Usage
Mono Ammonium Glycyrrhizinate (MAG) is prescribed for various medical conditions, primarily chronic liver diseases like chronic hepatitis and liver disorders. It also finds use in treating skin conditions like eczema and herpes simplex virus infections. It is also used as a flavoring substance in various foods and pharmaceutical products. Pharmacologically, it can be classified as an anti-inflammatory, antiviral, hepatoprotective, and immunomodulatory agent. Its mechanism of action involves multiple pathways, including inhibition of phospholipase A2, reduction of pro-inflammatory cytokine production (e.g., TNF-α, IL-1β), and modulation of the NF-κB pathway. It also exhibits mineralocorticoid-like effects.
Alternate Names
Mono Ammonium Glycyrrhizinate is also known as Glycyrram, Monoammonium glycyrrhizinate alpha-D-Glucopyranosiduronic acid, or ammonium glycyrrhizate. Brand names include Glizigen, P-Lyte, Glycyron, Stronger Neo-Minophagen C, and Neophagen.
How It Works
Pharmacodynamics: MAG exerts anti-inflammatory, antiviral, and hepatoprotective effects. It inhibits phospholipase A2, thereby reducing inflammation and exhibits antiviral activity. It also shows some degree of immunomodulating effects. It has mineralocorticoid activity due to inhibition of 11β-hydroxysteroid dehydrogenase type 2, resulting in increased cortisol activity.
Pharmacokinetics: MAG can be administered orally, topically, or intravenously. Oral administration is common for systemic conditions. It distributes to various organs, with the highest concentration found in the liver, followed by the kidney, lung, heart, and adrenal glands. It undergoes metabolism primarily in the liver and is eliminated through renal and hepatic pathways. Specific details on CYP enzyme involvement (e.g., CYP3A4) are available.
Mode of Action: MAG inhibits phospholipase A2, reducing the production of arachidonic acid and its metabolites involved in inflammation. It modulates pro-inflammatory cytokines like TNF-α and IL-1β and affects NF-κB signaling, further suppressing inflammation. It is an agonist of the human sweet taste receptor.
Receptor Binding, Enzyme Inhibition, or Neurotransmitter Modulation: MAG inhibits 11β-hydroxysteroid dehydrogenase type 2, leading to increased cortisol activity. It also inhibits phospholipase A2 and modulates NF-κB activity.
Elimination Pathways: MAG is eliminated via both renal and hepatic excretion. It may also involve interactions with specific CYP450 enzymes, like CYP3A4.
Dosage
Standard Dosage
Adults:
Oral: 75-150 mg per day, divided into multiple doses.
Intravenous: 40-60 mL per day, may increase up to 100mL, depending upon patients condition
Children:
Pediatric dosing information is limited and should be determined by a healthcare professional based on the child’s weight and age.
Special Cases:
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Elderly Patients: Close monitoring for side effects like hypokalemia is crucial due to increased incidence in this population. Dosage adjustments may be needed.
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Patients with Renal Impairment: Dose modification is required depending upon clearance rate
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Patients with Hepatic Dysfunction: Dose adjustment is necessary due to reduced metabolic capacity.
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Patients with Comorbid Conditions: Careful consideration for patients with hypertension, cardiovascular disease, diabetes, or electrolyte imbalances is necessary, particularly if using diuretics or other interacting medications.
Clinical Use Cases
- Intubation, Surgical Procedures, Mechanical Ventilation, ICU Use, Emergency Situations: Dosage recommendations for these specific settings are not consistently defined and should be decided based on patient condition and medical assessment. Intravenous administration might be preferred in these cases.
Dosage Adjustments
Dosage adjustments are required based on renal/hepatic dysfunction, electrolyte imbalances, co-administered medications (especially those affecting potassium levels, CYP3A4 substrates), and other individual factors.
Side Effects
Common Side Effects:
Nausea, vomiting, diarrhea, itching, rash, swelling.
Rare but Serious Side Effects:
Hypertension, hypokalemia, metabolic alkalosis, edema, cardiac arrhythmias, rhabdomyolysis (with oral use).
Long-Term Effects:
Chronic hypertension, hypokalemia, fluid and electrolyte imbalances, pseudoaldosteronism.
Adverse Drug Reactions (ADR)
Severe hypokalemia, allergic reactions (including anaphylaxis), pseudoaldosteronism, cardiac arrhythmias, severe edema.
Contraindications
Absolute contraindications: Hypersensitivity to MAG, aldosteronism, myopathy, hypokalemia.
Relative contraindications: Hypertension, congestive heart failure, kidney disease, pregnancy, breastfeeding, concurrent use of drugs interacting with MAG (e.g., corticosteroids, diuretics, CYP3A4 substrates, antihypertensives).
Drug Interactions
Clinically significant drug interactions include:
- Corticosteroids: Enhanced anti-inflammatory effects but increased risk of hypertension and hypokalemia.
- Antihypertensive medications: Reduced antihypertensive efficacy.
- Diuretics (thiazide, loop): Exacerbated hypokalemia.
- CYP3A4 substrates (e.g., warfarin, cyclosporine, statins): Altered plasma concentrations.
- Food and Lifestyle Factors: Information is limited, but caution with excessive licorice consumption and concomitant use of potassium-lowering agents is advisable.
Pregnancy and Breastfeeding
Pregnancy Safety: Not well-established; avoid use unless benefits outweigh risks. Potential for kidney malformation in animal studies.
Breastfeeding: Safety unknown. Avoid use or consider safer alternatives.
Drug Profile Summary
- Mechanism of Action: Inhibits phospholipase A2, reduces cytokine production (TNF-α, IL-1β), modulates NF-κB pathway, inhibits 11β-hydroxysteroid dehydrogenase type 2.
- Side Effects: Nausea, vomiting, diarrhea, hypertension, hypokalemia, edema, metabolic alkalosis, allergic reactions.
- Contraindications: Hypersensitivity, aldosteronism, myopathy, hypokalemia.
- Drug Interactions: Corticosteroids, antihypertensives, diuretics, CYP3A4 substrates.
- Pregnancy & Breastfeeding: Avoid unless benefits outweigh risks.
- Dosage: Adult oral: 75-150 mg/day; IV: 40-60 mL/day. Pediatric: individualized.
- Monitoring Parameters: Blood pressure, potassium levels, renal and liver function, signs of edema, electrolyte balance.
Popular Combinations
Combination of Monoammonium Glycyrrhizinate, glycine, and L-cysteine hydrochloride has been found to be clinically beneficial. Another combination includes Monoammonium Glycyrrhizinate, glycine and DL-methionine. Carpronium chloride can be combined with MAG for Alopecia Areata treatment.
Precautions
- General Precautions: Screen for allergies, hypertension, electrolyte imbalances, renal and hepatic dysfunction. Monitor blood pressure and potassium levels.
- Specific Populations: Avoid use in pregnancy/breastfeeding unless absolutely necessary. Monitor elderly patients closely for hypokalemia.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Mono Ammonium Glycyrrhizinate?
A: Adults: Oral: 75-150mg/day, IV: 40-60ml/day. Pediatric: Consult a healthcare professional.
Q2: What are the primary side effects?
A: Nausea, vomiting, diarrhea, hypertension, hypokalemia, and edema.
Q3: What are the contraindications for MAG?
A: Hypersensitivity, aldosteronism, myopathy, hypokalemia. Relative contraindications include hypertension and concurrent use of interacting drugs.
Q4: Does MAG interact with other medications?
A: Yes. Significant interactions occur with corticosteroids, antihypertensives, diuretics, and CYP3A4 substrates.
Q5: Can MAG be used during pregnancy or breastfeeding?
A: It’s generally avoided due to limited safety data. Consult a doctor if the benefits clearly outweigh the risks.
Q6: How does MAG work in the body?
A: It inhibits phospholipase A2, reduces pro-inflammatory cytokine production, modulates the NF-κB pathway, and exhibits mineralocorticoid-like effects.
Q7: What should be monitored in patients receiving MAG?
A: Blood pressure, potassium levels, renal and hepatic function, signs of edema, and overall electrolyte balance.
Q8: What conditions is MAG used to treat?
A: Chronic liver diseases (chronic hepatitis, liver disorders), skin conditions (eczema, herpes simplex), as well as a flavoring agent in food and drug products.
Q9: What are the long-term side effects of MAG?
A: Chronic hypertension, hypokalemia, fluid and electrolyte imbalances, and pseudoaldosteronism can occur with prolonged use, especially at high doses.
