T h e r a p e u t i c I n d e x 129 Special Precautions Consuming more than 10 lozenges per day is not advised. If consumed at a dose more than that recommended, an individual may experience abdominal cramps and diarrhea, as the product contains sugar polyols. Presentation Box of 10 strips of 6 lozenges each. Available in lemon-lime, ginger-mint, and orange flavors. Pharmacological Actions of Principal Ingredients 1. Demulcent and antitussive actions: Glycyrrhiza glabra root is extensively used in traditional medicine for treating sore throat, cough, and bronchial catarrh because of its demulcent and expectorant properties. The antitussive and expectorant actions help expel the congestion in the upper respiratory tract, as it accelerates tracheal mucous secretion. The extract containing water-soluble macromolecules derived from the fruits of Terminalia chebula exerts significant antitussive effect and effectively reduces bouts of cough induced by irritants. 2. Bronchodilatory action: Piperine, an active constituent of Piper nigrum, causes bronchodilation through dual inhibition of phosphodiesterase enzyme and Ca2+ influx and facilitates expectoration. 1,8-Cineole, a key constituent of Elettaria cardamomum oil, helps relax airway smooth muscles, thereby facilitating bronchodilation and expectoration. 3. Anti-inflammatory and analgesic actions: Terminalia chebula fruit extract possesses both analgesic and anti-inflammatory properties, which are believed to be because of its inhibitory effect on the synthesis and/or release of pain or inflammatory mediators. The Piper nigrum fruit extract (with piperine as one of its key constituents) has been observed through different experimental models to exert significant analgesic effect with an increased nociceptive threshold and antiinflammatory property mediated by inhibition of prostaglandin synthesis. Glycyrrhiza glabra is known to exert potent anti-inflammatory effect through different mechanisms: (i) suppression of prostaglandin (PG) synthesis (by inhibiting arachidonic acid cascade pathway–related enzymes) and (ii) neutrophil-mediated inhibition of reactive oxygen species (neutrophils are the most potent inflammatory mediators at the site of inflammation). Several studies involving different models have observed the ability of glycyrrhizin, a key constituent of Glycyrrhiza glabra, to downregulate proinflammatory cytokines (tumor necrosis factor [TNF]-α, interleukin [IL]-1β, IL-3, IL-5, IL-6, IL-10, IL-12 (p40), IL-12 (p70), and IL-13) and chemokines (IL-8 and eotaxin-1). Eugenol, a key constituent of Syzygium aromaticum oil, has potent analgesic effect. Eugenol exerts antinociceptive effect by blocking nerve conduction through the inhibition of voltage-gated sodium channels (VGSCs) and by activating transient receptor potential vanilloid subtype 1 (TRPV1), thus serving as a local anesthetic. Eugenol also exerts anti-inflammatory activity possibly through diverse mechanisms involving both central and peripheral pathways. β-Caryophyllene, another major constituent, contributes to the local anesthetic activity of Syzygium aromaticum oil. Elettaria cardamomum oil shows potent anti-inflammatory and analgesic properties because of its principal volatile constituent 1,8-cineole, which has the ability to inhibit the formation of prostaglandins and cytokines. In antigen-challenged animal models, eucalyptol (1,8-cineole) was able to prevent airway hyperresponsiveness, inhibit inflammation, and prevent reduction of mucociliary clearance. Koflet-SF® (lozenge)
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