wart pills for children

Contraindicated in children under 3 years - Isoprinosin, Alpizarin and Lycopid; children under 5 years - Cycloferon; under 7 years (according to other data - under 14 years) - Levamisole.

Use Wart pills 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 Isoprinosin include gout, presence of bladder stones, chronic kidney failure and heart rhythm disorders.

Contraindicated use:

• Lycopid - for fever and autoimmune thyroiditis;
• Cycloferon - in decompensated liver cirrhosis;
• Levamisole - for low levels of white blood cells in the blood.

Side effects Wart pills

Taking Isoprinosin may cause side effects in the form of: a feeling of general malaise, headaches and dizziness, abdominal pain, bowel disorders, sleep problems, skin itching, increased urine volume, joint pain.

Side effects of Alpizarin include headache and dizziness, nausea and weakness, stomach upset, and immediate-type allergic reactions.

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

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

Overdose

There is no information on overdose of Isoprinoz, Alpizarin, Lycopid and Cycloferon.

In case of overdose of Levamisole preparation convulsions and heart rhythm disturbances may occur; gastric lavage and enterosorbent (activated charcoal) should be performed. Treatment is symptomatic.

Interactions with other drugs

Isoprinosine is not taken with drugs used in the treatment of gout and diuretics.

Alpizarin is not used concomitantly with enterosorbents, and Lycopid - with antibiotics of the tetracycline group and sulfonamide drugs.

The ability of Lycopid to enhance the effect of antibacterial drugs and polyene antimycotics should be taken into account.

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

Storage conditions

All listed preparations in tablet form should be stored at room temperature (not higher than +22-25°C).

Shelf life

Shelf life of Isoprinosin, Alpizarin and Lycopid - 5 years; Levamisole - 3 years; Cycloferon - 2 years.

Immunotherapy has become one of the most important therapeutic tools for the treatment of warts, but there is often a lack of clinically validated evidence for its efficacy. Considering the reviews of experts, it should be kept in mind that there is no single absolutely effective treatment, and different treatments - surgical excision, cryo- and laser surgery, topical agents and immunotherapy - may be combined. The possibility of spontaneous regression of papillomas, especially in children, should also be taken into account, and therefore too aggressive an approach to their treatment should be avoided.