1-Docosanol Explained

1-Docosanol, also known as behenyl alcohol, is a saturated fatty alcohol containing 22 carbon atoms, used traditionally as an emollient, emulsifier, and thickener in cosmetics.[1]

In July 2000, docosanol was approved for medical use in the United States as an antiviral agent for reducing the duration of cold sores.[2] It is an over-the-counter medication (OTC). It is sold under the brand name Abreva among others.[3]

Side effects

One of the most common side effects that has been reported from docosanol is headache. Headaches caused by the medication tend to be mild and can occur in any region of the head.[4] In clinical trials, headache occurred in 10.4% of people treated with docosanol cream and 10.7% of people treated with placebo.

The most serious side effects, although rare, are allergic reactions. Some of the patients experienced the symptoms of allergic reactions, including difficulty breathing, confusion, angioedema (facial swelling), fainting, dizziness, hives or chest pain.[4]

Other side effects may include: acne, burning, dryness, itching, rash, redness, acute diarrhea, soreness, swelling.[5]

Mechanism of action

Docosanol is thought to work by interfering with and stabilizing the host cell's surface phospholipids, preventing the fusion of the herpes virus's viral envelope with the human host cell. This disrupted ability of the virus to fuse with the host cell membrane prevents entry and subsequent replication.[6] [7] [8]

History

The drug was approved as a cream for oral herpes after clinical trials by the FDA in July 2000.[9] It was shown to shorten the healing by 17.5 hours on average (95% confidence interval: 2 to 22 hours) in a placebo-controlled trial.[10] Another trial showed no effect when treating the infected backs of guinea pigs.[11]

Two experiments with 1-docosanol cream failed to show statistically significant differences by any parameter between 1-docosanol cream and vehicle control–treated sites or between 1-docosanol and untreated infection sites.

Society and culture

Controversy

In March 2007, it was the subject of a US nationwide class-action suit against Avanir and GlaxoSmithKline as the claim that it cut recovery times in half was found to have been misleading in a California court, but the case was eventually settled and the "cuts healing time in half" claim had not been used in product advertising for some years, instead stating "clinically proven to speed healing".[12]

Notes and References

  1. Web site: CosIng: Behenyl alcohol. European Commission. 14 March 2021. 27 August 2021. https://web.archive.org/web/20210827200639/https://ec.europa.eu/growth/tools-databases/cosing/?fuseaction=search.details_v2&id=74589. live.
  2. Katz DH, Marcelletti JF, Khalil MH, Pope LE, Katz LR . Antiviral activity of 1-docosanol, an inhibitor of lipid-enveloped viruses including herpes simplex . Proc. Natl. Acad. Sci. U.S.A. . 88 . 23 . 10825–10829 . December 1991 . 1660151 . 53024 . 10.1073/pnas.88.23.10825. 1991PNAS...8810825K . free .
  3. Web site: mediLexicon: Docosanol . 2 September 2008 . 10 March 2013 . https://web.archive.org/web/20130310114409/http://www.medilexicon.com/drugs/abreva.php . dead .
  4. Web site: Abreva Side Effects. Livestrong.com. 20 May 2010. 23 May 2010. https://web.archive.org/web/20100523015616/http://www.livestrong.com/article/112151-abreva-side-effects/. live.
  5. Web site: Side Effects. Drugs.com. 2010-05-20. 11 May 2008. https://web.archive.org/web/20080511134513/http://www.drugs.com/cons/docosanol-topical.html. live.
  6. Sadowski LA, Upadhyay R, Greeley ZW, Margulies BJ . Current Drugs to Treat Infections with Herpes Simplex Viruses-1 and -2 . Viruses . 13 . 7 . June 2021 . 1228 . 34202050 . 8310346 . 10.3390/v13071228 . free . n-Docosanol is a long-chain, 22-carbon, primary alcohol offered over the counter. It likely inhibits a broad range of enveloped viruses that uncoat at the plasma membrane of target cells. The drug appears to prevent binding and entry of HSVs by interfering directly with the cell surface phospholipids, which are required by the viruses for entry, and stabilizing them. This activity tends to work well against ACV-resistant HSVs and can even act synergistically with other anti-HSV drugs..
  7. Book: Austria-Codex. Haberfeld H . Erazaban Creme. Österreichischer Apothekerverlag. Vienna. 2020. German.
  8. Docosanol . Accessed 14 March 2021.
  9. Web site: Drug Name: Abreva (docosanol) – approval . centerwatch.com . July 2000 . 17 October 2007 . 6 October 2008 . https://web.archive.org/web/20081006230140/http://www.centerwatch.com/patient/drugs/dru627.html . dead .
  10. Sacks. SL. Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: A multicenter, randomized, placebo-controlled trial. J Am Acad Dermatol. 45. 2. 222–230. 11464183. 10.1067/mjd.2001.116215. 2001. Thisted. RA. Jones. TM. Barbarash. RA. Mikolich. DJ. Ruoff. GE. Jorizzo. JL. Gunnill. LB. Katz. DH. Khalil. MH. Morrow. Phillip R.. Yakatan. Gerald J.. Pope. Laura E.. Berga. James E.. 8.
  11. McKeough . MB. Spruance . SL. Comparison of new topical treatments for herpes labialis: Efficacy of penciclovir cream, acyclovir cream, and n-docosanol cream against experimental cutaneous herpes simplex virus type 1 infection. Archives of Dermatology. 137. 9. 1153–1158. 2001. 11559210. 10.1001/archderm.137.9.1153. free.
  12. Web site: California Court Upholds Settlement Of Class Action Over Cold Sore Medicationl . BNA Inc. . July 2000 . 17 October 2007 . https://web.archive.org/web/20080205070115/http://subscript.bna.com/SAMPLES/plp.nsf/85256269004a991e8525611300214487/29d5bb623a50fd25852572ad0074f772?OpenDocument . 5 February 2008.

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