Myrtol standardized

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Myrtol is a registered word mark for identification of a plant mixed distillate from rectified eucalyptus oil, rectified sweet orange, rectified myrtle oil and rectified lemon oil ( 66:32:1:1 ratio ) which, according to the manufacturer's instructions not less than 25 percent limonene, cineol 25 percent and 6.7 percent ( )- α - pinene. This mixture has a density of 0.895 g/cm3. It is an expectorant and expectorant and is therefore used in acute and chronic bronchitis, as well as a sinus infection (sinusitis).

Indication and method of administration

Myrtol is applied mucus and facilitate expectoration at aktuer and chronic bronchitis, as well as the mucus in inflammation of the sinuses (sinusitis). Myrtol is administered in the form of enteric-coated soft gelatin capsules that release the Myrtol when properly used in the small intestine.

Scientific data location

To Myrtol exist about 100 preclinical studies on pharmacodynamics, pharmacokinetics and toxicity as well as 27 clinical trials involving approximately 6200 patients. Myrtol is considered as the one drug based on essential oils, its effectiveness is best demonstrated by modern clinical studies.

Active effects / pharmacodynamics

Myrtol be attributed to the following effects:

• Mucolytic ( expectorant ) Effect: In a study had been in vitro sputum samples examined from patients with bronchial asthma, chronic bronchitis and cystic fibrosis. After addition of the viscoelasticity of mucus myrtol decreased about 10 to 16%. These values ​​are comparable to effects of N-acetylcysteine.
• Secretomotor effect (increase in ciliary beat frequency ): The tiny hairs ( cilia ) of certain mucosal cells provide with their wavy coordinated movements for the removal of mucus. The beat frequency of cilia is accelerated by Myrtol so that the transit time of the mucus is reduced. Thus, in one study, the ciliary beat frequency of mucosal tissue samples was recorded with a microscope and an associated high-speed camera. Myrtol increased the ciliary beat frequency significantly at doses that correspond to the usual dosage in humans. Here, Myrtol proved tends more effective than N- acetylcysteine. In another study, the ciliary beat frequency under Myrtol was compared to a sham drug (placebo) increased by a factor of 2 and reduces the transit time of the mucus by more than 5 minutes.
• Secretolytic ( schleimverflüssigende ) effect: it has been found that with increasing dose Myrtol an increasingly schleimverflüssigender effect occurs in mice. In a direct comparison to untreated animals, the effect was increased with secretolytic myrtol to 32 % and 21% when treated with a pure preparation of eucalyptus oil.
• Increase in mucociliary clearance: Because of the mucolytic, secretolytic and sekretomotorischen effects of natural cleaning mechanism of the mucous membranes is supported, ie Mucus and inhaled particles are increasingly being transported (fachsprachlich: mucociliary clearance enhancer, MCC). This effect probably prevents the formation of bacterial biofilms. It is believed that such biofilms can trigger chronic sinusitis. Biofilms protect the disease-causing bacteria from the body's defenses and from antibiotics and form a permanent bacterial reservoir. The effect of increased mucociliary clearance is experimental and has been demonstrated in humans several times.
• Antioxidant effects: Antioxidants are compounds that substances from unwanted oxidation and thus prior to the formation of harmful free radicals possibly protect. Natural antioxidants are mainly found in plants. The antioxidant effects of myrtol have been tested in various systems. So Myrtol inhibits the SIN system (3- morpholinosydnonimine ) the ethylene production by more than half. This was confirmed by the Fenton reaction with inhibition of ethylene formation by 82%. Myrtol interacts with aggressive oxygen species and thus attenuates the oxidative attack by infectious agents or environmental factors. This property may be responsible for tissue damage as they arise by a bacterial infection with Pseudomonas aeruginosa, for example, be prevented.
• Anti-inflammatory effects: respiratory infections such as acute and chronic bronchitis or bronchial asthma caused by various inflammatory cells and mediators ( inflammatory mediators ). Myrtol has resulted in attempts to decreased production of inflammatory mediators in inflammatory cells. Myrtol inhibits, inter alia, 5-lipoxygenase, a key enzyme in the inflammatory cascade.
• Bronchodilator effect: Myrtol acts on the bronchial smooth muscle antispasmodic ( spasmolytic ). So could histamine -induced bronchospasm in experiments with standardized Myrtol be prevented dose-dependent.
• Antimicrobial action: Under experimental conditions, myrtol inhibited depending on the dose used in various kinds of bacteria such as pneumococci and Haemophilus influenzae. These are considered as the most important bacteria in acute bronchitis as well as in an acute episode of chronic bronchitis. Although in principle the most acute infections of the upper and lower respiratory tract caused by viruses, it can come in the course of a respiratory infection to bacterial bacterial colonization especially in disturbed mucociliary clearance.

In summary, the mixed vegetable distillate Myrtol be described as primarily an expectorant herbal medicine with several additional effects. These are the various aspects of action to enhance the mucociliary clearance, as well as antioxidant effects ( free radical scavenger ). Accordingly, the herbal primarily occurs in respiratory diseases for use as in acute and chronic sinusitis and acute and chronic bronchitis.

Clinical trials

Myrtol has been used for decades and has been tested in clinical trials. Were randomized, double-blind, placebo-controlled, multicenter trials conducted according to international GCP standards ( Good Clinical Practice), with the aim of the efficacy and tolerability according to the principles of evidence-based medicine ( Evidence Based Medicine ) to prove. Were supplemented by observational clinical trials and non- interventional studies.

Acute sinusitis

In a study Myrtol and an essential oil were with acute sinusitis (acute sinusitis) administered in a total of 331 adults for about a week and compared with a dummy drug ( placebo). In order to eliminate distortions, knew neither investigators nor the patients, which was administered for a drug in each individual case ( double blinding ) and the allocation in the three groups was random ( randomization). The comparison of the symptoms - sum scores of the study participants showed a statistically significant superiority of Myrtols and the essential oil compared to placebo-treated patients, ie the patients recovered faster, especially with respect to the core symptoms of headache, pain when bending and pressure sensitivity to certain nerve exit points in the face. Antibiotic treatments were required less frequently than in the placebo group (23 % versus 40 %) in the Myrtol group after this treatment phase.

Chronic sinusitis

48 adults with chronic sinusitis (chronic sinusitis) had ( so ) either taken in a study according to international GCP standard three times a day Myrtol or a dummy drug (placebo), ie for a total of three months. All participants had CT scans (CT ) made ​​the sinuses, which confirmed the diagnosis and disease progression documented, particularly with the aid of a CT scores. Before starting treatment, this score was in both groups averaged about 9 points. Following treatment, this score was in the placebo group unchanged (no treatment effect). In the group treated with Myrtol study group, however, the value was statistically significant at 41% off ( improvement). Both about 90 % of the patients and the doctors certified Myrtol a good to very good tolerability.

Acute bronchitis

In a study on acute bronchitis Myrtol was compared with two antibiotics and a dummy drug (placebo), and for a period of 14 days. A total of 676 participants in the study were randomly divided into treatment groups ( randomization), neither investigators nor patients knew which they were treated ( double blinding ). After two weeks, Myrtol shown to be as acceptable as placebo, in effect Myrtol, however, was statistically significantly superior. The treatment effect of Myrtol was a total comparable to the under antibiotic treatment, with several parameters, a slight superiority over antibiotics showed. Because acute bronchitis is caused mainly by viruses, however, the usefulness of antibiotic therapy in this disease is in question.

The for bronchitis patients often nagging cough is also alleviated quickly and significantly with Myrtol; it produced compared to a dummy treatment less nighttime sleep, so also the result of a randomized, double-blind study with 413 participants. Regarding adverse events, there was no difference between placebo and Myrtol group revealed.

Chronic bronchitis

In the long-term treatment for chronic bronchitis Myrtol is just as acceptable as a placebo, but superior effect: the intensity and frequency of acute worsening ( exacerbations ) of chronic bronchitis can be reduced with Myrtol statistically significant and relevant extent, as well as the need for antibiotics. In a study of 246 patients with chronic bronchitis was the quality of life, assessed after the condition and state of being affected by cough and sputum, after six months of therapy in the winter time significantly improved. The treatment resulted in a in the placebo group for the season typical Exazerbationsgipfel between the 2nd and 4th month of treatment (usually December to February) was not detected in the Myrtol group. The quality of this study has been evaluated by the Cochrane Airways Group 4 out of 5 possible points.

To sum up Myrtol both in acute and chronic infections of the upper and lower respiratory tract a recognized proofs of efficacy.

Guideline recommendations

Based on the scientific literature suggest several medical societies, the use of Myrtol sinusitis as well as in chronic bronchitis.

Finished medicinal product

GeloMyrtol (AT, DE) / 300 mg (AT ) / forte (DE), GeloDurat (CH).

Side effects

Uncommon side effects of Myrtol are gastrointestinal complaints, rarely nausea, vomiting, or diarrhea may occur. Rarely, it can also cause hypersensitivity reactions.