Clinical data | |
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AHFS/Drugs.com | International Drug Names |
Routes of administration | By mouth, inhalation |
ATC code | |
Pharmacokinetic data | |
Protein binding | 65% |
Metabolism | liver |
Elimination half-life | 1–3 hours |
Identifiers | |
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CAS Number | |
PubChem CID | |
ChemSpider | |
UNII | |
KEGG | |
ChEMBL | |
CompTox Dashboard (EPA) | |
ECHA InfoCard | 100.169.984 |
Chemical and physical data | |
Formula | C8H11NO4S2 |
Molar mass | 249.30 g·mol−1 |
3D model (JSmol) | |
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Erdosteine is a molecule with mucolytic activity. Structurally it is a thiol derivative characterized by the presence of two thiol groups. [1] These two functional sulfhydryl groups contained in the molecule are released following first-pass metabolism with the conversion of erdosteine into its pharmacologically active metabolite Met-I.
The molecule has been discovered and developed in Italy by Edmond Pharma, today it is prescribed for chronic and acute respiratory disorders in more than 40 countries worldwide. The drug is sold under several commercial names (Esteclin, Erdomed, Erdos, Erdotin etc.), as hard capsules 300 mg, dispersible tablets 300 mg, granulates for oral suspension 225 mg and powder for oral suspension 175 mg/5ml.
Erdosteine is an oral mucoactive anti-oxidant molecule, characterized by a multi-faceted pharmacological profile that may positively interfere in more than one of the pathological processes ongoing in all respiratory disorders characterized by thickened or increased mucus production, increased oxidative stress and chronic inflammation. Moreover, an important feature of the pharmacological profile of erdosteine is represented by its synergy with antibiotics.
Erdosteine exerts its role as anti-oxidant and anti-inflammatory thanks to the free sulfhydryl groups of its active metabolite Met I, which has a direct scavenging effect (particularly on reactive oxygen species, ROS), and it is able to bind the free radicals preventing tissue damage.
Erdosteine exerts a protective role against lipid peroxidation (smokers, COPD patients) by increasing the availability of endogenous antioxidants, such as glutathione, in plasma and bronco-alveolar lavage.
Erdosteine is able to interfere with bacterial adhesion. In fact, Met I can affect the integrity of the natural intrachain disulphide bonds of pilin; the opening of this bond can induce a morphological change that interferes with the binding of bacterial adhesin (fimbriae) to receptor.
The bacterial adhesion reduction is reached by Met I ad concentration similar to the plasmatic peak obtained after a single 300 mg oral administration of erdosteine.
Erdosteine showed in vivo and in vitro synergistic activity with antibiotics, against bacterial adhesiveness, in patients with respiratory infections. [2] [3] Several clinical studies underline that, when given in combination with antibiotics, erdosteine does not interfere with their activity but improve their effects, causing an increase in therapeutic efficacy.
Erdosteine shows an important muco-regulatory activity (it increases mucus production and makes it more fluid and much less thick), and positively influences the mucociliary clearance. [4]
Several studies show that erdosteine results more active compared to other muco-regulatory drugs (such as N-acetylcysteina, sobrerol and ambroxol). [5]
Evidence obtained in patients with stable chronic bronchitis/COPD with mucus hypersecretion show that erdosteine can bring therapeutic advantages during long-term administration.
A long-term treatment with erdosteine (6–8 months) can significantly decrease the risk of exacerbations and hospitalizations and improve patients' quality of life. These data are in agreement with recent indications from the international literature, [6] that support the use of mucoactive agents in patients with hypersecreting chronic pulmonary diseases, especially during winter months.
A metanalysis conducted on 1278 patients demonstrated that erdosteine brings to symptoms improvement and reduces the risk of exacerbations of chronic bronchitis and COPD. Furthermore, erdosteine demonstrated to reduce the exacerbation duration and the hospitalization risk due to COPD.
The RESTORE study (Reducing Exacerbations and Symptoms by Treatment with ORal Erdosteine in COPD) was a multinational, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of erdosteine 300 mg/bid added to usual maintenance therapy vs. placebo over 12-months, a period long enough to avoid bias due to seasonal variability in exacerbation frequency. [7]
During the study 467 patients with moderate-to-severe stable COPD were randomized and treated in 47 hospital-based pulmonary clinics in 10 European countries.
After 1 year of treatment there was a 1.4% reduction in the exacerbation rate with erdosteine treatment; this result was mainly driven by the reduction in the rate of mid exacerbations equal to 57.1%.
Furthermore, erdosteine treatment was associated with a 24.6% decrease in all exacerbation duration compared to placebo. Both for exacerbation rate and duration, no significant differences among inhaled corticosteroids taking and non-taking patients has been registered.
A RESTORE sub-analysis demonstrated that adding erdosteine to the maintenance therapy reduces the number of mild exacerbations and the duration of all exacerbations in patients with moderate COPD. [8]
A metanalysis conducted on 2753 patients with moderate COPD shows that the efficacy and safety profile of erdosteine is superior to that of other muco-regulatory drugs (carbocysteine and N-acetylcysteine). Furthermore, erdosteine was the only mucolytic able to reduce the risk of hospitalization due to COPD exacerbations. [9]
Several studies demonstrate the efficacy of erdosteine in the treatment of bronchiectasis in terms of facility of expectoration. [10]
In several Countries in the world erdosteine is approved for the bronchiectasis treatment. Erdosteine has shown benefits also in the treatment of chronic rhinosinusitis with nasal polyposis and Otitis Media Secretorica. [11]
Erdosteine was tested in pediatric patients with lower tract respiratory disorders, in association with ampicillin, demonstrating a high symptoms reduction. [12]
In pediatric population with acute bronchitis, tracheobronchitis and pneumonia, erdosteine showed a significantly high reduction in cough intensity and improvement of clinical symptoms, with very good tolerability. [13]
Erdosteine, administered in single doses from 150 mg to 1200 mg to adult volunteers, shows a linear kinetic, with Met I serum concentration approximately 4-fold higher than those of erdosteine. The pharmacokinetic parameters of erdosteine and Met I are fully comparable after single and multiple doses, therefore there is no accumulation or metabolic activation after repeated administrations.
Food does not significantly affect the absorption of erdosteine.
After oral administration, erdosteine is rapidly absorbed in the gastro-intestinal tract and the plasmatic peak concentration (Cmax) is reached after 30–60 minutes (Tmax) from consumption. The molecule is rapidly transformed through a first-pass metabolism to the biologically active metabolite Met I. The drug bioavailability by oral route is very good. The half-life is 3 hours and the plasma binding protein is 65%.
With respect to pharmacokinetics in special populations, a study in 12 health volunteers (mean age 70 years) confirmed that pharmacokinetic parameters for both erdosteine and Met I were similar to those observed in younger adults (mean age 31 years). [14] Moderate renal dysfunction in elder volunteers did not affect erdosteine and Met I pharmacokinetics. [15]
The LD50 in rats is very high, between 3.500 and 5.000 mg/kg.
Clinical studies in more than 4.000 patients demonstrated that erdosteine is effective is the treatment of acute and chronic infections of upper and lower respiratory tract with mucus hypersecretion. It modulates the sputum viscosity in the respiratory tract, making it more fluid and less thick, bringing to an increase of mucociliary rate which allows the mucus removal from respiratory tract.
Erdosteine is used as mucolytic and fluidifying agent in upper and lower respiratory disorders. It modulates the sputum viscosity. Erdosteine efficacy is significant in reducing symptoms associated with Chronic Obstructive Pulmonary Disease. [16] [17] [18] [19] A multicentric, multinational study on more than 450 patients with COPD demonstrated that erdosteine is able to reduce both the frequency and the duration of symptomatic exacerbations, typical of this disease. [7]
The GOLD (Global Initiative for Chronic Obstructive Lung Disease) International Guidelines indicate that a regular treatment with a mucolytic like erdosteine can reduce exacerbations and improve the health status of patients with COPD. [20]
In some countries erdosteine in approved for the treatment of bronchiectasis.
Data from post marketing surveillance confirm that erdosteine is well tolerated, with an excellent safety profile. Frequency and severity of adverse effects in clinical studies (more than 2300 patients in more than 70 clinical studies) was very low and comparable to placebo.
Erdosteine is stable to hydrolysis in acid environment, so it does not have any direct effect on gastric mucus.
Less than 1 patient in 1.000 is expected to have gastrointestinal undesirable effects. Very rare (<1/10.000) adverse events are headache, dyspnea, taste alterations, nausea, vomiting, diarrhea, epigastric pain.
The drug is contraindicated in subjects with hypersensitivity to the active substance or to any of the excipients. It is contraindicated in subjects with active peptic ulcer.
Because of a possible interference of the product with methionine metabolism, the drug is contraindicated in patients with hepatic cirrhosis and deficiency of the cystathionine-synthetase enzyme.
No harmful interactions with other drugs have been reported and the product can therefore be administered together with antibiotics and bronchodilators (such as beta2-mimetics and cough sedatives). [21]
Sputum is mucus that is coughed up from the lower airways. In medicine, sputum samples are usually used for a naked eye examination, microbiological investigation of respiratory infections and cytological investigations of respiratory systems. It is crucial that the specimen does not include any mucoid material from the nose or oral cavity.
Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest pain. Wheezing and nail clubbing may also occur. Those with the disease often get lung infections.
Acetylcysteine, also known as N-acetylcysteine (NAC), is a medication that is used to treat paracetamol overdose and to loosen thick mucus in individuals with chronic bronchopulmonary disorders like pneumonia and bronchitis. It has been used to treat lactobezoar in infants. It can be taken intravenously, by mouth, or inhaled as a mist. Some people use it as a dietary supplement.
Bronchoconstriction is the constriction of the airways in the lungs due to the tightening of surrounding smooth muscle, with consequent coughing, wheezing, and shortness of breath.
Respiratory diseases, or lung diseases, are pathological conditions affecting the organs and tissues that make gas exchange difficult in air-breathing animals. They include conditions of the respiratory tract including the trachea, bronchi, bronchioles, alveoli, pleurae, pleural cavity, the nerves and muscles of respiration. Respiratory diseases range from mild and self-limiting, such as the common cold, influenza, and pharyngitis to life-threatening diseases such as bacterial pneumonia, pulmonary embolism, tuberculosis, acute asthma, lung cancer, and severe acute respiratory syndromes, such as COVID-19. Respiratory diseases can be classified in many different ways, including by the organ or tissue involved, by the type and pattern of associated signs and symptoms, or by the cause of the disease.
Carbocisteine, also called carbocysteine, is a mucolytic that reduces the viscosity of sputum and so can be used to help relieve the symptoms of chronic obstructive pulmonary disorder (COPD) and bronchiectasis by allowing the sufferer to bring up sputum more easily. Carbocisteine should not be used with antitussives or medicines that dry up bronchial secretions.
Bronchitis is inflammation of the bronchi in the lungs that causes coughing. Bronchitis usually begins as an infection in the nose, ears, throat, or sinuses. The infection then makes its way down to the bronchi. Symptoms include coughing up sputum, wheezing, shortness of breath, and chest pain. Bronchitis can be acute or chronic.
Obstructive lung disease is a category of respiratory disease characterized by airway obstruction. Many obstructive diseases of the lung result from narrowing (obstruction) of the smaller bronchi and larger bronchioles, often because of excessive contraction of the smooth muscle itself. It is generally characterized by inflamed and easily collapsible airways, obstruction to airflow, problems exhaling, and frequent medical clinic visits and hospitalizations. Types of obstructive lung disease include; asthma, bronchiectasis, bronchitis and chronic obstructive pulmonary disease (COPD). Although COPD shares similar characteristics with all other obstructive lung diseases, such as the signs of coughing and wheezing, they are distinct conditions in terms of disease onset, frequency of symptoms, and reversibility of airway obstruction. Cystic fibrosis is also sometimes included in obstructive pulmonary disease.
Cilomilast is a drug which was developed for the treatment of respiratory disorders such as asthma and chronic obstructive pulmonary disease (COPD). It is orally active and acts as a selective phosphodiesterase-4 inhibitor.
Williams–Campbell syndrome (WCS) is a disease of the airways where cartilage in the bronchi is defective. It is a form of congenital cystic bronchiectasis. This leads to collapse of the airways and bronchiectasis. It acts as one of the differential to allergic bronchopulmonary aspergillosis. WCS is a deficiency of the bronchial cartilage distally.
Doxofylline is a phosphodiesterase inhibiting bronchodilator used in the treatment of chronic respiratory diseases such as asthma and COPD. Like theophylline, it is a xanthine derivative.
Roflumilast, sold under the brand name Daxas among others, is a medication that acts as a selective, long-acting inhibitor of the enzyme phosphodiesterase-4 (PDE-4). It has anti-inflammatory effects and is used as an orally administered drug for the treatment of inflammatory conditions of the lungs such as chronic obstructive pulmonary disease (COPD).
Pulmonary rehabilitation, also known as respiratory rehabilitation, is an important part of the management and health maintenance of people with chronic respiratory disease who remain symptomatic or continue to have decreased function despite standard medical treatment. It is a broad therapeutic concept. It is defined by the American Thoracic Society and the European Respiratory Society as an evidence-based, multidisciplinary, and comprehensive intervention for patients with chronic respiratory diseases who are symptomatic and often have decreased daily life activities. In general, pulmonary rehabilitation refers to a series of services that are administered to patients of respiratory disease and their families, typically to attempt to improve the quality of life for the patient. Pulmonary rehabilitation may be carried out in a variety of settings, depending on the patient's needs, and may or may not include pharmacologic intervention.
Riociguat, sold under the brand name Adempas, is a medication by Bayer that is a stimulator of soluble guanylate cyclase (sGC). It is used to treat two forms of pulmonary hypertension (PH): chronic thromboembolic pulmonary hypertension (CTEPH) and pulmonary arterial hypertension (PAH). Riociguat constitutes the first drug of the class of sGC stimulators. The drug has a half-life of 12 hours and will decrease dyspnea associated with pulmonary arterial hypertension.
An acute exacerbation of chronic obstructive pulmonary disease, or acute exacerbations of chronic bronchitis (AECB), is a sudden worsening of chronic obstructive pulmonary disease (COPD) symptoms including shortness of breath, quantity and color of phlegm that typically lasts for several days.
ELOM-080 is the active ingredient of the herbal medicine named GeloMyrtol forte. The acronym ELOM stands for the oils from Eucalyptus, Lemon, (Sweet) Orange and Myrtle that it contains.
Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms of COPD include shortness of breath and a cough, which may or may not produce mucus. COPD progressively worsens, with everyday activities such as walking or dressing becoming difficult. While COPD is incurable, it is preventable and treatable. The two most common types of COPD are emphysema and chronic bronchitis and have been the two classic COPD phenotypes. However, this basic dogma has been challenged as varying degrees of co-existing emphysema, chronic bronchitis, and potentially significant vascular diseases have all been acknowledged in those with COPD, giving rise to the classification of other phenotypes or subtypes. Emphysema is defined as enlarged airspaces (alveoli) whose walls have broken down resulting in permanent damage to the lung tissue. Chronic bronchitis is defined as a productive cough that is present for at least three months each year for two years. Both of these conditions can exist without airflow limitation when they are not classed as COPD. Emphysema is just one of the structural abnormalities that can limit airflow and can exist without airflow limitation in a significant number of people. Chronic bronchitis does not always result in airflow limitation but in young adults with chronic bronchitis who smoke, the risk of developing COPD is high. Many definitions of COPD in the past included emphysema and chronic bronchitis, but these have never been included in GOLD report definitions. Emphysema and chronic bronchitis remain the predominant phenotypes of COPD but there is often overlap between them and a number of other phenotypes have also been described. COPD and asthma may coexist and converge in some individuals. COPD is associated with low-grade systemic inflammation.
Olodaterol is an ultra-long-acting β adrenoreceptor agonist (ultra-LABA) used as an inhalation for treating people with chronic obstructive pulmonary disease (COPD). It is manufactured by Boehringer Ingelheim.
Chronic cough is long-term coughing, sometimes defined as more than several weeks or months. Generally a cough lasting for more than eight weeks for an adult would meet the clinical definition of a chronic cough; and for children this threshold is lower. The term can be used to describe the different causes related to coughing, the three main ones being upper airway cough syndrome, asthma and gastroesophageal reflux disease. It occurs in the upper airway of the respiratory system. Generally, a cough lasts around one to two weeks; however, chronic cough can persist for an extended period of time defined as six weeks or longer. People with chronic cough often experience more than one cause present. Due to the nature of the syndrome, the treatments used are similar; however, there are a subsequent number of treatments available, and the clinical management of the patients remains a challenge.
Pulmonary drug delivery is a route of administration in which patients use an inhaler to inhale their medications and drugs are absorbed into the bloodstream via the lung mucous membrane. This technique is most commonly used in the treatment of lung diseases, for example, asthma and chronic obstructive pulmonary disease (COPD). Different types of inhalers include metered-dose inhalers (MDI), dry powder inhalers (DPI), soft mist inhalers (SMI) and nebulizers. The rate and efficacy of pulmonary drug delivery are affected by drug particle properties, breathing patterns and respiratory tract geometry.