Xylometazoline 0.1% / Dexpanthenol 5% nasal spray

BACKGROUND: Several drugs may be used to minimize pain during nasal intubation in awake patients. We hypothesized that the analgesic effect of cocaine would be at least as good (non-inferior) as that of lidocaine with xylometazoline rated as maximum pain felt during awake nasal intubation of healthy volunteers. METHODS: We conducted an outcome assessor blinded, randomized, triple crossover, non-inferiority study following approval from the local research ethics committee and the national medicine agency. Healthy volunteers came for three visits and received 2 mL 4% cocaine, 0.5 mL 4% lidocaine + 1.5 mL 0.1% xylometazoline, and 2 mL 0.9% saline in random order prior to nasal insertion of an endotracheal tube. Maximum pain felt during insertion was evaluated on a visual analogue scale of 0-100 mm. The non-inferiority margin was set to 11 mm on the visual analogue scale. RESULTS: A total of 16 volunteers were enrolled, and 14 completed all three visits. Maximum pain felt during tube insertion was a median of 69 mm (interquartile range [IQR]: 56-73 mm) after cocaine, 60 mm (IQR: 50-76 mm) after lidocaine/xylometazoline, and 70 mm (IQR: 63-81 mm) after saline. The mean difference in maximum pain scores between cocaine and lidocaine/xylometazoline was 3.3 mm (95% confidence interval: -4.6 to 11.1; p = 0.40). CONCLUSION: We found no statistically significant difference in pain scores between cocaine and lidocaine/xylometazoline when administered prior to awake nasal intubation but cannot conclude that cocaine was non-inferior to lidocaine/xylometazoline. EDITORIAL COMMENT: Nasal intubation may be uncomfortable and can be complicated by epistaxis. Cocaine has both vasoconstrictive and analgesic properties and was compared with placebo and lidocaine/xylometazoline for awake intubation in healthy volunteers. The trial did not identify any clinically important differences between groups in terms of pain or serious adverse events. Differences were numerically small, and non-inferiority between the active treatments was not demonstrated. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT06443255.

Abstract licence: CC BY

Background: Epistaxis is a frequent emergency room presentation, with a significant portion of cases requiring active medical intervention. While anterior nasal packing remains a conventional approach, newer pharmacological options like topical tranexamic acid (TXA) have gained attention due to their antifibrinolytic action. Xylometazoline, a topical decongestant with vasoconstrictive properties, is commonly used in emergency settings for anterior epistaxis, yet comparative data between the two agents remain limited. Objective: To compare the efficacy of topical application of intravenous TXA with topical xylometazoline in achieving hemostasis in patients presenting with anterior epistaxis who are on antiplatelet therapy. Methods: This prospective randomized controlled trial was conducted at the Emergency Department of the Pakistan Institute of Medical Sciences, Islamabad, from December 2023 to November 2024. A total of 88 patients, aged 13–60 years, using antiplatelet medications and presenting with anterior epistaxis were enrolled. Patients were randomized into two groups (n=44 each). Group A received 100 mg/mL of intravenous TXA applied topically via nasal spray. Group B received 2–3 puffs of 0.1% xylometazoline spray in each nostril. Hemostasis was assessed at 30 minutes post-administration. SPSS version 25.0 was used for statistical analysis, and chi-square test determined significance at p<0.05. Results: The mean age was 47.3 ± 7.4 years in Group A and 45.3 ± 8.6 years in Group B (p=0.846). Group A comprised 26 males (59%) and 18 females (41%), while Group B had 28 males (63.63%) and 16 females (36.36%) (p=0.568). Hemostasis at 30 minutes was achieved in 10 patients (22.73%) in Group A and 29 patients (65.91%) in Group B, showing a statistically significant difference (p<0.001). Conclusion: Topical xylometazoline demonstrated significantly higher efficacy compared to intravenous TXA preparation in achieving hemostasis for anterior epistaxis in patients on antiplatelet therapy, supporting its role as a first-line intervention in emergency care.

Abstract licence: CC BY-NC-ND

A 2-year-old boy with suspected lactose intolerance developed an extensive, itchy rash after using a nasal spray containing dexpanthenol. He was initially treated for a viral upper airway infection with ibuprofen, xylometazoline, and cetirizine. A switch to a drug containing dexpanthenol led to the appearance of the rash and subsequent sleep deprivation. No other possible cause of allergy was found. The withdrawal of all drugs but cetirizine led to full recovery. Dexpanthenol, an alcohol analog of vitamin B5, is present in many drugs for its positive impact on tissue repair. Although generally considered safe, it may rarely cause an allergic reaction, hence we underscore the importance of considering dexpanthenol oversensitivity in patients with unexplained widespread rashes, particularly in pediatric cases.

Abstract licence: CC BY-NC-SA

Chronic tobacco use can lead to liver damage and inflammation due to the accumulation of various toxins in the body. This study aimed to investigate the correlation between the molecular mechanisms of nicotine-induced liver injury, the caspase cascade, and the Akt/NF-κB signaling pathway, as well as the protective effects of dexpanthenol (DEX). Male rats were subjected to intraperitoneal injections of nicotine at a concentration of 0.5 mg/kg/day and/or DEX at a concentration of 500 mg/kg/day for 8 weeks. After the treatment period, liver function tests were conducted on serum samples, and tissue samples were analyzed for protein levels of Akt, NF-κB, Bax, Bcl-xL, Caspase-3, and Caspase-9, along with histopathological changes. Additionally, assessments of oxidative stress markers and proinflammatory cytokines were carried out. Nicotine administration led to elevated levels of IL-6, IL-1β, MDA, TOS, and oxidative stress index, accompanied by decreased TAS levels. Moreover, nicotine exposure reduced the p-Akt/Akt ratio, increased NF-κB, Bax, Caspase-3, and Caspase-9 protein levels, and decreased the antiapoptotic protein Bcl-xL levels. DEX treatment significantly mitigated these effects, restoring the parameters to levels comparable to those of the control group. Nicotine-induced liver injury resulted in oxidative stress, inflammation, and apoptosis, mediated by Bax/Bcl-xL, Caspase-3, Caspase-9, and Akt/NF-κB pathways. Conversely, DEX effectively attenuated nicotine-induced liver injury by modulating apoptosis through NF-κB, Caspase-3, Caspase-9, Bax inhibition, and Bcl-xL activation.

Abstract licence: CC BY-NC-ND

Introduction: Lipopolysaccharide (Lps) is an essential component responsible for the virulence of gram-negative bacteria. Lps can cause damage to many organs, including the heart, kidneys, and lungs. Dexpanthenol (Dex) is an agent that exhibits anti-oxidative and anti-inflammatory effects and stimulates epithelialization. In this study, we aimed to investigate the effects of Dex on Lps-induced cardiovascular toxicity. Methods: Rats were divided into four groups: control, Lps (5 mg/kg, intraperitoneal), Dex (500 mg/kg, intraperitoneal), and Lps + Dex. The control group received saline intraperitoneally (i.p.) once daily for three days. The Lps group received saline i.p. once daily for three days and a single dose of Lps i.p. was administered on the third day. The Dex group received Dex i.p. once daily for three days and saline on the third day. The Lps + Dex group received Dex i.p. once daily for three days and a single dose of Lps i.p. on the third day. Heart and aortic tissues were taken for biochemical, histopathological, immunohistochemical, and genetic analysis. Results: Lps injection caused histopathological changes in both heart and aortic tissues and significantly increased total oxidant status and oxidative stress index levels. Interleukin-6, and Tumor necrosis factor-α mRNA expressions were significantly altered in heart and aorta, likely do to the anti-inflammatory and antioxidative effects of Dex. Furthermore, Dex affected Caspase-3 and Hypoxia-inducible factor 1-α staining patterns. Conclusions: Our results show that Dex treatment has a protective effect on Lps-induced cardiac and endothelial damage in rats by reducing inflammation, oxidative stress, and apoptosis.

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Rhabdomyolysis (RM) can lead to life-threatening myoglobinuric acute kidney injury (AKI). Despite various treatment modalities for AKI, their effectiveness remains limited. Dexpanthenol (DEX) is an antioxidant, anti-inflammatory, and anti-apoptotic agent with demonstrated protective effects on various tissues. The current study aimed to investigate the protective effects and genetic mechanisms of DEX in AKI due to glycerol-induced RM. Thirty-two female Wistar Albino rats weighing between 250-300 g were allocated into four groups of eight rats each. The control group was given five days of intraperitoneal saline. The RM group was treated with an intramuscular injection of 8 ml/kg of 50% glycerol solution. The RM + DEX group was administered an intramuscular injection of 8 ml/kg of 50% glycerol solution and an intraperitoneal injection of 500 mg/kg DEX for five days, starting one hour after glycerol administration. The DEX group was treated with an intraperitoneal injection of 500 mg/kg DEX for five days. On the sixth day, rats were sacrificed and kidney tissues were taken. Histopathological analyses were performed on kidney tissue. Biochemical analyses were performed on kidney tissue and blood to evaluate kidney function and oxidative stress (BUN, creatinine, urea, CK, LDH, cystatin C, TAS, TOS, MDA, and CAT). Additionally, PGC-1α and SIRT-3 gene expression levels in kidney tissue were determined by qRT-PCR. All biomarkers significantly increased in the RM group. DEX treatment significantly reduced urea and creatinine levels. The increase in TOS levels and OSI in the RM group was significant compared to the control group, DEX treatment significantly reversed these effects. The RM and RM + DEX groups exhibited RM and nephropathy. Histopathological analysis revealed improvements in the RM + DEX group compared to the RM group. DEX treatment increased the expression of PGC-1α and SIRT-3 in the RM + DEX group. Histopathological and biochemical improvements, including reduced kidney damage and oxidative stress, were observed with DEX treatment and was associated with increased expression of the PGC-1α and SIRT-3 genes.

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Background: This study explores wound healing and the antimicrobial potential of a natural formulation containing a polysaccharide extract from Cerioporus squamosus, hyaluronic acid, and dexpanthenol. Methods: Wound healing effects were assessed using HaCaT keratinocytes, while antimicrobial activity was evaluated against human skin pathogens using a microdilution assay. In vitro cytotoxicity tests ensured formulation safety, whereas in vivo wound healing was further investigated using an animal model. Gene expression analysis was performed to assess the molecular mechanisms involved. Results: The unique glucan composition of C. squamosus (15.38% α-glucans and 7.91% β-glucans) deviated from typical mushroom polysaccharide profiles, warranting further exploration of its bioactivity. In vitro mushroom polysaccharides promoted 25.35% wound closure after 24 hours, while the three-component formulation achieved 35.81% closure. Antibacterial activity showed a minimum inhibitory concentration (MIC) of 0.44–1.75 mg/mL and minimum bactericidal concentration (MBCs) of 0.88–3.50 mg/mL, while antifungal activity ranged from 0.22 to 0.44 mg/mL (MICs) and 0.44 to 0.88 mg/mL (minimum fungicidal concentration—MFC). In vivo data showed that 60% of treated wounds fully closed by day 11, despite no statistically significant difference from the control. However, gene expression analysis highlighted VEGF and collagen upregulation, indicating an enhancement of wound healing on a molecular level. Conclusions: The novel three-component formulation demonstrated consistent wound healing and antimicrobial properties, supporting its potential as a safe and effective treatment for chronic and acute wounds.

Abstract licence: CC BY