MAXMOIST

Indications

• Wound healing
• Skin moisturizing
• Epithelial protection
• Treatment of skin irritations
• Topical anti-inflammatory treatment

Dosage

Children: Refer to BNF for Children for specific dosing recommendations based on age and condition.

Adults: Topical application as needed, typically applied to the affected area 1 to 3 times daily.

Mechanism of action

Dexpanthenol is enzymatically converted to pantothenic acid, a precursor of coenzyme A. This coenzyme acts as a cofactor in numerous enzymatic reactions critical for protein metabolism, particularly in epithelial cells. Topically, dexpanthenol enhances fibroblast proliferation and accelerates re-epithelialization in wound healing. It also functions as a moisturizer and has anti-inflammatory properties. Additionally, it increases the availability of coenzyme A for synthesizing acetylcholine, which is essential for maintaining intestinal tone and peristalsis.

Pharmacodynamics

Dexpanthenol, through its active form pantothenic acid, contributes to various biochemical pathways, particularly those involving the synthesis of coenzyme A. This coenzyme facilitates the transfer of acetyl groups necessary for the synthesis of acetylcholine, a neurotransmitter that regulates parasympathetic nervous system functions, including gastrointestinal motility. Enhanced levels of acetylcholine promote normal intestinal functions, while a deficiency may lead to decreased peristalsis.

Pharmacokinetics

Dexpanthenol is readily absorbed when applied topically, and it is metabolized to pantothenic acid, which is then incorporated into various metabolic pathways. The pharmacokinetics of dexpanthenol, including its distribution, metabolism, and elimination, are influenced by the route of administration. Its efficacy in promoting wound healing is attributed to its ability to penetrate the skin and exert effects at the cellular level.

Pregnancy

Dexpanthenol is generally considered safe during pregnancy; however, its use should be based on a risk-benefit assessment by a healthcare provider.

Breast-feeding

Dexpanthenol is excreted in breast milk in small amounts. Caution is advised when administered to breastfeeding women, and its use should be evaluated in terms of potential benefits and risks.

Storage

Store at room temperature, away from light and moisture. Keep out of reach of children.

Formulations

• Topical solution
• Cream
• Ointment

Indications

• Osteoarthritis of the knee
• Viscosupplementation for joint pain
• Dry eye syndrome
• Ocular surgeries (e.g., cataract surgery)
• Wound healing

Dosage

Adults: Refer to specific guidelines or literature for adult dosing recommendations, as they can vary based on

Mechanism of action

Hyaluronate acts by increasing the viscosity and elasticity of synovial fluid in joints, leading to improved lubrication and shock absorption. It binds to water molecules, thus enhancing the hydration of tissues. In the context of osteoarthritis, it helps to restore the normal viscoelastic properties of the joint fluid, which can help alleviate pain and improve joint function. In ocular applications, it serves to lubricate the surface of the eye, aiding in the comfort and healing of the cornea.

Pharmacodynamics

Hyaluronate's pharmacodynamic effects are primarily related to its hydrophilic nature and its ability to form a gel-like consistency when mixed with water. This property allows it to provide mechanical support and cushioning in joints, reducing friction and wear in the articular cartilage. It also plays a role in cell signaling and tissue hydration, influencing cell proliferation and migration in wound healing.

Pharmacokinetics

Hyaluronate is administered via injection or topical application, depending on the indication. After injection into the joint space, it can remain for several weeks, but its half-life is influenced by factors such as the degree of synovial fluid viscosity and the presence of inflammation. Systemic absorption is minimal, and it is primarily metabolized by hyaluronidase enzymes found in various tissues, leading to fragmentation and clearance from the body. In ocular formulations, its retention time on the eye surface can vary based on the formulation and the presence of preservatives.

Contra-indications

• Hypersensitivity to hyaluronate or any component of the formulation
• Infection at the injection site
• Active skin diseases

Adverse effects

• Injection site reactions (pain, swelling, redness)
• Allergic reactions
• Joint effusion
• Increased joint pain
• Headache

Precautions

• Use with caution in patients with bleeding disorders
• Careful consideration in patients with a history of allergic reactions
• Not recommended for intra-articular injection in patients with active infections

Pregnancy

Safety in pregnancy has not been established. Use only if clearly needed and the potential benefits justify the risks.

Breast-feeding

It is not known if hyaluronate is excreted in human milk. Use with caution and only if clearly needed.

Storage

Store at 2-25 degrees Celsius. Protect from light. Do not freeze.

Formulations

• Sodium hyaluronate injection
• Hyaluronic acid gel

Mechanism of action

Dexpanthenol is an alcohol derivative of pantothenic acid, a component of the B complex vitamins and an essential component of a normally functioning epithelium. Dexpanthenol is enzymatically cleaved to form pantothenic acid, which is an essential component of Coenzyme A, which acts as a cofactor in many enzymatic reactions that are important for protein metabolism in the epithelium. Dermatological effects of the topical use of dexpanthenol include increased fibroblast proliferation and accelerated re-epithelialization in wound healing. Furthermore, it acts as a topical protectant, moisturizer, and has demonstrated anti-inflammatory properties. This alcohol ... is said to increase the amount of coenzyme A available for the synthesis of acetylcholine. Increased formation of acetylcholine is thought to increase peristalsis and intestinal tone. ... To test the functional effect of pantothenate on dermal fibroblasts, cells were cultured and in vitro proliferation tests were performed using a standardized scratch test procedure. For all three donors analyzed, a strong stimulatory effect of pantothenate at a concentration of 20 ug/mL on the proliferation of cultivated dermal fibroblasts was observed. To study the molecular mechanisms resulting in the proliferative effect of pantothenate, gene expression was analyzed in dermal fibroblasts cultivated with 20 ug/mL of pantothenate compared with untreated cells using the GeneChip Human Exon 1.0 ST Array. A number of significantly regulated genes were identified including genes coding for interleukin (IL)-6, IL-8, Id1, HMOX-1, HspB7, CYP1B1 and MARCH-II. Regulation of these genes was subsequently verified by quantitative real-time polymerase chain reaction analysis. Induction of HMOX-1 expression by pantothenol and pantothenic acid in dermal cells was confirmed on the protein level using immunoblots. Functional studies revealed the enhanced suppression of free radical formation in skin fibroblasts cultured with panthenol. In conclusion, these studies provided new insight in the molecular mechanisms linked to the stimulatory effect of pantothenate and panthenol on the proliferation of dermal fibroblasts. /Calcium pantotenate/ ... Pantothenic acid, pantothenol and other derivatives ... are precursors of CoA /that/ protect cells and whole organs against peroxidative damage by increasing the content of cell glutathione...

Pharmacodynamics

Pantothenic acid is a precursor of coenzyme A, which serves as a cofactor for a variety of enzyme-catalyzed reactions involving transfer of acetyl groups. The final step in the synthesis of acetylcholine consists of the choline acetylase transfer of acetyl group from acetylcoenzyme A to choline. Acetylcholine is the neurohumoral transmitter in the parasympathetic system and as such maintains the normal functions of the intestine. Decrease in acetylcholine content would result in decreased peristalsis and in extreme cases adynamic ileus.