Cromolyn sodium

Cromoglicic acid

Clinical data
AHFS/Drugs.com	International Drug Names
License data	US FDA: Cromolyn
Pregnancy category	AU: B1 US: B (No risk in non-human studies)
Routes of administration	topical: oral, nasal spray, inhaled, eye drops
ATC code	A07EB01 (WHO) D11AH03 (WHO) R01AC01 (WHO) R03BC01 (WHO) S01GX01 (WHO)
Legal status
Legal status	AU: S2 (Pharmacy only) inhaler POM, eye OTC(UK) nasal OTC, eye, inhaler Rx(US)
Pharmacokinetic data
Bioavailability	1%
Biological half-life	1.3 hours
Identifiers
IUPAC name 5,5′-(2-hydroxypropane-1,3-diyl)bis(oxy)bis(4-oxo-4H-chromene-2-carboxylic acid)
CAS Number	16110-51-3 Y
PubChem (CID)	2882
IUPHAR/BPS	7608
DrugBank	DB01003 N
ChemSpider	2779 Y
UNII	Y0TK0FS77W Y
KEGG	D07753 Y
ChEBI	CHEBI:59773 Y
ChEMBL	CHEMBL74 N
ECHA InfoCard	100.036.602
Chemical and physical data
Formula	C23H16O11
Molar mass	468.367 g/mol
3D model (Jmol)	Interactive image
SMILES O=C(O)C=4Oc3cccc(OCC(O)COc2cccc1O/C(=C\C(=O)c12)C(=O)O)c3C(=O)C=4
InChI InChI=1S/C23H16O11/c24-11(9-31-14-3-1-5-16-20(14)12(25)7-18(33-16)22(27)28)10-32-15-4-2-6-17-21(15)13(26)8-19(34-17)23(29)30/h1-8,11,24H,9-10H2,(H,27,28)(H,29,30) Y Key:IMZMKUWMOSJXDT-UHFFFAOYSA-N Y
NY (what is this?)

Cromoglicic acid (INN) (also referred to as cromolyn (USAN), cromoglycate (former BAN), or cromoglicate) is traditionally described as a mast cell stabilizer, and is commonly marketed as the sodium salt sodium cromoglicate or cromolyn sodium. This drug prevents the release of inflammatory chemicals such as histamine from mast cells.

Because of their convenience (and perceived safety), leukotriene receptor antagonists have largely replaced it as the non-corticosteroid treatment of choice in the treatment of asthma. Cromoglicic acid requires administration four times daily, and does not provide additive benefit in combination with inhaled corticosteroids.

Cromolyn sodium was discovered by Roger Altounyan who was himself a lifelong asthma sufferer. It is considered a breakthrough drug in management of asthma, as the patients can be freed from steroids in many cases; however, it is mainly effective as a prophylaxis for allergic and exercise-induced asthma, not as a treatment for acute attacks. Altounyan was investigating certain plants and herbs which have bronchodilating properties. One such plant was khella (Ammi visnaga) which had been used as a muscle relaxant since ancient times in Egypt. Altounyan deliberately inhaled derivatives of the active ingredient khellin to determine if they could block his asthma attacks. After several years of trial he isolated an effective and safe asthma-preventing compound called cromolyn sodium.

Cromoglicic acid is available in multiple forms:

"Cromolyn works because it prevents the release of mediators that would normally attract inflammatory cells and because it stabilizes the inflammatory cells. MCT mast cells found in the mucosa are stabilised."Nedocromil is another mast cell stabilizer that also works in controlling asthma. The underlying mechanism of action is not fully understood; for while cromoglicate stabilizes mast cells, this mechanism is probably not why it works in asthma. Pharmaceutical companies have produced 20 related compounds that are equally or more potent at stabilising mast cells and none of them have shown any anti-asthmatic effect. It is more likely that these work by inhibiting the response of sensory C fibers to the irritant capsaicin, inhibiting local axon reflexes involved in asthma, and may inhibit the release of preformed T cell cytokines and mediators involved in asthma. (see review by Garland, 1991)