EPICROM 2 % STERILE OPHTHALMIC SOLUTION

Indications

• Asthma
• Allergic rhinitis
• Conjunctivitis
• Systemic mastocytosis
• Ulcerative colitis

Dosage

Children: Refer to the BNF for Children for appropriate dosing guidelines for paediatric patients.

Adults: Refer to the BNF for specific dosing recommendations based on the condition being treated.

Mechanism of action

Cromoglicate inhibits degranulation of mast cells, preventing the release of histamine and slow-reacting substance of anaphylaxis (SRS-A), which are mediators of type I allergic reactions. It may also reduce the release of inflammatory leukotrienes and is proposed to inhibit calcium influx, which is critical for mast cell degranulation in response to allergens.

Pharmacodynamics

Cromoglicate works by inhibiting antigen-induced bronchospasms and stabilizing mast cells, which helps prevent asthma attacks and alleviates symptoms of allergic rhinitis. It demonstrates efficacy in treating conjunctivitis through its action on mast cells in the conjunctival tissue and is used for systemic conditions like mastocytosis and ulcerative colitis due to its ability to modulate inflammatory responses.

Pharmacokinetics

Cromoglicate is poorly absorbed from the gastrointestinal tract when taken orally, which limits its systemic effects. It is primarily local-acting, and its effects are mainly observed in the respiratory and ocular systems. The half-life and specific metabolic pathways of cromoglicate are not well-defined, but it is known to act rapidly upon administration.

Adverse effects

• Local irritation
• Cough
• Nausea
• Headache

Precautions

• Use with caution in patients with known hypersensitivity to cromoglicate or any of its ingredients
• Monitor for efficacy and adverse effects in patients with asthma or other allergic conditions

Pregnancy

Cromoglicate should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Consult relevant guidelines.

Breast-feeding

Cromoglicate is excreted in breast milk, caution should be exercised when administering to nursing mothers.

Storage

Store below 25°C, protect from light. Do not freeze.

Formulations

• Ophthalmic solution
• Oral capsules
• Inhalation solution

Mechanism of action

Cromoglicate inhibits degranulation of mast cells, subsequently preventing the release of histamine and slow-reacting substance of anaphylaxis (SRS-A), mediators of type I allergic reactions. Cromoglicate also may reduce the release of inflammatory leukotrienes. Cromoglicate may act by inhibiting calcium influx. One important action of cromolyn is believed to be the inhibition of pulmonary mast cell degranulation in response to a variety of stimuli, including the interaction between cell-bound IgE and specific antigen. ... The release of histamine and other granular contents, as well as the production of leukotrienes, can be shown to be markedly reduced in vitro by cromolyn. However, its efficacy and potency are highly dependent on the source of the mast cells. ... Attention has been focused on the ability of cromolyn to reverse various functional changes in leukocytes obtained from the blood of asthmatic subjects undergoing allergen challenge, such as increased expression of membrane-bound receptors. ... Low concentrations (100 nM) of cromolyn can suppress completely the activation effects of chemoattractant peptides of human neutrophils, eosinophils, or monocytes. The mechanisms of action of cromolyn remain relatively poorly defined. Most attention has been focused on the ability of cromolyn to reduce the accumulation of intracellular Ca +2 induced by antigen in sensitized mast cells. One biochemical correlate of the reduction of histamine release from mast cells by cromolyn is the enhanced phosphorylation of a 78,000-dalton protein. Unfortunately, these observations have been made using rather high concn of cromolyn (50 to 200 uM), and their relationship to therapeutic response has yet to be established. For more Mechanism of Action (Complete) data for CROMOLYN (6 total), please visit the HSDB record page.

Pharmacodynamics

Cromoglicate or cromolyn (USAN), a synthetic compound, inhibits antigen-induced bronchospasms and, hence, is used to treat asthma and allergic rhinitis. Cromoglicate is used as an ophthalmic solution to treat conjunctivitis and is taken orally to treat systemic mastocytosis and ulcerative colitis.