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Therapeutic potential of alkaloids in cough treatment.

Cough is one of the most common symptoms for which patients have to take physicians and pulmonologists consultation, because it sometime can so intensely and adversely affect the quality of patients' lives [1]. Cough is an important characteristics of larynx and respiratory system which help out in the removal of foreign substances and secretions and prevent aspiration of food and fluids and thus prevent choking (suffocation) which may provoked by the presence of such agents [2]. Additionally, some of the drugs like ACE inhibitors also induce cough due to over production of bradykinin which intern cause hyperactivity of cough reflex or fentanyl can provoke cough by inducing a pulmonary chemo-reflex in 50% of patients; this is inhibited by terbutaline [3].

There are two types of cough i.e. productive cough with mucus and dry cough without mucus. Importantly, both types of cough required special treatment in order to improve patient's compliance. Different therapeutic agents have been practicing to treatment cough such as codeine alone or in combination; most of these formulations are sold as over-the-counter (OTC) drugs without caring the official guidelines and are found irrational. The American College of Chest Physicians suggested various guidelines for treating acute cough having no regards for OTC products [4]. Another irrational approach in cough formulations that enhances the risk of unwanted effects is the combination of two or more drugs in the same formulation, above and beyond having no supporting therapeutic grounds or scientific evidence [5]. Apart from irrational use, natural therapies are found more effective and safe compare to synthetic drugs [6,7], therefore encouraging the exploration of natural treasure for the treatment cough. Natural products serving the humanity by preventing or treating different pathological conditions since time immemorial [8,9]. The safety, affordability and believe of users of such product made an impressive impact on the world trade of such product [10]. Alkaloids represent a very important and most widely therapeutically explored biochemical class of natural compounds. More than 27,000 alkaloids have been reported with more than 4000 years old history of applications [11,12]. There are numerous plants alkaloids reported with marked antitussive and expectorant activity for the treatment of cough while list of various commercial formulation is presented in Table 1. In recent times, several more purified alkaloids and their extracts showed promising antitussive effects coupled with expectorant activity [7,13-15]. Based on the preliminary effects, further detail studies on the mechanism(s) of these finding is suggested as the cough reflex may be due to sensory limb, central control or efferent limb as indication of various pathological conditions. The cough sensitive receptors are located in the bronchial tree, particularly in the junction of the trachea which can be stimulated mechanically or chemically e.g. by inhalation of various irritants than nerve impulses activate the cough center in the brain [16]. It is, therefore, deem necessary to explore the clinical potential of such reported compounds in term of efficacy and safety.

http://dx.doi.org/10.4172/0974-8369.1000e122

References

[1.] Irwin RS, Madison JM (2000) The diagnosis and treatment of cough. N Engl J Med 343: 1715-1721.

[2.] Hadjikoutis S1, Wiles CM, Eccles R (1999) Cough in motor neuron disease: a review of mechanisms. QJM 92: 487-494.

[3.] Babu KS, Marshall BG (2004) Drug-induced airway diseases. Clin Chest Med 25: 113-122.

[4.] Bolser, D (2006). Cough suppressant and pharmacologic protussive therapy, ACCP evidence-based clinical practice guidelines. Chest 129: 238-249.

[5.] Woo T (2008) Pharmacology of cough and cold medicines. J Pediatr Health Care 22: 73-79.

[6.] Wang D, Wang S, Chen X, Xu X, Zhu J, et al. (2012) Antitussive, expectorant and anti-inflammatory activities of four alkaloids isolated from Bulbus of Fritillaria wabuensis. J Ethnopharmacol 139: 189-193.

[7.] Shang JH, Cai XH, Zhao YL, Feng T, Luo XD (2010) Pharmacological evaluation of Alstonia scholaris: anti-tussive, anti-asthmatic and expectorant activities. J Ethnopharmacol 129: 293-298.

[8.] Khan H (2014) Medicinal Plants in Light of History: Recognized Therapeutic Modality. J Evid Based Complementary Altern Med 19: 216-219.

[9.] Khan H (2014). Medicinal plants need biological screening: A future treasure as therapeutic agents. Biol Med 6: e110.

[10.] Rauf A, Khan H (2014). Medicinal Plants: Economic Perspective and Recent Developments. World App Sci J 31: 1925-1929.

[11.] Amirkia V, Heinrich M (2014) Alkaloids as drug leads - A predictive structural and biodiversity-based analysis. Phytochem Letters 10: xlviii-liii.

[12.] Khan H (2015) Alkaloids: potential therapeuty modality in the management of asthma. J Ayur Herbal Med 1: 3-3.

[13.] Wang D, Zhu J, Wang S, Wang X, Ou Y, et al. (2011) Antitussive, expectorant and anti-inflammatory alkaloids from Bulbus Fritillariae Cirrhosae. Fitoterapia 82: 1290-1294.

[14.] Wang D, Wang S, Chen X, Xu X, Zhu J, et al. (2012) Antitussive, expectorant and anti-inflammatory activities of four alkaloids isolated from Bulbus of Fritillaria wabuensis. J Ethnopharmacol 139: 189-193.

[15.] Xu YT, Shaw PC, Jiang RW, Hon PM, Chan YM, et al. (2010) Antitussive and central respiratory depressant effects of Stemona tuberosa. J Ethnopharmacol 128: 679-684.

[16.] Vogel H (2008) Drug Discovery and Evaluation Pharmacological Assays, Springer-Verlag Berlin Heidelberg publication: NY.

Haroon Khan *

Associate Professor, Department of Pharmacy, Abdul Wali Khan University Mardan 23200 Pakistan

* Corresponding author: Haroon Khan, Associate Professor and Chairman, Department of Pharmacy, Abdul Wali Khan university Mardan 23200 Pakistan, Tel: 3329123171; E-mail: hkdr2006@gmail.com

Received October 13, 2015; Accepted October 17, 2015; Published JOctober 24, 2015
Table 1: List of commercial alkaloids used for the
treatment of cough.

S. No   Alkaloid Name   Commercial brand (s)

        Codeine         Antitus[TM], Codicaps[TM],
                          Tussipax[TM]
        Lobeline        Citotal[TM], Lobatox[TM],
                          Refrane[TM], Stopsmoke[TM]
        Noscapine       Bequitusin[TM], Degoran[TM],
                          Tossamine[TM],
                          Tussisedal[TM]
        Theophylline    Adenovasin[TM], Aerobin[TM],
                          Euphyllin[TM],
                          Theochron[TM]
        Ephedrine       Amidoyna[TM], Bronchicum[TM],
                          Peripherin[TM], Solamin[TM]
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Author:Khan, Haroon
Publication:Biology and Medicine
Article Type:Editorial
Geographic Code:1USA
Date:Mar 1, 2016
Words:956
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