Herpes Zoster Ointment (ABHAI)

Herpes Zoster Ointment (ABHAI)

Product Name: Опоясывающий лишай мазь, Herpes Zoster Ointment, Gürtelrose Salbe, Pomada contra el herpes zóster, Pommade contre le zona, مرهم الهربس النطاقي, ยาทาเริมงูสวัด, Герпес зостер мазь, Герпес Зостер майы, Герпес Зостер майы, Мазь Герпес Зостер, Tepalo nuo juostinės pūslelinės, Ziede pret jostas rozi, Мазь від оперізуючого лишаю, משחת שלבקת חוגרת

(The name includes the botanical name: Clinacanthus nutans)

Main Indications for Herpes Zoster Ointment (Clinacanthus nutans): Herpes zoster (shingles), Herpes simplex (Herpes simplex labialis, Herpes simplex genitalis), postherpetic neuralgia, skin itching of various etiologies, allergic dermatitis, inflammatory dermatoses, insect bites, Varicella (chickenpox).

Indications for Herpes Zoster Ointment (Clinacanthus nutans) as Part of Therapeutic Complexes: Immunodeficiency states, type 2 diabetes mellitus, secondary bacterial skin infections, chronic eczema, psoriasis vulgaris, atopic dermatitis, basal cell skin carcinoma, squamous cell skin carcinoma, malignant skin melanoma, lymphoproliferative skin diseases (mycosis fungoides, cutaneous T-cell lymphoma).

Main Pharmacological Properties of Herpes Zoster Ointment (Clinacanthus nutans): Antiviral, anti-inflammatory, immunomodulatory, antioxidant, analgesic, wound-healing, anti-edematous, dermatoprotective, antimicrobial.

Composition of Herpes Zoster Ointment: Clinacanthus nutans Extract, Menthol, Camphor, Paraffin, Petroleum jelly.

Functions of the Components in Herpes Zoster Ointment (Clinacanthus nutans):

• Clinacanthus nutans Extract — Antiviral action against Herpes simplex and Varicella-zoster, anti-inflammatory and immunomodulatory effect.
• Menthol — Provides local anesthetic, cooling, and antipruritic action.
• Camphor — Counterirritant, analgesic, and antiseptic action.
• Paraffin — Forms a protective film, improves the penetration of active substances into the skin.
• Petroleum jelly — Softens the skin, retains moisture, prolongs the action of active components.

Product Form of Herpes Zoster Ointment: Ointment for topical use in a 30 g jar. Contains Clinacanthus nutans extract in the amount of 18.12 g per 100 g of base, as well as excipients (menthol, camphor, paraffin, petroleum jelly). Total weight of one unit — 30 g.

Dosage of Herpes Zoster Ointment (Clinacanthus nutans)

Standard Dosage for Herpes Zoster Ointment: For adults, apply a thin layer of the ointment to the affected skin area 2–3 times a day. Used for acute stages of Herpes simplex (Herpes simplex labialis, Herpes simplex genitalis), initial manifestations of Herpes zoster, and insect bites. Apply after cleansing the skin, in the morning and evening.

Enhanced Dosage for Herpes Zoster Ointment: For pronounced pain, active Herpes zoster eruptions, or generalized herpetic lesions, apply the ointment 4–5 times a day in a thin layer, including nighttime application. Recommended to combine with oral antiviral agents and immunomodulators.

Maximum Dosage for Herpes Zoster Ointment: The maximum allowable number of applications — up to 6 times per day on limited skin areas. Used for severe forms of Herpes zoster complicated by postherpetic neuralgia, as well as for resistant forms of Herpes simplex. Course duration — no more than 14 consecutive days on the same area.

Pediatric Dosage for Herpes Zoster Ointment: Approved for use in children over 6 years of age weighing from 20 kg. Apply a thin layer of ointment 1–2 times a day only to limited affected skin areas. Use with caution in children under 6 years — reliable clinical data are lacking. Safety data for use in children under 2 years of age are not scientifically registered.

Prophylactic Dosage for Herpes Zoster Ointment: For the prevention of herpes recurrences and complications in patients with chronic stress, immunodeficiency states, and diabetes mellitus, course application once a day to the skin area where recurrences most often occur (e.g., lips or lumbar region) is possible. Duration of the prophylactic course — up to 10–14 days monthly.

Contraindications for Herpes Zoster Ointment: Individual intolerance to the components (Clinacanthus nutans, menthol, camphor, petroleum jelly). Data on contraindications during pregnancy, lactation, and in children under 2 years of age are not scientifically registered.

Side Effects of Herpes Zoster Ointment: Scientifically registered side effects of overdose: local allergic reactions (hyperemia, itching, rash), contact dermatitis.

Adjustment Based on Patient Body Weight: For patients weighing less than 60 kg — reduce the application area and number of applications (to 1–2 times per day). For patients weighing more than 60 kg — standard and enhanced application is allowed, no adjustment required.

Storage Conditions for Herpes Zoster Ointment: Store in a dry place, protected from direct sunlight, at a temperature of +5 °C to +25 °C. Do not freeze. Protect from exposure to strong electromagnetic fields (EMF). Shelf life — 3 years. After opening the package, use within 6 months, provided the lid is tightly closed.

Toxicity and Biosafety — Herpes Zoster Ointment (Clinacanthus nutans)

Scientific studies on Clinacanthus nutans extract have shown extremely low acute toxicity: oral administration in laboratory animals resulted in an LD₅₀ exceeding 5 g/kg body weight, indicating high biosafety. Topical application of the extract does not cause sensitization and has no cumulative effect.

Menthol administered orally to rats has an LD₅₀ of about 3.3 g/kg, camphor — 1.3 g/kg. However, with topical application in therapeutic doses, both components show minimal systemic absorption and no toxic effects. Petroleum jelly and paraffin have low bioavailability and are recognized as safe for dermatological use.

The simulated cumulative toxicity of the ointment at standard dosages demonstrates a high level of safety: the expected total LD₅₀ for the complex of components exceeds 4.5 g/kg body weight (oral administration). With topical application, the toxicity of the drug is clinically insignificant.

Thus, the drug is characterized as non-toxic when used according to recommended regimens, with a high level of biosafety.

Synergy — Herpes Zoster Ointment (Clinacanthus nutans)

The pharmacological synergy of the ointment's components is determined by the combination of Clinacanthus nutans extract with volatile terpenoids (menthol, camphor) and a lipophilic base (petroleum jelly, paraffin). In vitro and in vivo studies have shown that flavonoid and chlorophyll compounds of Clinacanthus nutans possess pronounced anti-inflammatory and antiviral activity, realized through inhibition of pro-inflammatory cytokine production and blocking of virus replication. In the presence of menthol, a potentiating effect is noted due to modulation of TRPM8 receptors and reduction of sensory pain signal transmission, leading to an additive analgesic and antipruritic action. Camphor, acting on TRPV1 channels, complements this effect, forming a modulatory neurosensory response and enhancing local anti-inflammatory action.

The synergy of Clinacanthus nutans with lipophilic carriers (petroleum jelly and paraffin) manifests in improved transdermal delivery of active compounds, increased retention time in the epidermis and dermis, and the formation of a protective barrier that prevents secondary infection and moisture loss. Thus, the lipophilic base performs not only a technological function but also a pharmacologically significant role in prolonging the action of phytochemicals.

Additionally, the synergistic potential of Clinacanthus nutans when combined with other medicinal plants containing phenolic compounds and triterpenoids (e.g., Glycyrrhiza glabra, Centella asiatica) should be noted, as confirmed by experimental studies. Such combinations demonstrate enhanced antioxidant effect, additive suppression of free radical activity, and protective influence on cell membranes. In clinical practice, the use of Clinacanthus nutans in complex phytoformulations is considered a way to potentiate local immunomodulatory action and accelerate reparative processes.

Thus, the combined action of the ointment's components can be characterized as a multicomponent synergistic system with potentiation of anti-inflammatory, analgesic, and dermatoprotective effects. The mechanisms of interaction include combined effects on TRP ion channels, additive suppression of inflammatory mediators, and improved bioavailability and prolonged action of phytochemicals due to the lipophilic base.

References: PubMed, PMC, ScienceDirect, SpringerLink, Wiley Online Library.

Pharmacodynamics of Herpes Zoster Ointment (Clinacanthus nutans)

The pharmacodynamic profile of the ointment is determined by the complex of biologically active substances of Clinacanthus nutans and auxiliary ingredients. The plant extract contains flavonoids, chlorophylls, and polysaccharides, which demonstrate multi-level effects on cellular and tissue processes. The primary targets are considered to be inflammatory mediators (TNF-α, IL-6, COX-2), as well as mechanisms of oxidative stress, providing pronounced anti-inflammatory and antioxidant action. At the systemic level, an immunomodulatory influence is noted, associated with the normalization of cytokine balance and enhanced activity of innate immune cells.

Menthol, included in the ointment, activates cold receptors TRPM8 and partially inhibits the transmission of nociceptive signals, providing a local analgesic and antipruritic effect. Camphor acts as a mild agonist of TRPV1 receptors, inducing short-term activation and subsequent desensitization of sensory neurons, manifested as reduced pain and irritation. Together, these components form a modulatory influence on the nervous system of the skin and subcutaneous tissue.

The lipophilic base (petroleum jelly and paraffin) contributes to the creation of a semi-permeable protective film, increasing the residence time of active substances in the epidermis and dermis. This ensures prolonged action of the Clinacanthus nutans extract and its active components, and also maintains optimal skin hydration, reducing the risk of secondary damage.

From a pharmacodynamic perspective, the ointment acts primarily at the local level, exerting a dermatotropic effect. Systemic immunomodulatory and antioxidant influences are possible, especially with long-term course use. The complex action can be characterized as tissue-specific (skin and nerve endings) and cellular (immune and epithelial cells).

Thus, the pharmacodynamics of the drug includes three key directions: suppression of inflammatory processes, modulation of sensory receptors, and maintenance of skin barrier functions. These effects are confirmed by studies on cell cultures, animal models, and in clinical practice, allowing the ointment to be considered a multicomponent pharmacological agent with a high level of biosafety.

References: PubMed, PMC, Semantic Scholar, ScienceDirect, SpringerLink, WHO monographs.

Pharmacokinetics of Herpes Zoster Ointment (Clinacanthus nutans)

The pharmacokinetics of the ointment are determined by the transdermal route of administration. The Clinacanthus nutans extract contains polar and weakly polar flavonoids, chlorophylls, and polysaccharides, which, when applied to the skin, penetrate primarily into the epidermis and dermis, fixing in the lipid layers of the stratum corneum. At this level, local biological activity is ensured, associated with the inhibition of inflammatory mediators and regulation of the skin's immune response. Deep systemic absorption of plant polysaccharides and large flavonoids is limited, reducing the risk of systemic effects.

Menthol and camphor are characterized by higher lipophilicity and penetrate the skin faster. They accumulate in the subcutaneous tissue and are partially distributed into the systemic circulation, undergoing further metabolism in the liver with the formation of hydroxylated metabolites. Petroleum jelly and paraffin act as lipophilic carriers, slowing the evaporation of volatile compounds and ensuring prolonged release of active substances.

The metabolism of polyphenolic compounds from the Clinacanthus nutans extract occurs in the liver via phase II enzyme systems (glucuronidation, sulfation), contributing to their inactivation and subsequent excretion. Menthol is metabolized with the participation of hepatic oxidoreductases, and camphor undergoes hydroxylation and conjugation. Excretion of metabolites occurs primarily by the kidneys via urine, and to a lesser extent through bile.

Systemic exposure with topical application is minimal, resulting in a high safety profile. No accumulation in tissues has been identified with standard use. Possible interaction with skin microflora is associated with the enzymatic biotransformation of some polysaccharides and glycosides into biologically active metabolites.

References: PubMed, PMC, ScienceDirect, SpringerLink, Wiley Online Library.

Mechanisms of Action and Scientific Rationale: Herpes Zoster Ointment (Clinacanthus nutans)

Liver and Gastrointestinal Tract. Flavonoids of Clinacanthus nutans exhibit antioxidant and membrane-stabilizing effects by inhibiting lipid peroxidation and regulating the activity of antioxidant defense enzymes (SOD, CAT, GPx). At the cellular level, they block NF-κB and MAPK signaling cascades, reducing the production of pro-inflammatory mediators. Menthol and camphor demonstrate hepatotropic properties in models of oxidative stress, modulating the activity of cytochrome P450 enzymes.
Reference: PubMed

Immune System. The Clinacanthus nutans extract exerts a modulatory influence on the cytokine balance: it reduces the levels of pro-inflammatory IL-1β, IL-6, TNF-α and stimulates the production of anti-inflammatory IL-10. This provides an additive anti-inflammatory effect and stabilizes the activity of T-lymphocytes and macrophages. Interaction with the TRP receptors of menthol and camphor enhances the local immune response, contributing to reduced skin hyperreactivity.
Reference: ScienceDirect

Nervous System. Menthol activates TRPM8 receptors, reducing the intensity of pain impulses, and camphor, via TRPV1, exerts a potentiating and sequentially desensitizing effect. These processes form an additive analgesic and antipruritic response. Flavonoids of Clinacanthus nutans influence the level of neurotransmitters and inflammatory mediators, indirectly modulating sensory signaling pathways.
Reference: Wiley

Endocrine and Metabolic Regulation. Phenolic compounds of Clinacanthus nutans have a modulating effect on carbohydrate and lipid metabolism by regulating the activity of adipokines and JAK/STAT signaling pathways. Camphor additionally influences energy metabolism, activating mitochondrial processes and enhancing local blood circulation. These effects are considered at tissue-specific and systemic levels of regulation.
Reference: SpringerLink

Thus, the mechanisms of action of the ointment include antioxidant, anti-inflammatory, immunomodulatory, and neurosensory influences, realized through the regulation of cytokines, inflammatory mediators, TRP ion channels, and antioxidant defense enzyme systems. The combination of components forms a multicomponent modulating effect with tissue-specific and systemic levels of impact.
References: PubMed, PMC, Phytochemical Database, ScienceDirect, SpringerLink, Wiley, WHO.