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 antiallergic 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 diseases and other diseases associated with inflammation and allergies. It is also used as an adjuvant in pharmaceuticals to improve their taste and as a potential treatment for some viral infections.

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

Indications Glycyrama

1. Cough of various etiologies, including cough due to ARVI and influenza.
2. Diseases of the upper respiratory tract, such as bronchitis, tracheitis, laryngitis.
3. Nasal congestion accompanying 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 usually available in several forms, including tablets, syrups and injections.

Pharmacodynamics

1. Anti-inflammatory effect:

   • Ammonium glycyrrhizinate has an anti-inflammatory effect by inhibiting 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 lead to a reduction in inflammation and associated symptoms such as pain, swelling and flushing.

2. Antiviral effect:

   • Ammonium glycyrrhizinate also has an antiviral effect. 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 effect:

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

4. Immunomodulatory effect:

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

Pharmacokinetics

1. Absorption: Following oral administration of ammonium glycyrrhizinate, it may be partially absorbed from the gastrointestinal tract. However, a significant part of the drug usually remains in the gastrointestinal tract and has 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 from the body.
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 in the form of syrup or lozenges, the peak blood concentration and duration of action of ammonium glycyrrhizinate are usually not considered, since its action is directed to the mucous membrane of the respiratory tract.
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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 using several drugs simultaneously.
6. Side effects: When using ammonium glycyrrhizinate, various side effects may occur, such as hypertension, fluid and sodium retention, hypokalemia, suppression of adrenal function, and others.

Dosing and administration

1. Tablets:

   • Glyciram 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. Typically, 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 effective.
   • The dosage of injections is usually determined by the doctor depending on the patient’s condition.

Use Glycyrama during pregnancy

Use of ammonium glycyrrhizinate (Glycyram) during pregnancy may pose risks to the fetus. In a study on rats, it was shown that ammonium glycyrrhizinate caused an increase in embryonic lethality and the appearance of external hemorrhages in the fetus. There was also an increase in minor skeletal abnormalities, especially in the thoracic vertebrae, and a significant increase in renal ectopy at the highest dose (Mantovani et al., 1988).

These results indicate the possible embryotoxicity of ammonium glycyrrhizinate, especially at high doses, which should be taken into account when using it during pregnancy. You should consult your doctor before using this substance because of the potential risks.

Contraindications

1. Hypersensitivity: People with a known hypersensitivity to ammonium glycyrrhizinate or other components of the drug should not use Glyciram.
2. Hypertension: It is known that glycyrrhizic acid contained in ammonium glycyrrhizinate can increase glucocorticoid levels in the body, which can lead to sodium and water retention in the body, causing increased blood pressure. Therefore, the use of Glyciram may be contraindicated in case of high blood pressure.
3. Heart disease: In patients with serious heart disease, such as heart failure, arrhythmias, or past myocardial infarction, the use of Glycyram may be contraindicated due to the risk of worsening these conditions.
4. Kidney disease: In patients with severely impaired renal function, the use of Glycyram may be limited due to the possible accumulation of metabolites and deterioration of renal function.
5. Pregnancy and breastfeeding: Data on the safety of Glycyram during pregnancy and breastfeeding are limited, so its use during this period should only be done on the advice of a physician.
6. Children: The safety and effectiveness of Glycyram in children may not have been sufficiently studied, so its use in children may require consultation with a doctor.
7. Acute liver disease: Glycyram may be contraindicated in acute liver disease due to the risk of deterioration of liver function.

Side effects Glycyrama

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. Increasing pressure.
6. Increased mucus separation.
7. Headache.
8. It is rare that potassium levels in the blood may increase.

Overdose

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

Interactions with other drugs

1. Medicines that increase the risk of side effects:

   • Drugs that can also cause fluid and sodium retention or increase potassium (such as 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 (such as antiarrhythmic drugs) may interact with ammonium glycyrrhizinate, which may lead to electrolyte disturbances.

3. Drugs affecting the central nervous system:

   • Drugs that cause central nervous system depression (for example, hypnotics, analgesics) may increase the sedative effect of ammonium glycyrrhizinate, which can lead to increased drowsiness and decreased response.

4. Drugs affecting kidney and liver function:

   • Drugs that may have negative effects on renal or hepatic function may interact with ammonium glycyrrhizinate because its metabolism and elimination 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 reduce the absorption of ammonium glycyrrhizinate.