Sodium Cromoglicate

(BANM, rINNM)
Sodium Cromoglicate Chemical formula
Synonyms: Cromoglicate de Sodium; Cromoglicato de sodio; Cromoglicato disódico; Cromolyn Sodium natrium-chromoglykát; Disodium Cromoglycate; FPL-670; Natrii cromoglicas; Natrio kromoglikatas; Natriumchromoglicat; Natriumkromoglikaatti; Natriumkromoglikat; Nátrium-kromoglikát; Sodium, cromoglicate de; Sodium Cromoglycate; Sodyum Kromoglikat. Disodium 4,4′-dioxo-5,5′-(2-hydroxytrimethylenedioxy)di(4H-chromene-2-carboxylate).
Cyrillic synonym: Натрий Кромоглициат.

💊 Chemical information

Chemical formula: C23H14Na2O11 = 512.3.
CAS — 16110-51-3 (cromoglicic acid); 15826-37-6 (sodium cromoglicate).
ATC — A07EB01; D11AX17; R01AC01; R03BC01; S01GX01.
ATC Vet — QA07EB01; QD11AX17; QR01AC01; QR03BC01; QS01GX01.

Pharmacopoeias.

In Chin., Eur., Int., Jpn, and US.

Ph. Eur. 6.2

(Sodium Cromoglicate). A white or almost white, hygroscopic, crystalline powder. Soluble in water; practically insoluble in alcohol. Store in airtight containers. Protect from light.

USP 31

(Cromolyn Sodium). A white, odourless, hygroscopic, crystalline powder. Soluble in water; insoluble in alcohol and in chloroform. Store in airtight containers.

💊 Adverse Effects

Inhalation of sodium cromoglicate may cause transient bronchospasm, wheezing, cough, nasal congestion, and irritation of the throat. Nausea, headache, dizziness, an unpleasant taste, and joint pain and swelling have been reported. Other reactions include aggravation of existing asthma, urticaria, rashes, pulmonary infiltrates with eosinophilia, dysuria, and urinary frequency. Severe reactions such as marked bronchospasm, laryngeal oedema, angioedema, and anaphylaxis have been reported rarely. Intranasal use of sodium cromoglicate may cause transient irritation of the nasal mucosa, sneezing, and occasionally epistaxis. Nausea, skin rashes, and joint pains have occurred when it is taken orally. Transient burning and stinging have occasionally been reported after use of sodium cromoglicate eye drops.

Formulation.

Some of the adverse effects reported with sodium cromoglicate may be due to its formulation: there is a view that some of the irritant effects reported on inhalation may be due to the use of dry powder inhalers. It has also been suggested that in some patients receiving sodium cromoglicate via a nebuliser, hypotonicity of the nebuliser solution may induce bronchospasm,1 although others consider this debatable.2 Nausea, bloating, abdominal cramps, and flatulence developed in a 24-yearold lactase-deficient woman 2 hours after the use of sodium cromoglicate (Intal) inhalation capsules via a turbo-haler for exercise-induced asthma.3 These symptoms recurred on rechallenge and were attributed to ingestion of lactose contained within the capsules.
1. Chin TW, Nussbaum E. Detrimental effect of hypotonic cromolyn sodium. J Pediatr 1992; 120: 641–3
2. Rachelefsky GS, et al. Detrimental effects of hypotonic cromolyn sodium. J Pediatr 1992; 121: 992
3. Brandstetter RD, et al. Lactose intolerance associated with Intal capsules. N Engl J Med 1986; 315: 1613–14.

💊 Precautions

Sodium cromoglicate has no role in the treatment of acute asthmatic attacks. Withdrawal of sodium cromoglicate may lead to recurrence of the symptoms of asthma. Should withdrawal be necessary it has been suggested that the dose be reduced gradually over a period of one week; patients in whom sodium cromoglicate therapy has permitted a reduction of corticosteroid dosage may require restoration of full corticosteroid cover. Systemic corticosteroid therapy that has been reduced or stopped in asthmatic patients may need to be reinstated if symptoms increase, during periods of stress such as infection, illness, trauma, or severe antigen challenge, or where airways obstruction impairs inhalation of sodium cromoglicate.

💊 Pharmacokinetics

Sodium cromoglicate is poorly absorbed from the gastrointestinal tract, with a reported bioavailability of only 1%. It has been reported that on inhalation as a fine powder only about 8% of a dose is deposited in the lungs from where it is rapidly absorbed and excreted unchanged in the urine and bile. Less than 7% of an intranasal dose appears to be absorbed. The majority of an inhaled or an intranasal dose is swallowed and excreted unchanged via the gastrointestinal tract. About 0.03% of an ophthalmic dose is reported to be absorbed. The terminal elimination half-life has been reported to be about 20 minutes after intravenous dosage, but the elimination half-life after oral doses or inhalation is about 80 minutes.
1. Patel KR, et al. Plasma concentrations of sodium cromoglycate given by nebulisation and metered dose inhalers in patients with exercise-induced asthma: relationship to protective effect. Br J Clin Pharmacol 1986; 21: 231–3
2. Yahav Y, et al. Sodium cromoglycate in asthma: correlation between response and serum concentrations. Arch Dis Child 1988; 63: 592–7.

💊 Uses and Administration

Sodium cromoglicate is used for the prevention of allergic reactions. Although its precise mode of action remains uncertain, it is believed to act primarily by preventing release of mediators of inflammation from sensitised mast cells through stabilisation of mast-cell membranes. It has no direct antihistamine or anti-inflammatory action. Sodium cromoglicate can prevent the asthmatic response to a variety of allergic and non-allergic stimuli. It is used in the management of chronic asthma that cannot be managed with inhaled beta 2 agonists alone; it is not used for acute attacks of asthma. Sodium cromoglicate is also used in the prophylaxis and treatment of seasonal and perennial allergic rhinitis and allergic conditions of the eye including acute and chronic allergic conjunctivitis and vernal keratoconjunctivitis. It has been given orally, with dietary restriction, for the prevention of food allergies, and is also used in the treatment of mastocytosis. It is important that the regular use of sodium cromoglicate is maintained, both in the prophylactic control of asthma and in the management of other allergic conditions. Beneficial effects may take several weeks to become established. In the prophylaxis of asthma, sodium cromoglicate is given by inhalation either as a dry powder, or as a nebulised solution, or from a metered-dose aerosol. The usual dose as dry powder or nebulised solution is 20 mg by inhalation 4 times daily increased, if necessary, to 6 or 8 times daily. Once the asthma has been stabilised it may be possible to reduce the dosage. In different countries, sodium cromoglicate is available in different strengths of metered-dose aerosol. Using a metered-dose aerosol providing 5 mg per inhalation, the usual dose is 10 mg four times daily, increased to 6 to 8 times daily if necessary; it may be possible to reduce the dosage to 5 mg four times daily once the asthma has been stabilised. Additional doses as the aerosol or dry powder may be taken before exercise. Metereddose aerosols providing 1 mg per inhalation are also available. The usual dose is 2 mg four times daily, which can be doubled if necessary. The adequacy of the lower dosage has been questioned (see under Administration, below). Inhalation of sodium cromoglicate may cause bronchospasm; separate inhalation of a beta 2 agonist such as salbutamol a few minutes beforehand should prevent this. Use of a combination product containing a beta 2 agonist is not recommended as this is liable to be used inappropriately for relief of bronchospasm rather than for its prophylactic effect. For the prophylaxis of allergic rhinitis, a 2 or 4% sodium cromoglicate solution can be given as a spray into both nostrils. The 2% spray contains about 2.5 mg per actuation and is given 4 to 6 times daily, and the 4% spray contains about 5 mg per actuation and is given 2 to 4 times daily. Prophylactic treatment for seasonal allergic rhinitis should begin 2 to 3 weeks before exposure to the offending allergen and should continue throughout the season. In allergic conjunctivitis and vernal keratoconjunctivitis, sodium cromoglicate is used as drops of 2 or 4%, applied 4 to 6 times daily. In food allergy and in mastocytosis, sodium cromoglicate may be given in oral doses of 200 mg four times daily before meals. If satisfactory control is not achieved within 2 to 3 weeks the dosage may be doubled, but should not exceed 40 mg/kg daily; a reduction in dosage may be possible once symptoms have been controlled. For details of doses in children, see Administration in Children below.

Action.

Sodium cromoglicate has a range of actions at cellular level that may be important for its protective effect in asthma. It is known as a mast cell stabiliser that inhibits the release of histamine and other inflammatory mediators from sensitised mast cells. Other reported actions include a direct effect on airway nerves1,2 and antagonism3 of substance P, which ties up with its inhibition of the effects of platelet activating factor (PAF).4,5 There have been a few reports6-8 of sodium cromoglicate producing bronchodilatation. However, in practice other drugs with accepted bronchodilating activity are used for this effect in asthma treatment schedules.
1. Barnes PJ. Asthma as an axon reflex. Lancet 1986; i: 242–5
2. Dixon M, et al. The effects of sodium cromoglycate on lung irritant receptors and left ventricular cardiac receptors in the anaesthetized dog. Br J Pharmacol 1979; 67: 569–74
3. Page C. Sodium cromoglycate, a tachykinin antagonist? Lancet 1994; 343: 70
4. Morley J, et al. The platelet in asthma. Lancet 1984; ii: 1142–4
5. Morley J. PAF and airway hyperreactivity: prospects for novel prophylactic anti-asthma drugs. In: PAF, Platelets, and Asthma, Basel, Birkhäuser Verlag, 1987: 87–95
6. Horn CR, et al. Bronchodilator effect of disodium cromoglycate administered as a dry powder in exercise induced asthma. Br J Clin Pharmacol 1984; 18: 798–801
7. Weiner P, et al. Bronchodilating effect of cromolyn sodium in asthmatic patients at rest and following exercise. Ann Allergy 1984; 53: 186–8
8. Yuksel B, Greenough A. Bronchodilator effect of nebulized sodium cromoglycate in children born prematurely. Eur Respir J 1993; 6: 387–90.

Administration.

The effectiveness of sodium cromoglicate 2 mg four times daily by metered-dose aerosol inhaler has been reported by controlled studies in adults and children with asthma.1-5 However, although sodium cromoglicate 2 mg by inhalation from a metered-dose aerosol was reported6 to be as effective as 20 mg inhaled as powder, the tenfold difference in dosage has been questioned,7 and others have reported contrary results.8,9 It has been suggested that an aerosol supplying 5 mg per metered dose (see Uses and Administration, above) would be preferable.10 In a comparison of single-dose pretreatment from metereddose inhalers, sodium cromoglicate 10 mg (2 × 5 mg puffs) was as effective as beclometasone dipropionate 200 micrograms in inhibiting bronchial responsiveness to histamine.11 Care is required if inhaled sodium cromoglicate is given via a spacer device; evidence suggests that these may greatly influence the amount of drug delivered, reducing it to one-third of the dose delivered by inhaler actuation in some cases.12
1. Geller-Bernstein C, Levin S. Sodium cromoglycate pressurised aerosol in childhood asthma. Curr Ther Res 1983; 34: 345–9
2. Wheatley D. Sodium cromoglycate in aerosol form in regular users of bronchodilator drugs. Curr Med Res Opin 1983; 8: 333–7
3. Rubin AE, et al. The treatment of asthma in adults using sodium cromoglycate pressurized aerosol: a double-blind controlled trial. Curr Med Res Opin 1983; 8: 553–8
4. Blumenthal MN, et al. A multicenter evaluation of the clinical benefits of cromolyn sodium aerosol by metered-dose inhaler in the treatment of asthma. J Allergy Clin Immunol 1988; 81: 681–7
5. Selcow JE, et al. Clinical benefits of cromolyn sodium aerosol (MDI) in the treatment of asthma in children. Ann Allergy 1989; 62: 195–9
6. Latimer KM, et al. Inhibition by sodium cromoglycate of bronchoconstriction stimulated by respiratory heat loss: comparison of pressurised aerosol and powder. Thorax 1984; 39: 277–81
7. Anonymous. Sodium cromoglycate aerosol. Drug Ther Bull 1982; 20: 27
8. Robson RA, et al. Sodium cromoglycate: spincaps or metered dose aerosol. Br J Clin Pharmacol 1981; 11: 383–4
9. Bar-Yishay E, et al. Duration of action of sodium cromoglycate on exercise induced asthma: comparison of 2 formulations. Arch Dis Child 1983; 58: 624–7
10. Tullett WM, et al. Dose-response effect of sodium cromoglycate pressurised aerosol in exercise induced asthma. Thorax 1985; 40: 41–4
11. Cockcroft DW, Murdock KY. Comparative effects of inhaled salbutamol, sodium cromoglycate, and beclomethasone dipropionate on allergen-induced early asthmatic responses, late asthmatic responses, and increased bronchial responsiveness to histamine. J Allergy Clin Immunol 1987; 79: 734–40
12. Barry PW, O’Callaghan C. Inhalational drug delivery from seven different spacer devices. Thorax 1996; 51: 835–40.

Administration in children.

Children may be given sodium cromoglicate for prophylactic management of asthma and allergic rhinitis, and in the prophylaxis and treatment of acute and chronic allergic conjunctivitis and vernal keratoconjunctivitis, using adult doses, see Uses and Administration, above. Different countries may have different licensed lower age limits and some inhalation dosage forms are unsuitable in very young children. In food allergy and in mastocytosis, sodium cromoglicate may be given orally to children from 2 years of age. A dose of 100 mg is given four times daily before meals. If satisfactory control is not achieved within 2 to 3 weeks the dosage may be doubled but should not exceed 40 mg/kg daily; a reduction in dosage may be possible once symptoms have been controlled. For food allergy, adult doses may be given to children from 14 years of age, and from 13 years for mastocytosis, see above.

Asthma.

Sodium cromoglicate is used as a prophylactic agent in the management of chronic asthma, but in practice inhaled corticosteroids are preferred if regular prophylactic treatment is indicated, i.e. if the condition cannot be managed with occasional use of an inhaled short-acting beta2 agonist alone. Even in children, in whom cromoglicate has tended to be more widely used, inhaled corticosteroids are considered first-line preventers. A systematic review1 comparing sodium cromoglicate with inhaled corticosteroids found that inhaled corticosteroids were superior in terms of asthma control and lung function for both children and adults with chronic asthma. However, guidelines still specify the use of cromoglicate or nedocromil as a valid alternative to inhaled corticosteroids in some circumstances. Response to treatment with nebulised sodium cromoglicate was found to be age-related in a study of children under 2 years of age with recurrent or persistent wheezy bronchitis and a history of allergic symptoms.2 It was effective in children of 12 to 24 months of age but not in those below 12 months. Similarly, nebulised sodium cromoglicate was no more effective than placebo in the treatment of a group of 31 infants with persistent wheezing aged under 1 year,3 and long-term inhalation therapy was ineffective in children aged 1 to 4 years.4
1. Guevara JP, et al. Inhaled corticosteroids versus sodium cromoglycate in children and adults with asthma. Available in The Cochrane Database of Systematic Reviews; Issu
2. Chichester: John Wiley; 2006 (accessed 14/04/08)
2. Geller-Bernstein C, Levin S. Nebulised sodium cromoglycate in the treatment of wheezy bronchitis in infants and young children. Respiration 1982; 43: 294–8
3. Furfaro S, et al. Efficacy of cromoglycate in persistently wheezing infants. Arch Dis Child 1994; 71: 331–4
4. Tasche MJA, et al. Randomised placebo-controlled trial of inhaled sodium cromoglycate in 1-4-year-old children with moderate asthma. Lancet 1997; 350: 1060–4. Correction. ibid. 1998; 351: 376.

Cogan’s syndrome.

Sodium cromoglicate eye drops improved blurred vision in a patient who had had Cogan’s syndrome for 18 years.1 Sodium cromoglicate capsules [by mouth] also reduced the frequency of fever attacks in this patient.
1. Carter F, Nabarro J. Cromoglycate for Cogan’s syndrome. Lancet 1987; i: 858.

Cough.

Sodium cromoglicate has been used with modest success by aerosol inhalation to suppress the cough associated with ACE inhibitor therapy in some patients.1,2 However, inhalation of nedocromil sodium was not helpful in the treatment of ACE inhibitor induced cough in 6 diabetic patients.3 A systematic review4 considered that there was no good evidence to support the use of inhaled cromoglicate or nedocromil in the treatment of non-specific cough in children.
1. Keogh A. Sodium cromoglycate prophylaxis for angiotensinconverting enzyme inhibitor cough. Lancet 1993; 341: 560
2. Hargreaves MR, Benson MK. Inhaled sodium cromoglycate in angiotensin-converting enzyme inhibitor cough. Lancet 1995; 345: 13–16
3. Puolijoki H, Rekiaro M. Lack of effect of nedocromil sodium in ACE-inhibitor-induced cough. Lancet 1995; 345: 394
4. Chang A, et al. Inhaled cromones for prolonged non-specific cough in children. Available in The Cochrane Database of Systematic Reviews; Issu
1. Chichester: John Wiley; 2004 (accessed 14/04/08).

Eczema.

Application of a 4% sodium cromoglicate lotion was found to be of benefit in improving symptoms and reducing topical corticosteroid use in a study1 in children with moderately severe atopic dermatitis.
1. Stainer R, et al. Efficacy and acceptability of a new topical skin lotion of sodium cromoglicate (Altoderm) in atopic dermatitis in children aged 2–12 years: a double-blind, randomized, placebocontrolled trial. Br J Dermatol 2005; 152: 334–41.

Food allergy.

Oral sodium cromoglicate has been used in the prophylaxis of food allergy reactions. However, efficacy has not been unequivocally established.

Mastocytosis.

Mastocytosis is a rare condition characterised by abnormal proliferation of mast cells and their accumulation in body tissues.1-3 Signs and symptoms of the disease result from the spontaneous or induced release of mast cell mediators. Mastocytosis occurs in cutaneous or systemic forms, which are further subdivided based on clinical presentation and prognosis. Clinical algorithms and recommendations for diagnosis, treatment, and response criteria have been developed.4
Cutaneous mastocytosis most often manifests as urticaria pigmentosa (disseminated red-brown macules, papules, or plaques); other symptoms include flushing, pruritus, urticaria, blistering, and dermatographism. Mastocytomas may occur as brownish solitary or multiple nodular accumulations of mast cells. In children with cutaneous mastocytosis, symptoms will resolve in about half by adolescence.
Systemic mastocytosis can involve diverse organs and tissues including the bones, liver, spleen, lymph nodes, haematopoietic system, gastrointestinal tract, and also the skin. General symptoms include fatigue, weight loss, fever, and sweats. Gastrointestinal complaints such as abdominal pain and diarrhoea are common, and some patients may experience malabsorption, steatorrhoea, or peptic ulcer disease. Bone marrow involvement may result in bone pain, osteoporosis, fractures, bone marrow fibrosis, and myeloproliferative and myelodysplastic diseases. Other systemic effects include lymphadenopathy, hepatosplenomegaly, headache and other neuropsychiatric symptoms, syncope, and anaphylactoid reactions. Avoidance of trigger factors is an important measure in the management of mastocytosis. Such factors include exposure to extremes of cold or heat (hot bath or sunbathing), emotional stress, mechanical irritation (vigorous towel rubbing, massage), infections, alcohol, some drugs (e.g. aspirin, NSAIDs, opioid analgesics, sympathomimetics, polymyxin B, dextran, radiographic dyes), and animal venoms.1,2,5 Treatment is aimed at relieving symptoms and does not alter the course of the disease.1,2,4-6 H1-antagonist antihistamines such as hydroxyzine and cyproheptadine are used to provide relief of flushing, pruritus, urticaria, blistering, and abdominal pain. Patients at risk of anaphylactoid reactions should carry adrenaline for self-injection, and those who have repeated reactions should be given prophylactic antihistamines. H2-antagonist antihistamines such as cimetidine, and proton pump inhibitors such as omeprazole, are used to manage gastrointestinal symptoms, particularly gastritis and peptic ulcer disease. Bisphosphonates may be helpful for osteopenia and bone pain. Sodium cromoglicate is given to manage abdominal pain, nausea, and diarrhoea. It may also provide some relief of headache, neuropsychiatric symptoms, and skin symptoms in some patients. Photochemotherapy using an oral psoralen with ultraviolet A irradiation has been used to reduce cutaneous manifestations of mastocytosis, but urticaria pigmentosa usually recurs within several weeks. Topical PUVA appears to be ineffective. Mastocytomas that cause symptoms may be treated with local PUVA or potent topical corticosteroids. Although surgical removal may be considered, the majority of mastocytomas will involute spontaneously. Other treatments have also been tried in the treatment of small numbers of patients with aggressive systemic mastocytosis. Mixed results have been reported with the use of interferon alfa.1There is a report of ciclosporin with methylprednisolone being used successfully.4 Imatinib has been used successfully in systemic mastocytosis with associated eosinophilia and with a mutation of the platelet-derived growth factor receptorα gene on chromosome 4q12.6 Beneficial responses to cladribine have also occurred in a small number of patients with systemic disease.6,7
1. Hartmann K, Henz BM. Mastocytosis: recent advances in defining the disease. Br J Dermatol 2001; 144: 682–95
2. Carter MC, Metcalfe DD. Paediatric mastocytosis. Arch Dis Child 2002; 86: 315–19
3. Castells MC. Mastocytosis: classification, diagnosis, and clinical presentation. Allergy Asthma Proc 2004; 25: 33–6
4. Valent P, et al. Standards and standardization in mastocytosis: consensus statements on diagnostics, treatment recommendations and response criteria. Eur J Clin Invest 2007; 37: 435–53
5. Almahroos M, Kurban AK. Management of mastocytosis. Clin Dermatol 2003; 21: 274–7
6. Tefferi A, Pardanani A. Systemic mastocytosis: current concepts and treatment advances. Curr Hematol Rep 2004; 3: 197–202
7. Kluin-Nelemans HC, et al. Cladribine therapy for systemic mastocytosis. Blood 2003; 102: 4270–6.

Rhinitis and conjunctivitis.

Many drugs, including sodium cromoglicate, are used in the management of allergic rhinitis and conjunctivitis. There is some evidence that nedocromil1 or lodoxamide2 may be more effective than cromoglicate in the management of vernal keratoconjunctivitis.
1. El Hennawi M. A double-blind placebo controlled group comparative study of ophthalmic sodium cromoglycate and nedocromil sodium in the treatment of vernal keratoconjunctivitis. Br J Ophthalmol 1994; 78: 365–9
2. Leonardi A, et al. Effect of lodoxamide and disodium cromoglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis. Br J Ophthalmol 1997; 81: 23–6.

💊 Preparations

BP 2008: Sodium Cromoglicate Eye Drops; Sodium Cromoglicate Powder for Inhalation; USP 31: Cromolyn Sodium Inhalation Powder; Cromolyn Sodium Inhalation Solution; Cromolyn Sodium Nasal Solution; Cromolyn Sodium Ophthalmic Solution.

Proprietary Preparations

Arg.: Claroftal; Clo-5†; Intal; Klonalcrom; Sificrom†; Austral.: Cromese; Intal; Opticrom; Rynacrom; Austria: Acromax; Aeropaxyn†; Allergo-COMOD; Coldacrom; Cromal†; Cromoglin; Cromophtal; Intal; Lomusol; Vividrin; Belg.: Cromabak; Cromonez-Pos; Cromophta-Pos; Lomudal; Lomusol; Opticrom; Braz.: Cromabak; Cromocato; Cromolerg; Intal; Maxicrom; Rilan†; Canad.: Apo-Cromolyn; Cromolyn; Gen-Cromolyn†; Intal; Nalcrom; Opticrom; Solu-Crom; Chile: Oftacon; Cz.: Allergo-COMOD; Allergocrom; Cromobene; Cromogen†; Cromohexal; Cromolyn†; Cusicrom; DNCG†; Hay-Crom†; Intal†; Lecrolyn; Nalcrom; Stadaglicin†; SteriNeb Cromogen†; Vividrin†; Denm.: Hexacroman†; Lecrolyn; Lomudal; Fin.: Glinor; Lecrolyn; Lomudal; Fr.: Allergo-COMOD†; Alloptrex; Cromabak; Cromadoses; Cromoptic; Cromosoft†; Intercron; Lomudal; Lomusol; Multicrom; Nalcron†; Ophtacalm; Opticron; Ger.: Acecromol†; Alerg†; Allergo-COMOD; Allergocrom; Allergoval; Colimune; Crom-Ophtal; Cromo; Cromoglicin†; Cromohexal; Cromolind; Cromopp; Diffusyl; Dispacromil; DNCG; duracroman†; Fenistil†; Flenid†; Flui-DNCG; Intal; IsoCrom; Lomupren; Opticrom; Otriven H†; Padiacrom; Pentacrom†; Pentatop; Pulbil†; Siozwo Allerg†; Vividrin; Gr.: Allergojovis; Allergostop; Allergotin; Botastin; Crolidin†; Cromabak; Cromo-POS; Cromodal; Cromolergin UD; Duobetic†; Erystamine-K; Fluvet†; Indoprex†; Iopanchol; Kaosyl; Lomudal; Nalcrom; Spaziron; Ufocollyre; Vekfanol; Vividrin; Zineli; Zulboral; Hong Kong: Cromabak; Cromal; Intal†; Mitayaku; Opticrom†; Stadaglicin; Hung.: Cromohexal; Cromolyn†; Cusicrom†; Intal; Lecrolyn; Opticrom; Stadaglicin†; Taleum; India: Cromal; Fintal†; Indon.: Crom-Ophtal; Irl.: Cromogen; Hay-Crom; Intal; Nalcrom; Opticrom; Rynacrom; Vividrin; Israel: Cromogen†; Cromolyn; Cromoptic; Cronase; Lomudal; Opticrom; Vicrom; Ital.: Acticrom†; Brunicrom; Cromabak; Cromantal; Cromosan†; Frenal†; Gastrofrenal; Lomudal; Lomuspray†; Nalcrom; Sificrom; Jpn: Intal; Malaysia: Allergocrom†; Cusicrom; Intal†; Opticrom; Stadaglicin; Vividrin†; Mex.: Alercrom; Exaler†; Intal; Livari; Maxicrom; Oftacon†; Opticrom; Rynacrom; Spralyn; Mon.: Zallyre; Neth.: Allerg-Abak; Allergo-COMOD; Allergocrom†; Lomudal; Lomusol; Nalcrom; Opticrom; Otrivin hooikoorts†; Prevalin; Vividrin; Norw.: Lecrolyn; Lomudal; NZ: Cromolux; Intal; Nalcrom; Opticrom; Optrex Hayfever Allergy; Rynacrom; Vicrom; Philipp.: Cromabak; Lecrolyn; Vividrin; Pol.: Allergo-COMOD; Allergocrom; Cromogen; Cromohexal; Cromosol; Cromoxal; Cropoz G; Cusicrom; Lecrolyn; Nalcrom; Polcrom; Vividrin; Port.: Croglina; Cromabak; Cromex†; Cusicrom†; Davicrome; Fenolip; Intal; Opticrom; Rynacrom†; Rus.: Cromoglin (Кромоглин); Cromohexal (Кромогексал); Cropoz (Кропоз); Hay-Crom (Хай-кром); Ifiral (Ифирал); Intal (Интал); Lecrolyn (Лекролин); S.Afr.: Cromabak†; Cromohexal; Stop-Allerg; Vividrin†; Singapore: Cromabak; Intal; Opticrom; Rynacrom†; Sificrom†; Vividrin; Spain: Alergocrom; Cromo Asma†; Cusicrom; Farmacrom; Frenal; Gastrofrenal; Intal†; Nebulasma; Nebulcrom; Poledin†; Primover; Renocil; Rinilyn†; Rinofrenal; Swed.: Lecrolyn; Lomudal; Pollyferm; Rinil†; Switz.: Allergo-COMOD; Cromabak; Cromodyn; Cromosol ophta; Cromosol UD; Glicinal†; Lomudal; Lomusol; Nalcrom; Opticrom; Vividrin; Thai.: Intal; Lecrolyn†; Opticrom†; Rynacrom; Vividrin; Turk.: Allergo-COMOD; Allergocrom; Allersol; Intal; Opticrom; Rynacrom; UK: Clariteyes; Clarityn; Cromogen†; Hay-Crom; Hayfever Eye Drops; Intal; Nalcrom; Opticrom; Optrex Allergy; Pollenase Allergy; Rynacrom; Vivicrom; Vividrin; USA: Crolom; Gastrocrom; Intal; Nasalcrom; Opticrom; Venez.: Alergocrom†; Cromisol; Cromo-Spray†; Cromoftal; Maxicrom†. Multi-ingredient: Arg.: Duotec†; Hyalcrom; Rinogel; Austria: Ditec; Cz.: Allergocrom Kombi; Ditec†; Intal Plus†; Ger.: Aarane N; Allergospasmin; Ditec†; Lomupren compositum†; Hung.: Duotec†; India: Asthacrom; Ital.: Cromozil; Rinofrenal; Visuglican; Malaysia: Rynacrom Compound†; Port.: Rinoglin†; Rus.: Ditec (Дитек); Spain: Frenal Compositum; Rinofrenal Plus; Switz.: Aarane†; Allergospasmine†; Lomusol-X†; Thai.: Rynacrom Compound†; Turk.: Rynacrom Compound; UK: Rynacrom Compound†.
Published December 18, 2018.