How can inosine pranobex help with viral infections?
Inosine pranobex has long been used for its immunomodulatory and antiviral effects in the prophylaxis and therapy of various viral infections. Below we summarize its mechanism of action, indications, usage, and side effects.
Mechanism of Action
Inosine pranobex (IP; also known as inosine acedoben dimepranol or methisoprinol) is a synthetic purine derivative with immunomodulatory and antiviral (viostatic) effects (it influences the amount of viral RNA and suppresses the replication of certain viruses). It acts on both non-specific and specific immune mechanisms. IP accelerates antigen presentation and the formation of virus-specific antibodies, cytotoxic T lymphocytes, and pro-inflammatory cytokines, thereby strengthening the immune system in immunosuppressed patients.
IP was able to activate the proliferation and differentiation of NK cells in a small study with healthy volunteers. In 5 healthy volunteers, an increase in the proportion of NK cells in the total number of lymphocytes in peripheral blood was observed within 90 minutes, and by day 5, this trend was observed in almost all subjects, with ≥ 2-fold increase in NK cells persisting until the end of the observation period on day 14.
IP and Viral Infections
Due to its aforementioned effects, inosine pranobex is approved for use in adults, adolescents, and children over 1 year old. In patients with immunodeficiency, particularly cellular immunity disorders (reduced number or impaired function of T lymphocytes), it is used to treat more severe or recurrent viral infections, primarily respiratory ones. Numerous studies have shown a reduction and shortening of the duration of symptoms of acute viral respiratory diseases (e.g., influenza) compared to placebo.
It is also used to treat the following viral infections:
- Recurrent herpetic infections (herpes labialis and genitalis, herpes zoster)
- Subacute sclerosing panencephalitis
- Cytomegalovirus infections
- Condylomata acuminata, mucocutaneous and vulvovaginal infections or infections caused by human papillomavirus (HPV) affecting the cervical mucosa
In the acute phase of viral infection, it is typically used at a total daily dose of 50 mg/kg (usually 2 tablets 3–4 times a day, with a maximum possible dose of 4 g per day), in maintenance therapy then at a dose of 0.5–1 g per day. For acute viral diseases with a short course, the usual duration of treatment is 5–10 days and should continue for at least 1–2 days after symptoms resolve. The treatment of diseases with a longer course should continue for another 1–2 weeks after symptoms resolve. In case of recurrent infections, the dose in the maintenance phase can be reduced to 1–2 tablets per day.
Safety Profile
The drug is generally well tolerated. With long-term use of higher doses, transient nausea may occur. The most commonly reported side effect is a reversible increase in uric acid levels in serum and urine (more frequent in men and older patients). Therefore, increased caution is needed in patients with gout, urolithiasis, and renal insufficiency. Regular monitoring of uric acid concentration and renal parameters is advisable.
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Sources:
1. Rumel Ahmed S., Newman A. S., O'Daly J. et al. Inosine acedoben dimepranol promotes an early and sustained increase in the natural killer cell component of circulating lymphocytes: a clinical trial supporting anti-viral indications. Int Immunopharmacol 2017; 42: 108–114, doi: 10.1016/j.intimp.2016.11.023.
2. Slíva J., Pantzartzi C. N., Votava M. Inosine pranobex: a key player in the game against a wide range of viral infections and non-infectious diseases. Adv Ther 2019; 36 (8): 1878–1905, doi: 10.1007/s12325-019-00995-6.
3. SPC Isoprinosine. Available at: www.sukl.cz/modules/medication/download.php?file=SPC136224.pdf&type=spc&as=isoprinosine-spc
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