A clinical overview of Tilarin
It is important that a topical medication for the relief of allergy symptoms be well tolerated by patients, and not remain in circulation within the body for extended periods of time, where it might accumulate at harmful levels with repeated doses. The antiinflammatory drug Tilarin meets these requirements handsomely, and appears to also offer greater relief than the old standby sodium cromoglycate.
Tilarin is a solution of 1% nedocromil sodium, which is highly water-soluble but barely fat-soluble, making it ideally suited to topical use on mucous-covered surfaces such as nasal passages. Less than 8% of the nasal spray is absorbed into the system from the nasal mucosa, and even that is rapidly eliminated from the bloodstream.
The elimination of drugs from the circulation is measured by half-life in the same way as radiation. Nedocromil sodium has an elimination half-life of about five minutes, which means that when that time has elapsed any amount of the compound introduced in the bloodstream will have been reduced to half. After a further five minutes it will have been reduced again to a quarter of the original dose and so on. Most of it is then eliminated from the body in urine, and the remainder in bile, without being metabolized. This means that unless it is wildly overused, there is no danger of nedocromil sodium lingering in the blood and creating a cumulative systemic overdose.
Nedocromil sodium is also very unlikely to cause serious adverse reactions. It has no known human metabolite, meaning that it does not break down or transform into any other substance in the human body. A comparison of side-effects reported by Tilarin users showed that no significant differences existed between the drug and a harmless placebo, except in one category: it produced a distinctive taste in the mouth in about 7% of patients.
Twenty-eight studies have measured the efficacy of nedocromil sodium in treating SAR, mostly with similar results. The drug was found to reduce aggravating symptoms and nasal discharge, to score higher than placebo in patient and clinician appraisals of treatment outcomes, and to reduce the tendency of SAR sufferers to reach for antihistamines as a last line of defence.
Tilarin has been found effective by North American ragweed sufferers, Finnish birch pollen sufferers, and Italian grass pollen sufferers. Canadian and U.S. studies that sought to monitor Tilarin groups as they progressed from the beginning through the peak of the ragweed pollen season found great reductions in nasal discharge and antihistamine use
compared with placebo users, and an absolute reduction in sleep loss, even though pollen levels quadrupled during the study. A U.S. ragweed study compared Tilarin with sodium cromoglycate and found that it produced slightly lower symptom severity scores in all five categories: stuffy nose, runny nose, itchy nose, sneezing and sleep disturbance. Patient satisfaction was also higher in the Tilarin group. Sodium cromoglycate users, however, had less recourse to antihistamine rescue therapy.
An Italian study of the efficacy of Tilarin in treating grass pollen SAR found that symptom severity scores of Tilarin users during the four-week peak pollen period consistently fell while those of placebo users rose slightly. The Tilarin group, which had slightly worse average symptom scores when the study began, ended the trial period with severity scores less than half that of their placebo counterparts.
In conclusion, Tilarin has been shown to be a safe topical remedy for SAR symptoms both in adults and small children, without any of the potential side effects of topical steroids. It can be used regularly from the first day of the pollen season, but will also prove useful to patients who are already suffering. It reduces the need for antihistamines in most users, but if symptoms are not alleviated by Tilarin alone, it is safe to use in conjunction with any other SAR medication.
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