Generic Name

Somavert

Mechanism

• Disodium cromoglycate is a mast‑cell stabilizer that prevents degranulation of mast cells and basophils by blocking calcium influx.
• Inhibition of histamine, leukotrienes, and other mediators reduces the late‑phase allergic response.
• It also stabilizes leukocyte membranes, suppressing inflammation in allergic tissues.

Pharmacokinetics

• Route & Absorption
• *Intranasal*: ≈ 30 % absorbed locally; minimal systemic exposure.
• *Ocular*: Very limited systemic absorption.
• *Inhaled*: Rapid pulmonary deposition; ~ 25 % absorbed into circulation.
• Distribution: Predominantly extracellular; poorly protein‑bound (< 1 %).
• Metabolism: Minimal hepatic metabolism; largely unchanged.
• Elimination: Renal excretion of unchanged drug; half‑life ≈ 1–2 h (locally) or ~ 3 h systemically.
• Drug‑drug interactions: No clinically relevant interactions; no CYP inhibition or induction.

Indications

• Allergic rhinitis (seasonal or perennial)
• Allergic conjunctivitis (seasonal, perennial, or drug‑induced)
• Exercise‑induced asthma (prophylaxis)
• Allergic urticaria (as adjunct to antihistamines)

Contraindications

• Contraindicated:
• Hypersensitivity to cromoglycate or any excipient.
• Warnings:
• Rare systemic allergic reactions (anaphylaxis) with inhalation or intranasal use.
• Use with caution in patients with asthma; avoid in acute bronchospasm.
• No specific pregnancy or lactation data; use only if benefits outweigh risks.

Dosing

*Note*: Adjust dosing in renal impairment if oral tablets are used; local administration requires no dose adjustment.

Adverse Effects

• Common:
• Nasal irritation, burning, or dryness (intranasal).
• Conjunctival redness or itching (ocular).
• Mild cough or throat irritation (inhaled).
• Serious:
• Anaphylaxis (rare).
• Bronchospasm with inhalation in susceptible asthmatics.
• Other:
• Nausea or gastrointestinal upset (oral).
• Headache (inhalation).

Monitoring

• Intranasal/Ocular: No routine monitoring necessary.
• Inhaled:
• Observe for bronchospasm or respiratory distress.
• If severe asthma present, do not use as sole agent; combine with β₂‑agonist.
• Laboratory: Not required for routine use.

Clinical Pearls

• Early Use is Key – Start Somavert 30 min before allergen exposure; early prophylaxis maximizes mast‑cell stabilization.
• Non‑corticoid Option – Ideal for patients who cannot tolerate or wish to avoid antihistamine or steroid side‑effects.
• Exercise‑Induced Asthma – Combines well with short‑acting β₂‑agonists; use 2 puffs 5 min pre‑exercise for maximal benefit.
• Cross‑reactivity – A patient allergic to cromoglycate cannot receive other mast‑cell stabilizers (e.g., nedocromil).
• Storage – Keep spray away from heat and light; check expiry before use.

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