101
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Misaka S, Shimomura K. Similar effect of quercetin on CYP2E1 and CYP2C9 activities in humans? Eur J Clin Pharmacol 2018; 74:1187-1188. [PMID: 29770840 DOI: 10.1007/s00228-018-2479-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/10/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Shingen Misaka
- Department of Pharmacology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan.
| | - Kenju Shimomura
- Department of Pharmacology, School of Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 960-1295, Japan
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Wu JJ, Zhu YF, Guo ZZ, Lou YM, He SG, Guan Y, Zhu LJ, Liu ZQ, Lu LL, Liu L. Aconitum alkaloids, the major components of Aconitum species, affect expression of multidrug resistance-associated protein 2 and breast cancer resistance protein by activating the Nrf2-mediated signalling pathway. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2018; 44:87-97. [PMID: 29277460 DOI: 10.1016/j.phymed.2017.12.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 11/02/2017] [Accepted: 12/06/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Aconitum alkaloids from Aconitum species are often used to treat arthritis and rheumatic diseases but have the drawback of high toxicity. Identifying their pharmacokinetic behaviour is important for the safe clinical application of Aconitum species. Efflux transporters (ETs), including P-glycoprotein (P-gp), multidrug resistance-associated protein 2 (MRP2), and breast cancer resistance protein (BCRP), have important functions in regulating the pharmacokinetic behaviours of drugs and in herb-herb or herb-drug interactions (HDIs). The Aconitum alkaloids regulate P-gp expression and function, but their effects on MRP2 and BCRP expression remain unknown. PURPOSE To determine the effects of three Aconitum alkaloids, aconitine (AC), benzoylaconine (BAC), and aconine, on MRP2 and BCRP. METHODS The levels of the protein and mRNA expression of MRP2 and BCRP in vivo and in vitro were measured via Western blotting and real-time PCR, respectively. Fluorescence signals of MRP2 and BCRP were detected via confocal fluorescence microscopy. A reporter assay using HepG2-C8 cells, which were generated by transfecting plasmids containing the antioxidant response element (ARE)-luciferin gene into HepG2 cells, was used to examine the ARE-luciferin activity. The transport activities of MRP2 and BCRP were tested via flow cytometry using substrate probes. RESULTS The Aconitum alkaloids significantly up-regulated MRP2 and BCRP expression, accompanied by a marked increase in nuclear factor E2-related factor-2 (Nrf2) expression in the jejunum, ileum, and colon of FVB mice, in the order AC < BAC < aconine. In the in vitro model, the Aconitum alkaloids increased MRP2 and BCRP expression in Caco-2 and LS174T cells, in the order AC < BAC < aconine. Additionally, these alkaloids promoted the translocation of Nrf2 from the cytoplasm to the nucleus and significantly increased ARE-luciferin activity in HepG2-C8 cells. Luteolin, a potent inhibitor of Nrf2, markedly prevented MRP2 and BCRP expression from being induced by the three Aconitum alkaloids. The efflux activity of MRP2 was also significantly increased in cells receiving the same treatment. CONCLUSIONS The tested Aconitum alkaloids significantly increased the expression of MRP2 and BCRP by activating the Nrf2-mediated signalling pathway and enhanced the efflux activity of MRP2. The potential for herb-herb interactions or HDIs exists when Aconitum species are co-administered with substrate drugs that are transported via MRP2 and BCRP. Therefore, the Aconitum alkaloids may be used as quality indicators for the herbs of Aconitum species.
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Affiliation(s)
- Jin-Jun Wu
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Yuan-Feng Zhu
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Zhen-Zhen Guo
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Yan-Mei Lou
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Shu-Gui He
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Yang Guan
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Li-Jun Zhu
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China
| | - Zhong-Qiu Liu
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China; State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau
| | - Lin-Lin Lu
- Interational Institute for Translational Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510006, China; State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau.
| | - Liang Liu
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau.
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103
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Waddington F, Naunton M, Kyle G, O Kane G, Cooper G, Thomas J. Australian pharmacists' knowledge of the efficacy and safety of complementary medicines. Aust J Prim Health 2018; 24:273-279. [PMID: 29735003 DOI: 10.1071/py17023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022]
Abstract
Global usage and expenditure on complementary medicines is increasing. Over 50% of consumers purchase these products from pharmacies and expect pharmacists to provide them with appropriate information regarding efficacy and safety of these products. Internationally, pharmacists have identified their lack of detailed knowledge of the efficacy and safety of these products as a barrier to recommending these products. Currently, little is known about the actual knowledge Australian pharmacists have of these products. This research seeks to determine Australian pharmacists' knowledge of the efficacy and safety of complementary medicines. An online survey was validated and distributed by three professional pharmacy bodies in Australia and online social media to survey Australian pharmacists' knowledge of a selection of complementary medicines that are defined as having therapeutic benefits as per the Australian Therapeutic Guidelines. In total, 535 complete surveys were returned and included in the final analysis. Surveys were predominantly completed by community pharmacists. The mean knowledge score obtained was 62%. There were no statistically significantly different results from pharmacists with a nutritional qualification. Australian pharmacists appear to have a basic knowledge of complementary medicines with a defined clinical effect. Specialised and targeted education focussing on relevant and efficacious complementary medicines with strong clinical evidence base is required.
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Affiliation(s)
- Freya Waddington
- Discipline of Pharmacy, University of Canberra, Bruce, ACT 2615, Australia
| | - Mark Naunton
- Discipline of Pharmacy, University of Canberra, Bruce, ACT 2615, Australia
| | - Greg Kyle
- School of Clinical Sciences, Queensland University of Technology, Brisbane, Qld 4000, Australia
| | - Gabrielle O Kane
- Health Research Institute, University of Canberra, Bruce, ACT 2615, Australia
| | - Gabrielle Cooper
- Discipline of Pharmacy, University of Canberra, Bruce, ACT 2615, Australia
| | - Jackson Thomas
- Discipline of Pharmacy, University of Canberra, Bruce, ACT 2615, Australia
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104
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Feinberg T, Jones DL, Lilly C, Umer A, Innes K. The Complementary Health Approaches for Pain Survey (CHAPS): Validity testing and characteristics of a rural population with pain. PLoS One 2018; 13:e0196390. [PMID: 29718951 PMCID: PMC5931640 DOI: 10.1371/journal.pone.0196390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/12/2018] [Indexed: 12/25/2022] Open
Abstract
Objectives Little is known about patterns and correlates of Complementary Health Approaches (CHAs) in chronic pain populations, particularly in rural, underserved communities. This article details the development and implementation of a new survey instrument designed to address this gap, the Complementary Health Approaches for Pain Survey (CHAPS). Design Following pilot-testing using pre-specified criteria to assess quality and comprehension in our target population, and after feedback regarding face-validity from content experts and stakeholders, the final cross-sectional self-report survey required 10–12 minutes to complete. It contained 69 demographic, lifestyle and health-related factors, and utilized a Transtheoretical Model (TTM) underpinning to assess short- and long-term use of 12 CHAs for pain management. Twenty additional items on pain severity, feelings, clinical outcomes, and activities were assessed using the Short-Form Global Pain Scale (SF-GPS); Internal reliability was assessed using Cronbach’s alpha. Settings/location Investigators conducted consecutive sampling in four West Virginia pain management and rheumatology practices. Participants 301 Appalachian adult patients seeking conventional care for pain management. Results Response rates were high (88% ± 4.1%). High quality and comprehension deemed the CHAPS an appropriate measurement tool in a rural population with pain. Missing data were unrelated to patient characteristics. Participants predominantly experienced chronic pain (93%), had five or more health conditions (56%, Mean = 5.4±3.1), were white (92%), female (57%), and middle-aged (Mean = 55.6 (SD = 13.6) years). Over 40% were disabled (43%) and/or obese (44%, Mean BMI = 33.4±31.5). Additionally, 44% used opioids, 31% used other prescription medications, and 66% used at least one CHA for pain, with 48% using CHAs for greater than 6 months. There was high internal reliability of the SF-GPS (alpha = .93) and satisfactory internal reliability for each of the five TTM stages across (all) twelve CHAs: precontemplation (0.89), contemplation (0.72), preparation (0.75), action (0.70), and maintenance (0.70). Conclusions The CHAPS is the first comprehensive measurement tool to assess CHA use specifically for pain management. Ease of administration in a population with pain support further use in population- and clinic-based studies in similar populations.
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Affiliation(s)
- Termeh Feinberg
- Department of Family and Community Medicine, Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
- * E-mail:
| | - Dina L. Jones
- Department of Orthopaedics, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Division of Physical Therapy, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Injury Control Research Center, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
| | - Christa Lilly
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
| | - Amna Umer
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Kim Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America
- Center for the Study of Complementary and Alternative Therapies, University of Virginia Health System, Charlottesville, Virginia, United States of America
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105
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Ricklefs I, Hohmann-Ebbers M, Herz A, Kopp MV. Use of complementary and alternative medicine in children with asthma. Pediatr Allergy Immunol 2018; 29:326-328. [PMID: 29336063 DOI: 10.1111/pai.12863] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Isabell Ricklefs
- Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Michelle Hohmann-Ebbers
- Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany
| | - Alexander Herz
- Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
| | - Matthias V Kopp
- Department of Pediatric Allergy and Pulmonology, Clinic of Pediatrics UKSH, University of Luebeck, Luebeck, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Grosshansdorf, Germany
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106
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Agbabiaka TB, Wider B, Watson LK, Goodman C. Concurrent Use of Prescription Drugs and Herbal Medicinal Products in Older Adults: A Systematic Review. Drugs Aging 2018; 34:891-905. [PMID: 29196903 PMCID: PMC5730633 DOI: 10.1007/s40266-017-0501-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background The use of herbal medicinal products (HMPs) is common among older adults; however, little is known about concurrent use with prescription drugs, as well as potential interactions associated with such combinations. Objective The aim of this systematic review was to identify and evaluate the literature on concurrent prescription and HMP use among older adults to assess prevalence, patterns, potential interactions and factors associated with this use. Methods Systematic searches were conducted in the MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, Web of Science and Cochrane databases from inception to May 2017 for studies reporting concurrent use of prescription medicines with HMPs in adults ≥ 65 years of age. Quality was assessed using the Joanna Briggs Institute checklists. And the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) three-stage approach to mixed method research was used to synthesise data. Results Twenty-two studies were included. A definition of HMPs or what was considered an HMP was frequently missing. Prevalence of concurrent use by older adults varied widely between 5.3 and 88.3%. Prescription medicines most combined with HMPs were antihypertensive drugs, β-blockers, diuretics, antihyperlipidemic agents, anticoagulants, analgesics, antihistamines, antidiabetics, antidepressants and statins. The HMPs most frequently used were Ginkgo biloba, garlic, ginseng, St John’s wort, Echinacea, saw palmetto, evening primrose oil and ginger. Potential risks of bleeding due to the use of Ginkgo biloba, garlic or ginseng with aspirin or warfarin was the most reported herb–drug interaction. Some data suggest being female, and having a lower household income and less than a high-school education were associated with concurrent use. Conclusion The prevalence of concurrent prescription drugs and HMP use among older adults is substantial and potential interactions have been reported. Knowledge of the extent and manner in which older adults combine prescription drugs will aid healthcare professionals in appropriately identifying and managing patients at risk. Systematic Review Registration Number: PROSPERO 2014:CRD42014009091. Electronic supplementary material The online version of this article (10.1007/s40266-017-0501-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Taofikat B Agbabiaka
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK. .,Patient Safety, Medical Directorate, NHS Improvement, London, UK.
| | - Barbara Wider
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Leala K Watson
- Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care (CRIPACC), University of Hertfordshire, Hatfield, UK
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107
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Berretta M, Della Pepa C, Tralongo P, Fulvi A, Martellotta F, Lleshi A, Nasti G, Fisichella R, Romano C, De Divitiis C, Taibi R, Fiorica F, Di Francia R, Di Mari A, Del Pup L, Crispo A, De Paoli P, Santorelli A, Quagliariello V, Iaffaioli RV, Tirelli U, Facchini G. Use of Complementary and Alternative Medicine (CAM) in cancer patients: An Italian multicenter survey. Oncotarget 2018; 8:24401-24414. [PMID: 28212560 PMCID: PMC5421857 DOI: 10.18632/oncotarget.14224] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 11/20/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction Complementary and Alternative Medicine (CAM) include a wide range of products (herbs, vitamins, minerals, and probiotics) and medical practices, developed outside of the mainstream Western medicine. Patients with cancer are more likely to resort to CAM first or then in their disease history; the potential side effects as well as the costs of such practices are largely underestimated. Patients and method We conducted a descriptive survey in five Italian hospitals involving 468 patients with different malignancies. The survey consisted of a forty-two question questionnaire, patients were eligible if they were Italian-speaking and receiving an anticancer treatment at the time of the survey or had received an anticancer treatment no more than three years before participating in the survey. RESULTS Of our patients, 48.9% said they use or have recently used CAM. The univariate analysis showed that female gender, high education, receiving treatment in a highly specialized institute and receiving chemotherapy are associated with CAM use; at the multivariate analysis high education (Odds Ratio, (OR): 1.96 95% Confidence Interval, CI, 1.27-3.05) and receiving treatment in a specialized cancer center (OR: 2.75 95% CI, 1.53-4.94) were confirmed as risk factors for CAM use. Conclusion Roughly half of our patients receiving treatment for cancer use CAM. It is necessary that health professional explore the use of CAM with their cancer patients, educate them about potentially beneficial therapies in light of the limited available evidence of effectiveness, and work towards an integrated model of health-care provision.
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Affiliation(s)
| | - Chiara Della Pepa
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Alberto Fulvi
- Department of Medicine and Surgery of Integrated Treatment, Division of Thoracic Oncology, "San Camillo Forlanini" Hospital, Rome, Italy
| | | | - Arben Lleshi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Guglielmo Nasti
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | | | - Carmela Romano
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Chiara De Divitiis
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Francesco Fiorica
- Department of Radiation Oncology University Hospital Ferrara, Division of Radiotherapy, "Arcispedale Sant'Anna" Hospital, Ferrara, Italy
| | - Raffaele Di Francia
- Department of Hematology, Istituto Nazionale Tumori 'Fondazione Giovanni Pascale', IRCCS, Naples, Italy.,Gruppo Oncologico Ricercatori Italiani, GORI, Pordenone, Italy
| | - Anna Di Mari
- Division of Medical Oncology, "Umberto I" Hospital, Syracuse, Italy
| | - Lino Del Pup
- Division of Gynaecological Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Anna Crispo
- Unit of Epidemiology, Struttura Complessa di Statistica Medica, Biometria e Bioinformatica, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
| | - Paolo De Paoli
- Scientific Directorate, National Cancer Institute, Aviano (PN), Italy
| | - Adriano Santorelli
- Department of Plastic Surgery, Regenerative Medicine, Health Park Hospital, Naples, Italy
| | - Vincenzo Quagliariello
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Rosario Vincenzo Iaffaioli
- Department of Abdominal Oncology, Division of Medical Oncology B, National Cancer Institute, "G. Pascale" Foundation, Naples, Italy
| | - Umberto Tirelli
- Department of Medical Oncology, National Cancer Institute, Aviano (PN), Italy
| | - Gaetano Facchini
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale", Naples, Italy
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108
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Singhal S, Roy V. Awareness, practice and views about integrating AYUSH in allopathic curriculum of allopathic doctors and interns in a tertiary care teaching hospital in New Delhi, India. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018. [PMID: 29526234 DOI: 10.1016/j.joim.2018.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the knowledge, attitude, perception and practice of Ayurveda, yoga, Unani, Siddha, homeopathy and naturopathy (AYUSH) among allopathic doctors and interns and determine their opinion regarding integration of AYUSH education within the allopathic curriculum. METHODS This prospective, cross sectional study was conducted in a tertiary care teaching Hospital, New Delhi, India, from March 2016 to March 2017. A survey of 500 allopathic doctors and 150 interns was performed using a structured questionnaire. RESULTS A majority of doctors (95.2%) were aware of the term AYUSH and had knowledge of yoga (70.6%), homeopathy (55.6%), Ayurveda (50.3%), Siddha (47.8%), naturopathy (32.9%) and Unani (28.9%). Most of the participants (63.0%) felt that therapies under AYUSH are effective. A majority (84.0%) of the doctors were of the view that more research is required in the field of AYUSH. While homeopathy (44.0%) was the most common system used by doctors for themselves, yoga was the therapy most commonly (60.0%) recommended to patients. Nearly half of the doctors (46.7%) recommended AYUSH to their patients, mainly for chronic illness (74.0%). A majority (77.5%) of the respondents agreed that students of allopathic medicine should be familiarized with AYUSH. The modes of incorporation of AYUSH into the medical curriculum most commonly suggested by respondents were optional courses (54.5%) and introductory lectures (42.3%). CONCLUSION Doctors and interns of allopathic medicine are aware of AYUSH systems. They use it for themselves and recommend it to patients. They believe that familiarization of Bachelor of Medicine and Bachelor of Surgery students with AYUSH therapies and their integration with allopathic medicine may help in improving patient care.
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Affiliation(s)
- Shubha Singhal
- Department of Pharmacology, Maulana Azad Medical College, New Delhi 110002, India
| | - Vandana Roy
- Department of Pharmacology, Maulana Azad Medical College, New Delhi 110002, India.
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109
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Perdigoto DN, Amaro P, Ferreira M, Tomé L. Flupirtine drug-induced liver injury in a patient developing acute liver failure. BMJ Case Rep 2018. [PMID: 29523613 DOI: 10.1136/bcr-2017-223329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A patient is admitted with complaints of recent onset nausea, discomfort, jaundice and blood tests that reveal severe hepatitis. At the time, she had been taking medication with Hypericum perforatum (St John's wort) for 6 months, and 6 weeks before this event, she took flupirtine maleate. A few days after being admitted, she developed encephalopathy progressing to acute liver failure (ALF) requiring unsuccessful liver transplantation. The patient was ultimately diagnosed with drug-induced liver injury (DILI). In this context, while H. perforatum could interfere with other medication or trigger DILI itself, flupirtine appears to have triggered the DILI, given its liver toxicity capacity. DILI is one of the major ALF causes and can jeopardise patient's life. Accordingly, all efforts to reduce medication potentially hazardous to the liver are recommended.
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Affiliation(s)
- David Noiva Perdigoto
- Department of Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Pedro Amaro
- Department of Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Manuela Ferreira
- Department of Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
| | - Luis Tomé
- Department of Gastroenterology, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal.,Faculty of Medicine, Coimbra University, Coimbra, Portugal
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110
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Yang L, Peng W, Adams J, Sibbritt DW. Treating people with arthritis with traditional Chinese medicine (TCM): an examination of the perception of TCM practitioners. Acupunct Med 2018. [PMID: 29519859 DOI: 10.1136/acupmed-2017-011527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Emerging evidence has shown that traditional Chinese medicine (TCM) has a positive effect on arthritis. This research provides the first critical, systematic examination of TCM practitioners' perceptions of TCM use for people with arthritis. METHODS An online survey was distributed to all TCM professionals including acupuncturists and Chinese herbal medicine practitioners registered with the Practitioner Research and Collaborate Initiative (PRACI) practitioner database. The survey questions focus on practitioner characteristics, practice characteristics and clinical management approaches regarding arthritis care. RESULTS The survey attracted a response rate of 53% (n=52). The average age of the respondents was 49.9 years, more than half were female, and the majority held a bachelor degree or higher qualification. More than two thirds of TCM practitioners in our study worked with other health professionals, while they had a high level of referral relationships with a wide range of conventional, allied health and complementary and alternative medicine (CAM) providers. Most of the TCM practitioners reported that their patients with arthritis used other treatments alongside TCM and a large number of the TCM practitioners who participated believed that TCM was effective for treating arthritis. CONCLUSIONS The TCM profession represents a substantial component of the healthcare field in Australia, and treating patients with arthritis appears to be an important area of TCM practice, among others. Further detailed research is needed to help ensure effective, safe patient care for those with arthritis who may be utilising TCM alongside a broader range of conventional medicine, allied health, and other CAM treatments.
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Affiliation(s)
- Lu Yang
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Wenbo Peng
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - Jon Adams
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
| | - David William Sibbritt
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), Faculty of Health, University of Technology Sydney, Broadway, New South Wales, Australia
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111
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Gong EC, Chea S, Balupuri A, Kang NS, Chin YW, Choi YH. Enzyme Kinetics and Molecular Docking Studies on Cytochrome 2B6, 2C19, 2E1, and 3A4 Activities by Sauchinone. Molecules 2018; 23:molecules23030555. [PMID: 29498658 PMCID: PMC6017976 DOI: 10.3390/molecules23030555] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 02/06/2023] Open
Abstract
Sauchinone, an active lignan isolated from the aerial parts of Saururus chinensis (Saururaceae), exhibits anti-inflammatory, anti-obesity, anti-hyperglycemic, and anti-hepatic steatosis effects. As herb–drug interaction (HDI) through cytochrome P450s (CYPs)-mediated metabolism limits clinical application of herbs and drugs in combination, this study sought to explore the enzyme kinetics of sauchinone towards CYP inhibition in in vitro human liver microsomes (HLMs) and in vivo mice studies and computational molecular docking analysis. In in vitro HLMs, sauchinone reversibly inhibited CYP2B6, 2C19, 2E1, and 3A4 activities in non-competitive modes, showing inhibition constant (Ki) values of 14.3, 16.8, 41.7, and 6.84 μM, respectively. Also, sauchinone time-dependently inhibited CYP2B6, 2E1 and 3A4 activities in vitro HLMs. Molecular docking study showed that sauchinone could be bound to a few key amino acid residues in the active site of CYP2B6, 2C19, 2E1, and 3A4. When sibutramine, clopidogrel, or chlorzoxazone was co-administered with sauchinone to mice, the systemic exposure of each drug was increased compared to that without sauchinone, because sauchinone reduced the metabolic clearance of each drug. In conclusion, when sauchinone was co-treated with drugs metabolized via CYP2B6, 2C19, 2E1, or 3A4, sauchinone–drug interactions occurred because sauchinone inhibited the CYP-mediated metabolic activities.
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Affiliation(s)
- Eun Chae Gong
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Satya Chea
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Anand Balupuri
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon 305-764, Korea; (A.B.); (N.S.K)
| | - Nam Sook Kang
- Graduate School of New Drug Discovery and Development, Chungnam National University, Daejeon 305-764, Korea; (A.B.); (N.S.K)
| | - Young-Won Chin
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
| | - Young Hee Choi
- College of Pharmacy and Intergrated Research Institute for Drug Development, Dongguk University-Seoul, 32 Dongguk-lo, Ilsandong-gu, Goyang, Gyeonggi-do 10326, Korea; (E.C.G.); (S.C.); (Y.-W.C.)
- Correspondence: ; Tel.: +82-31-961-5212
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Inhibitory Influence of Panax notoginseng Saponins on Aspirin Hydrolysis in Human Intestinal Caco-2 Cells. Molecules 2018; 23:molecules23020455. [PMID: 29463025 PMCID: PMC6016969 DOI: 10.3390/molecules23020455] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/15/2018] [Accepted: 02/15/2018] [Indexed: 01/18/2023] Open
Abstract
Herb-drug interactions are important safety concerns in clinical practice. The interactions occur firstly in the intestinal absorption for orally administered drugs. Aspirin and Panax notoginseng saponins (PNS)-based drugs are often combined in China to prevent larger-artery atherosclerosis. Here, we aimed to characterize the aspirin transport across Caco-2 cell monolayers, a model of the intestinal absorption, and further to evaluate the influence of PNS on aspirin hydrolysis and the relating mechanisms. Transcellular transport of aspirin and the influence of PNS were explored using Caco-2 cell monolayers. The protein expression of human carboxylesterase 1 (hCE1) and hCE2 in Caco-2 cells after PNS treatment was analyzed by ELISA, and the mRNA level were determined by qRT-PCR. In the study, Caco-2 cells showed high level of hydrolase activity, and most aspirin was hydrolyzed inside the cells during the transport process. Interestingly, PNS were demonstrated to inhibit the esterase activities responsible for aspirin hydrolysis in Caco-2 cells. PNS could also decrease the protein expression of hCE1 and hCE2, whereas exhibited minor effect on the mRNA expression. These results indicated that oral administration of PNS-based drugs might inhibit the hydrolysis of aspirin during intestinal absorption thus promoting its bioavailability.
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Conte-Schmidt N, Cruz-Rivera O. Concurrent use of herbal supplements and prescription drugs in northeastern Puerto Rico. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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James PB, Kamara H, Bah AJ, Steel A, Wardle J. Herbal medicine use among hypertensive patients attending public and private health facilities in Freetown Sierra Leone. Complement Ther Clin Pract 2018; 31:7-15. [PMID: 29705483 DOI: 10.1016/j.ctcp.2018.01.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/21/2017] [Accepted: 01/03/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study aimed to determine the prevalence, determinants and pattern of herbal medicine use among hypertensive patients in Freetown. METHODS AND MATERIALS We conducted a cross-sectional study among hypertensive patients attending public and private health facilities in Freetown, Sierra Leone between August and October 2016. We analyzed the data using SPSS version 24. We used Chi-square, Fisher exact two-tailed test and regression analysis for data analysis. A p-value less than 0.05 was considered statistically significant. RESULTS Out of 260 study participants, over half (n = 148, 56.9%) reported using herbal medicine for the treatment of hypertension alone or together with comorbid condition(s). The most commonly used herbal medicine among users were honey (n = 89, 33.3%), moringa (n = 80, 30.0%) and garlic (n = 73, 27.3%). No significant difference existed between users and non-users of herbal medicine with regards to socio-demographic and health-related factors. The majority (n = 241, 92.7%) of respondents considered herbal medicine beneficial if it was recommended by a healthcare provider yet 85.1% (n = 126) did not disclose their herbal medicine use to their health care provider. CONCLUSION There is a high use of herbal medicines among hypertensive patients in Freetown, Sierra Leone. It is essential for healthcare providers to take heed of the findings of this study and routinely ask their patients about their herbal medicine use status. Such practice will provide the opportunity to discuss the benefits and risks of herbal medicine use with the aim of maximizing patient desired therapeutic outcomes.
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Affiliation(s)
- Peter Bai James
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia; Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Halimatu Kamara
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Abdulai Jawo Bah
- Faculty of Pharmaceutical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone; Faculty of Basic Medical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
| | - Amie Steel
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia; Endeavour College of Natural Health, 269 Wickham St, Fortitude Valley, Brisbane, QLD 4006, Australia.
| | - Jon Wardle
- Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW 2007, Australia.
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Wang Z, Hwang SH, Zuo G, Kim SB, Lim SS. An in vitro affinity-based method for studying herb–drug interactions for direct identification of cytochrome P450 1A2, 3A4, and 2C9 specific ligands from herbal extracts using ultrafiltration-high performance liquid chromatography. RSC Adv 2018; 8:8944-8949. [PMID: 35539875 PMCID: PMC9078662 DOI: 10.1039/c7ra12161j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/20/2018] [Indexed: 12/25/2022] Open
Abstract
The specific ligands in natural product extracts could be identified from a multi-target system by ultrafiltration-high performance liquid chromatography using competitive probes.
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Affiliation(s)
- Zhiqiang Wang
- College of Public Health
- Hebei University
- Baoding
- China
- Department of Food Science and Nutrition
| | - Seung Hwan Hwang
- Department of Food Science and Nutrition
- Hallym University
- Chuncheon
- Republic of Korea
| | - Guanglei Zuo
- Department of Food Science and Nutrition
- Hallym University
- Chuncheon
- Republic of Korea
| | - Set Byeol Kim
- Department of Food Science and Nutrition
- Hallym University
- Chuncheon
- Republic of Korea
| | - Soon Sung Lim
- Department of Food Science and Nutrition
- Hallym University
- Chuncheon
- Republic of Korea
- Institute of Korea Nutrition
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Yurdakok-Dikmen B, Turgut Y, Filazi A. Herbal Bioenhancers in Veterinary Phytomedicine. Front Vet Sci 2018; 5:249. [PMID: 30364115 PMCID: PMC6191517 DOI: 10.3389/fvets.2018.00249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 09/18/2018] [Indexed: 12/21/2022] Open
Abstract
Herbal bioenhancers are active phytomolecules that increase the bioavailability, bioefficacy and biological activity of various drugs when coadministered at low concentrations. These valuable compounds reduce the dose, increase the treatment rate, decrease the treatment duration, drug resistance or related adverse reactions which have economical implications in livestock and pet medicine. Eventhough the concept of herbal bioenhancers are known for years through Ayurvedic medicine, the underlying mechanisms remains unclear. The main mechanisms involved are related to drug absorption (effect on solubility, drug efflux and transport proteins, increased permeability in gastrointestinal system) and drug metabolism (inhibition/induction of drug metabolysing enzymes, thermogenic effect). Due to species specific differences in these mechanisms, corresponding data on human and laboratory animal could not be attributed. As multidrug resistance is a major treat to both human and animal health, within "One Health" concept, efficient therapeutical strategies are encouraged by authorities, where focus on herbal supplements as a vast unexploited field remains to be researched within "Bioenhancement Concept." This review brings insight to mechanims involved in bioenhancing effect, examples of herbal extracts and phytoactive compounds and their potential in the veterinary medicine including different classes of drugs such as antibiotics, anticancerous, antiviral, and antituberculosis.
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Felicilda-Reynaldo RF, Choi S. U.S. Filipino Adults' Patterns of CAM Use and Medical Pluralism: Secondary Analysis of 2012 National Health Interview Survey. Asian Pac Isl Nurs J 2018; 3:93-104. [PMID: 31037259 PMCID: PMC6482519 DOI: 10.31372/20180303.1003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The cultural health beliefs of the Filipino population and colonial history of medicine in the Philippines could mean high use of complementary and alternative therapies (CAM) and increased engagement in medical pluralism (i.e., combined use of conventional medicine and CAM) among the U.S. Filipino population, the fourth largest immigrant group in the United States. However, there is limited research regarding U.S. Filipinos’ health behaviors related to CAM use and medical pluralism engagement. The purpose of this study was to explore patterns of CAM use and medical pluralism practices of Filipino adults living in the United States. Data from Filipino adult respondents of the 2012 National Health Interview Survey adult CAM supplement were analyzed to determine most common CAM used, most common conditions for which CAM was used as a treatment, reasons for using CAM for treatment of health conditions, and sources of recommendations for CAM as a treatment in this population. Dietary supplements were the most common CAM used by Filipino adults living in the United States. A small number of U.S. Filipino adults reported using CAM to treat pain-related and cardiovascular conditions, with the most common source of recommendations coming from friends and family members. Most common reasons for using CAM for treatment of health condition were: CAM is natural; CAM had a holistic approach, and CAM could be taken/practiced independently. Based on the findings of the study, Filipino adults living in the United States engage in a pluralistic approach to health by using CAM for treatment of health conditions. Analysis of the 2012 NHIS adult CAM supplement provided an overview of Filipino adults’ patterns of CAM use and medical pluralism; however, future research is still needed to explain such health behavior patterns.
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Affiliation(s)
| | - Soyung Choi
- University of Hawaii, John A. Burns School of Medicine, Honolulu, Hawaii, USA
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Zhang Y, Miao L, Lin L, Ren CY, Liu JX, Cui YM. Repeated administration of Sailuotong, a fixed combination of Panax ginseng, Ginkgo biloba, and Crocus sativus extracts for vascular dementia, alters CYP450 activities in rats. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2018; 38:125-134. [PMID: 29425645 DOI: 10.1016/j.phymed.2017.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 02/14/2017] [Accepted: 02/24/2017] [Indexed: 05/10/2023]
Abstract
BACKGROUND Sailuotong (SLT) is a standard Chinese preparation made from extracts of Panax ginseng (ginseng), Ginkgo biloba (ginkgo), and Crocus sativus (saffron). Preliminary clinical trials and animal experiments have demonstrated that SLT could improve cognition of vascular dementia (VD). PURPOSE To avoid incident drug-drug interaction which is easily encountered in patients of VD, the potential influence of SLT on main drug-metabolic cytochromes P450 enzymes (CYP450) was investigated. METHOD A "cocktail probes" approach was employed to evaluate the activities of CYP450. A rapid and selective analysis method was developed to examine 5 CYP probe drugs and their specific metabolites in plasma by using online SPE followed by a single LC-MS/MS run. After pretreatment for 2 weeks with SLT, ginseng, gingko, saffron or water (control), a cocktail solution containing caffeine, losartan, omeprazole, dextromethorphan and midazolam was given to rats orally. The plasma was obtained at different time intervals and then measured for the concentration of probes and their metabolites using developed SPE-LC-MS/MS method. Activity of five isozymes was estimated by comparing plasma pharmacokinetics of substrates and their metabolites (caffeine/paraxanthine for CYP1A2, losartan/E-3174 for CYP2C11, omeprazole/5-hydroxyl omeprazole for CYP2C6, dextromethorphan/dextrophan for CYP2D2 and midazolam/1-hydroxyl midazolam for CYP3A1/2) between control and drug treatment groups. RESULT Compared with control group, repeated administration of SLT induced CYP1A2 by enhancing AUC paraxanthine / AUC caffeine to144%. The influence is attributed to its herbal component of ginseng to a large extent. Meanwhile, metabolic ability towards losartan was significantly elevated in SLT and gingko group by 31% and 25% respectively, indicating weak induction of CYP2C11 in rats. The analysis on probes of omeprazole and dextromethorphan showed a lack of influence on CYP 2C6 and CYP2D2 in all treated groups. In terms of CYP3A1/2, SLT decreased AUC ratio of 1-hydroxyl midazolam to midazolam by 39% and extended the half-life of midazolam apparently. Besides, significantly decreased systematic exposure of midazolam suggested the inhibition on metabolism of CYP3A1/2 is likely secondary to the interaction on absorption at intestinal level. The inhibition of SLT on CYP3A was likely attributed to ginseng and gingko cooperatively. CONCLUSION Further observation on herb-drug interaction should be considered during clinical application of SLT.
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Affiliation(s)
- Ying Zhang
- School of Pharmaceutical Sciences, Peking University, Beijing 100191, PR China; Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing key laboratory of pharmacology of Chinese material medica, Beijing 10091, PR China
| | - Lan Miao
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing key laboratory of pharmacology of Chinese material medica, Beijing 10091, PR China
| | - Li Lin
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing key laboratory of pharmacology of Chinese material medica, Beijing 10091, PR China
| | - Chang-Ying Ren
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing key laboratory of pharmacology of Chinese material medica, Beijing 10091, PR China
| | - Jian-Xun Liu
- Institute of Basic Medical Sciences of Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing key laboratory of pharmacology of Chinese material medica, Beijing 10091, PR China.
| | - Yi-Min Cui
- School of Pharmaceutical Sciences, Peking University, Beijing 100191, PR China.
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Ramos-Hryb AB, Cunha MP, Kaster MP, Rodrigues ALS. Natural Polyphenols and Terpenoids for Depression Treatment: Current Status. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/b978-0-444-64068-0.00006-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
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Arif T, Dorjay K, Adil M. Silymarin: An interesting modality in dermatological therapeutics. Indian J Dermatol Venereol Leprol 2018; 84:238-243. [DOI: 10.4103/ijdvl.ijdvl_746_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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122
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Andrew R, Izzo AA. Principles of pharmacological research of nutraceuticals. Br J Pharmacol 2017; 174:1177-1194. [PMID: 28500635 DOI: 10.1111/bph.13779] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
LINKED ARTICLES This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.
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Affiliation(s)
- Ruth Andrew
- Centre for Cardiovascular Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - Angelo A Izzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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McLay JS, Izzati N, Pallivalapila AR, Shetty A, Pande B, Rore C, Al Hail M, Stewart D. Pregnancy, prescription medicines and the potential risk of herb-drug interactions: a cross-sectional survey. Altern Ther Health Med 2017; 17:543. [PMID: 29258478 PMCID: PMC5738179 DOI: 10.1186/s12906-017-2052-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 12/07/2017] [Indexed: 12/27/2022]
Abstract
Background Pregnant women are routinely prescribed medicines while self-medicating with herbal natural products to treat predominantly pregnancy related conditions. The aim of this study was to assess the potential for herb-drug interactions (HDIs) in pregnant women and to explore possible herb-drug interactions and their potential clinical significance. Methods A cross-sectional survey of women during early pregnancy or immediately postpartum in North-East Scotland. Outcome measures included; Prescription medicines use excluding vitamins and potential HDIs assessed using Natural Medicines Comprehensive Database. Results The survey was completed by 889 respondents (73% response rate). 45.3% (403) reported the use of at least one prescription medicine, excluding vitamins. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). A total of 91 different prescription medicines were reported by respondents using HNPs. Of those taking prescription medicines, 44.9% (181) also reported concurrent use of at least one HNP (Range 1–12). Thirty-four herb-drug interactions were identified in 23 (12.7%) women with the potential to increase the risk of postpartum haemorrhage, alter maternal haemodynamics, and enhance maternal/fetal CNS depression. Almost all were rated as moderate (93.9%), one as a potentially major (ginger and nifedipine) and only one minor (ondansetron and chamomile). Conclusion Almost half of pregnant women in this study were prescribed medicines excluding vitamins and minerals and almost half of these used HNPs. Potential moderate to severe HDIs were identified in an eighth of the study cohort. Healthcare professionals should be aware that the concurrent use of HNPs and prescription medicines during pregnancy is common and carries potential risks.
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Biggs JM, Morgan JA, Lardieri AB, Kishk OA, Klein-Schwartz W. Abuse and Misuse of Selected Dietary Supplements Among Adolescents: a Look at Poison Center Data. J Pediatr Pharmacol Ther 2017; 22:385-393. [PMID: 29290737 DOI: 10.5863/1551-6776-22.6.385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The use of dietary supplements has increased and is associated with adverse effects. Indications for use include recreation, body image concerns, mood enhancement, or control of medical conditions. The risk of adverse effects may be enhanced if agents are used improperly. The objective of this study was to determine the frequency of abuse and misuse of 4 dietary substances among adolescents reported nationally to poison centers. Secondary outcomes included an assessment of medical outcomes, clinical effects, location of treatments provided, and treatments administered. METHODS This descriptive retrospective review assessed data concerning the use of garcinia (Garcinia cambogia), guarana (Paullinia cupana), salvia (Salvia divinorum), and St John's wort (Hypericum perforatum) among adolescents reported nationally to poison centers from 2003 to 2014. Adolescents with a singlesubstance exposure to one of the substances of interest coded as intentional abuse or misuse were included. Poison center calls for drug information or those with unrelated clinical effects were excluded. Data were collected from the National Poison Data System. RESULTS There were 84 cases: 7 cases of Garcinia cambogia, 28 Paullinia cupana, 23 Salvia divinorum, and 26 Hypericum perforatum. Garcinia cambogia was used more frequently by females (100% versus 0%), and Paullinia cupana and Salvia divinorum were used more frequently by males (61% versus 36% and 91% versus 9%, respectively). Abuse, driven by Salvia divinorum, was more common overall than misuse. Abuse was also more common among males than females (p <0.001). Use of these agents fluctuated over time. Overall, use trended down since 2010, except for Garcinia cambogia use. In 62 cases (73.8%), the medical outcome was minor or had no effect or was judged as nontoxic or minimally toxic. Clinical effects were most common with Paullinia cupana and Salvia divinorum. Treatment sites included emergency department (n = 33; 39.3%), non-healthcare facility (n = 24; 28.6%), admission to a health care facility (n = 8; 9.5%), and other/unknown (n = 19; 22.6%). CONCLUSIONS Abuse and misuse of these dietary supplements was uncommon, and outcomes were mild. Further research should be performed to determine use and outcomes of abuse/misuse of other dietary supplements in this population.
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Affiliation(s)
- Jessica M Biggs
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Jill A Morgan
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Allison B Lardieri
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Omayma A Kishk
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
| | - Wendy Klein-Schwartz
- Department of Pharmacy (JMB, OAK), University of Maryland Medical Center, Baltimore, Maryland; Department of Pharmacy Practice and Science (JAM, ABL, WKS), University of Maryland School of Pharmacy, Baltimore, Maryland; and (WKS) Maryland Poison Center, Baltimore, Maryland
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An Investigation of the Use of Traditional Chinese Medicine and Complementary and Alternative Medicine in Stroke Patients. Holist Nurs Pract 2017; 31:400-407. [PMID: 29028779 DOI: 10.1097/hnp.0000000000000238] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study aimed to investigate the use of traditional Chinese medicine and complementary and alternative medicine in stroke patients in Taiwan. Chinese herbal medicine, massage, acupuncture, natural products, and exercise were widely used among stroke patients. Integrating safe and effective traditional Chinese medicine and complementary and alternative medicine into conventional therapies is suggested.
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Al-Enazi NM, Awaad AS, Alqasoumi SI, Alwethairi MF. Biological activities of the red algae Galaxaura rugosa and Liagora hawaiiana butters. Saudi Pharm J 2017; 26:25-32. [PMID: 29379330 PMCID: PMC5783822 DOI: 10.1016/j.jsps.2017.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 11/12/2017] [Indexed: 11/29/2022] Open
Abstract
The biological activities; antimicrobial, antioxidant and anticancer, of the red algae Galaxaura rugosa and Liagora hawaiiana were determined. The total ethanol, lipoidal matters, chloroform, n-butanol, aqueous extracts and powder of both algae showed and bacterial and antifungal activities. However, the chloroform extract of Galaxaura rugosa showed antibacterial activity against Klebsiella pneumoniae (24 mm, 0.15 mg/ml) higher than gentamycin (23 mm, 0.49 mg/ml). Moreover, the total ethanol, lipoidal matter and chloroform extracts showed antifungal activity (21, 22 and 25 mm, 1.25, 0.312 and 0.156 mg/ml) similar to the antibiotic Ketoconazole activity (23, 24 and 27 mm, 1.25, 0.312 and 0.156 mg/ml) against Aspergillus fumigatus, A. niger and Candida trobicalis, respectively. A good antioxidant activity (80.96%, IC50 = 27.8 µg/ml) was provided by Galaxaura rugosa. The anticancer activity results revealed that the lipoidal matters of Galaxaura rugosa and Liagora hawaiiana possessed antitumor activity (IC50 = 15 ± 1.7 and 21.2 ± 1.6, respectively) against lung carcinoma (A-549) better than vinblastine sulfate (IC50 = 24.6 ± 0.7). Although, the lipoidal matters of Galaxaura rugosa and Liagora hawaiiana antitumor activity against cervical carcinoma (HeLa) and intestinal carcinoma (CACO-2) (IC50 = 10.2 ± 0.6 and 12.2 ± 0.6, respectively) preferable than vinblastine sulfate (IC50 = 59.7 ± 2.1 and 30.3 ± 1.4, respectively).
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Affiliation(s)
- Nouf M Al-Enazi
- Biology Department, College of Science and Humanity Studies, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Amani S Awaad
- Pharmacognosy Department, College of Pharmacy, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Saleh I Alqasoumi
- Pharmacognosy Department, College of Pharmacy, King Saud University, Saudi Arabia
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Suttorp M, Bornhäuser M, Metzler M, Millot F, Schleyer E. Pharmacology and pharmacokinetics of imatinib in pediatric patients. Expert Rev Clin Pharmacol 2017; 11:219-231. [PMID: 29076384 DOI: 10.1080/17512433.2018.1398644] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The tyrosine kinase inhibitor (TKI) imatinib was rationally designed to target BCR-ABL1 which is constitutively activated in chronic myeloid leukemia (CML). Following the tremendous success in adults, imatinib also became licensed for treatment of CML in minors. The rarity of pediatric CML hampers the conduction of formal trials. Thus, imatinib is still the single TKI approved for CML treatment in childhood. Areas covered: This review attempts to provide an overview of the literature on pharmacology, pharmacokinetic, and pharmacogenetic of imatinib concerning pediatric CML treatment. Articles were identified through a PubMed search and by reviewing abstracts from relevant hematology congresses. Additional information was provided from the authors' libraries and expertise and from our own measurements of imatinib trough plasma levels in children. Pharmacokinetic variables (e.g. alpha 1-acid glycoprotein binding, drug-drug/food-drug interactions via cytochrome P450 3A4/5, cellular uptake mediated via OCT-1-influx variations and P-glycoprotein-mediated drug efflux) still await to be addressed in pediatric patients systematically. Expert commentary: TKI response rates vary among different individuals and pharmacokinetic variables all can influence CML treatment success. Adherence to imatinib intake may be the most prominent factor influencing treatment outcome in teenagers thus pointing towards the potential benefits of regular drug monitoring.
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Affiliation(s)
- Meinolf Suttorp
- a Pediatric Hematology and Oncology , University Hospital 'Carl Gustav Carus' , Dresden , Germany
| | - Martin Bornhäuser
- b I. Medical Clinic , University Hospital 'Carl Gustav Carus' , Dresden , Germany
| | - Markus Metzler
- c Department of Paediatrics and Adolescent Medicine , University Hospital Erlangen , Erlangen , Germany
| | - Frédéric Millot
- d Pediatric Oncology Unit , CIC 802 INSERM, University Hospital , Poitiers , France
| | - Eberhard Schleyer
- b I. Medical Clinic , University Hospital 'Carl Gustav Carus' , Dresden , Germany
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Chen YJ, Tsai TH, Wang LY, Hsieh CH. Local Radiotherapy Affects Drug Pharmacokinetics-Exploration of a Neglected but Significant Uncertainty of Cancer Therapy. Technol Cancer Res Treat 2017; 16:705-716. [PMID: 29332468 PMCID: PMC5762083 DOI: 10.1177/1533034617737011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Concurrent chemoradiation therapy is the mainstay of treatment for many types of malignancies. However, concurrent chemoradiation therapy is associated with a greater number of systemic adverse effects than radiotherapy or chemotherapy alone. Summary: Pharmacokinetics is the study of a drug and/or its metabolite kinetics in the body, including absorption, distribution, metabolism, and elimination. The incidences of adverse effects are markedly higher in patients who receive concurrent chemoradiation therapy than in those who receive either radiotherapy or chemotherapy alone. This phenomenon implies that irradiation affects the pharmacokinetics of cytotoxic agents, namely the radiotherapy–pharmacokinetic phenomenon. Experimental animal studies have shown that local irradiation affects the systemic pharmacokinetics of 5-fluorouracil and cisplatin at both low dose (simulating generous dose distributed to normal tissues) and daily practice dose (mimicking therapeutic dose to target volumes). These effects are significant in the circulation of blood and lymphatic system as well as in the hepatobiliary excretion. Furthermore, recent studies have demonstrated that matrix metalloproteinase-8 plays an important role in the radiotherapy–pharmacokinetic phenomenon. Conclusion: In the present review, we provide a general overview of the radiotherapy–pharmacokinetic phenomenon and discuss the possible mechanisms governing the phenomenon.
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Affiliation(s)
- Yu-Jen Chen
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiation Oncology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medical Research, Mackay Memorial Hospital, Taipei, Taiwan
| | - Tung-Hu Tsai
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Chemical Engineering, National United University, Miaoli, Taiwan
| | - Li-Ying Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.,Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Hsi Hsieh
- Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Radiation Oncology, Department of Radiology, Far Eastern Memorial Hospital, Taipei, Taiwan
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129
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Nounou MI, Ko Y, Helal NA, Boltz JF. Adulteration and Counterfeiting of Online Nutraceutical Formulations in the United States: Time for Intervention? J Diet Suppl 2017; 15:789-804. [PMID: 29020476 DOI: 10.1080/19390211.2017.1360976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Global prevalence of nutraceuticals is noticeably high. The American market is flooded with nutraceuticals claiming to be of natural origin and sold with a therapeutic claim by major online retail stores such as Amazon and eBay. The objective of this commentary is to highlight the possible problems of online-sold nutraceuticals in the United States with respect to claim, adulterants, and safety. Furthermore, there is a lack of strict regulatory laws governing the sales, manufacturing, marketing, and label claims of nutraceutical formulations currently sold in the U.S. market. Major online retail stores and Internet pharmacies aid the widespread sale of nutraceuticals. Finally, according to the literature, many of these products were found to be either counterfeit or adulterated with active pharmaceutical ingredients (API) and mislabeled as being safe and natural. Therefore, regulatory authorities along with the research community should intervene to draw attention to these products and their possible effects.
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Affiliation(s)
- Mohamed Ismail Nounou
- a Department of Pharmaceutical Sciences, School of Pharmacy , University of Saint Joseph (USJ) , Hartford , USA.,b Department of Pharmaceutical Sciences , Appalachian College of Pharmacy , Oakwood , USA
| | - Yamin Ko
- b Department of Pharmaceutical Sciences , Appalachian College of Pharmacy , Oakwood , USA
| | - Nada A Helal
- c Department of Pharmaceutics, Faculty of Pharmacy , Alexandria University , Egypt
| | - Jeremy F Boltz
- b Department of Pharmaceutical Sciences , Appalachian College of Pharmacy , Oakwood , USA
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Choi S, Oh DS, Jerng UM. A systematic review of the pharmacokinetic and pharmacodynamic interactions of herbal medicine with warfarin. PLoS One 2017; 12:e0182794. [PMID: 28797065 PMCID: PMC5552262 DOI: 10.1371/journal.pone.0182794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 07/25/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study was to systematically review data regarding pharmacokinetic (PK)-pharmacodynamic (PD) parameters from randomized controlled trials relating to interactions between herbal medicines and warfarin. Methods Three electronic databases were searched to identify relevant trials. Two reviewers independently performed the study selection and data extraction. The risk of bias and reporting quality were also assessed independently by two reviewers using the Cochrane risk of bias tool and the consolidated standards of reporting trials (CONSORT). Outcomes were measured for all reported PK-PD parameters and adverse events. Results Nine randomized controlled trials met our inclusion criteria. Most of the included studies were unclear regarding the risk of bias and had a low quality of methodology. Using CONSORT, the reporting percentages for the articles ranged from 36.5% to 61.5% and the mean percentage for all articles was 45.6%. St John’s wort and echinacea affected the PK parameters of warfarin. Ginseng, ginger, garlic, and cranberry had no significant effect on the PK parameters. American ginseng altered the PD parameters of warfarin. St John’s wort, ginseng, Korea red ginseng, ginkgo, ginger, garlic, aged garlic, and echincea did not significantly alter the PD parameters. Studies of ginkgo and cranberry showed conflicting results on the PK parameters and PD parameters, respectively. The incidence of adverse events in all trials was low and no major adverse events were reported. Conclusions It was difficult to determine whether ten herbal medicines had significant effects on the PK-PD parameters of warfarin. Low quality of evidence, different compounds within and different compositions of the herbs, and methodological limitations of the crossover study, which is a clinical study in which subjects receive a sequence of different interventions, made it difficult to form conclusions. Additional studies that remedy these vulnerabilities are necessary to verify these results.
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Affiliation(s)
- Songie Choi
- The K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Dal-Seok Oh
- The K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ui Min Jerng
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- * E-mail:
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Complementary and Alternative Medicine: Italian Validation of a Questionnaire on Nurses' Personal and Professional Use, Knowledge, and Attitudes. J Nurs Meas 2017; 25:292-304. [PMID: 28789752 DOI: 10.1891/1061-3749.25.2.292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients are showing an increasing interest in the use of complementary and alternative medicine (CAM). Most nurses are open to the adoption of CAM into clinical nursing practice, but they may experience a lack of knowledge about the safe and effective use of these therapies. Several studies concerning nurses' knowledge and attitudes toward CAM have been published, but only in one, the authors (Shorofi and Arbon) used a validated questionnaire. In Italy, there are no validated questionnaires to investigate this aspect of nursing practice. PURPOSE To test the psychometric properties of the Italian Shorofi and Arbon questionnaire for use with Italian nurses. METHODS A forward-backward translation method was used to translate the questionnaire from English to Italian. Content validity, face validity and reliability were established. RESULTS AND CONCLUSIONS This study examined the potential usefulness of the Shorofi and Arbon questionnaire for the evaluation of CAM knowledge of Italian speaking nurses, which showed good content validity and good reliability.
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132
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Liperoti R, Vetrano DL, Bernabei R, Onder G. Herbal Medications in Cardiovascular Medicine. J Am Coll Cardiol 2017; 69:1188-1199. [PMID: 28254182 DOI: 10.1016/j.jacc.2016.11.078] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 10/11/2016] [Accepted: 11/07/2016] [Indexed: 01/01/2023]
Abstract
Herbal medications are commonly used for clinical purposes, including the treatment of cardiovascular conditions. Compared with conventional medications, herbal medications do not require clinical studies before their marketing or formal approval from regulatory agencies, and for this reason their efficacy and safety are rarely proven. In this review, we summarize available evidence on herbal medications mostly used in cardiovascular medicine. We show that the use of these medications for the treatment of cardiovascular diseases is often not supported by scientific evidence. Despite most of these herbs showing an effect on biological mechanisms related to the cardiovascular system, data on their clinical effects are lacking. Potential relevant side effects, including increased risk of drug interactions, are described, and the possibility of contamination or substitution with other medications represents a concern. Physicians should always assess the use of herbal medications with patients and discuss the possible benefits and side effects with them.
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Affiliation(s)
- Rosa Liperoti
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Davide L Vetrano
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Roberto Bernabei
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Graziano Onder
- Department of Geriatrics, Neurosciences and Orthopaedics, A. Gemelli University Hospital, Università Cattolica del Sacro Cuore, Rome, Italy.
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Kampouraki E, Kamali F. Dietary implications for patients receiving long-term oral anticoagulation therapy for treatment and prevention of thromboembolic disease. Expert Rev Clin Pharmacol 2017. [PMID: 28635328 DOI: 10.1080/17512433.2017.1345622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The effectiveness of oral anticoagulation therapy with warfarin (a vitamin K antagonist) in the treatment of thromboembolic disease, including stroke prophylaxis in patients with atrial fibrillation is well recognised. However, warfarin has a narrow therapeutic window and an unpredictable anticoagulation response, which make it difficult to achieve and maintain optimal anticoagulation. Various dietary factors, including sudden changes in eating patterns, can significantly alter anticoagulation control, thereby potentially exposing patients to the risk of bleeding or thromboembolic complications. Dietary vitamin K intake is a particularly important factor, given the mechanism of action of warfarin. Areas covered: In this article, we cover the sources of vitamin K and their potential effect of dietary vitamin K on anticoagulation response to warfarin. We also discuss the results of studies on the effect of vitamin K supplementation on anticoagulation stability. Expert commentary: A stable dietary vitamin K, promoted by daily oral vitamin K supplementation, can improve anticoagulation stability in patients on warfarin therapy. There is experimental evidence in animals that dietary vitamin K affects anticoagulation response to the direct thrombin inhibitor, ximelagatran. Whether dietary vitamin K affects anticoagulation response to the currently licensed direct oral anticoagulants (DOACs) in man remains to be investigated.
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Affiliation(s)
| | - Farhad Kamali
- a Institute of Cellular Medicine , Newcastle University , Newcastle upon Tyne , UK
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134
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Herbal and Alternative Medicine Use in Tanzanian Adults Admitted with Hypertension-Related Diseases: A Mixed-Methods Study. Int J Hypertens 2017. [PMID: 28634545 PMCID: PMC5467304 DOI: 10.1155/2017/5692572] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Hypertension is increasingly common in sub-Saharan Africa where traditional medicine use is also common. We conducted a hospital-based, mixed-methods study to determine prevalence, pattern, and correlates of herbal and alternative medicine use in Tanzanian adults hospitalized with hypertension. Methods A standardized questionnaire was administered. In-depth interviews were performed on a subset of participants. Factors associated with herbal medicine use were determined by logistic regression. The association between traditional medicine uses and allopathic medication adherence was determined using ordinal logistic regression. Qualitative data were analyzed according to grounded theory. Results Of 213 adults enrolled, 52 (24.4%) reported using herbs during the previous month and 47 (22.1%) reported concurrent use of herbs and allopathic medicines. Lower educational level, nonprofessional employment, and lack of health insurance were significantly associated with herbal medicine use. Alternative medicines use was not associated with lower medication adherence. Qualitative interviews identified several important themes including reasons for herbal medicine use. Conclusion The use of traditional medicines is very common among patients with hypertension. Adults from low socioeconomic status, those with misunderstandings about hypertension, and those without health insurance were more likely to take herbs. Open, nonjudgmental communication between healthcare workers and patients regarding use of traditional medicines must be encouraged in Africa.
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135
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Christensen CM, Morris RS, Kapsandoy SC, Archer M, Kuang J, Shane-McWhorter L, Bray BE, Zeng-Treitler Q. Patient needs and preferences for herb-drug-disease interaction alerts: a structured interview study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:272. [PMID: 28526079 PMCID: PMC5438528 DOI: 10.1186/s12906-017-1630-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 02/08/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND While complementary and alternative medicine (CAM) is commonly used in the United States and elsewhere, and hazardous interactions with prescription drugs can occur, patients do not regularly communicate with physicians about their CAM use. The objective of this study was to discover patient information needs and preferences for herb-drug-disease interaction alerts. METHODS We recruited 50 people from several locations within the University of Utah Hospital to participate in this structured interview study. They were asked to provide their preferences for the herb-drug-disease interaction alerts. Qualitative methods were used to reveal the themes that emerged from the interviews. RESULTS Most participants reported they had previously used, or they were currently using, CAM therapies. The majority had made the effort to inform their healthcare provider(s) about their CAM usage, although some had not. We found that most respondents were interested in receiving alerts and information about potential interactions. Many preferred to receive the alerts in a variety of ways, both in person and electronically. CONCLUSIONS In addition to conventional medicine, many patients regularly use complementary and alternative therapies. And yet, communication between patients and providers about CAM use is not consistent. There is a demand for interventions in health care that provide timely, integrative communication support. Delivering the herb-drug-disease alerts through multiple channels could help meet critical patient information needs.
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136
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Deng Y, Wang Y, Sun L, Lu P, Wang R, Ye L, Xu D, Ye R, Liu Y, Bi S, Gooneratne R. Biotransformation enzyme activities and phase I metabolites analysis in Litopenaeus vannamei following intramuscular administration of T-2 toxin. Drug Chem Toxicol 2017; 41:113-122. [DOI: 10.1080/01480545.2017.1320407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Yijia Deng
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Yaling Wang
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Lijun Sun
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Pengli Lu
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Rundong Wang
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Lin Ye
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Defeng Xu
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Riying Ye
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Ying Liu
- College of Food Science and Technology, Guangdong Ocean University, Guangdong Provincial Key Laboratory of Aquatic Product Processing and Safety, Key Laboratory of Advanced Processing of Aquatic Products of Guangdong Higher Education Institution, Zhanjiang, China
| | - Siyuan Bi
- Shenzhen Bioeasy Biotechnologies Co, Shenzhen, China
| | - Ravi Gooneratne
- Department of Wine, Food and Molecular Biosciences, Centre for Food Research and Innovation, Lincoln University, Lincoln, New Zealand
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Lee G, Bae H. Therapeutic Effects of Phytochemicals and Medicinal Herbs on Depression. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6596241. [PMID: 28503571 PMCID: PMC5414506 DOI: 10.1155/2017/6596241] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 01/21/2023]
Abstract
Background. Depression is a recurrent, common, and potentially life-threatening psychiatric disease related to multiple assignable causes. Although conventional antidepressant therapy can help relieve symptoms of depression and prevent relapse of the illness, complementary therapies are required due to disadvantage of the current therapy such as adverse effects. Moreover, a number of studies have researched adjunctive therapeutic approaches to improve outcomes for depression patients. Purpose. One potential complementary method with conventional antidepressants involves the use of medicinal herbs and phytochemicals that provide therapeutic benefits. Studies have revealed beneficial effects of medical herbs and phytochemicals on depression and their central nervous system mechanism. Here, we summarize the current knowledge of the therapeutic benefits of phytochemicals and medicinal herbs against depression and describe their detailed mechanisms. Sections. There are two sections, phytochemicals against depression and medical herbs against depression, in this review. Conclusion. Use of phytomedicine may be an alternative option for the treatment of depression in case conventional drugs are not applicable due to their side effects, low effectiveness, or inaccessibility. However, the efficacy and safety of these phytomedicine treatments for depression have to be supported by clinical studies.
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Affiliation(s)
- Gihyun Lee
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
- Department of Research and Development, National Development Institute of Korean Medicine, 94 Hwarang-ro, Gyeongsan-si, Gyeongsangbuk-do 38540, Republic of Korea
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University, 26 Kyunghee-daero, Dongdaemun-gu, Seoul 02447, Republic of Korea
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Shih CC, Huang LH, Yeh CC, Lane HL, Hsieh CJ, Tsai CC, Lin LW, Chen TL, Liao CC. The prevalence, characteristics, and factors associated with purchasing Chinese herbal medicine among adults in Taiwan. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:169. [PMID: 28347338 PMCID: PMC5369211 DOI: 10.1186/s12906-017-1679-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/11/2017] [Indexed: 02/05/2023]
Abstract
Background The objective of this study was to investigate the prevalence and factors associated with purchasing Chinese herbal medicine (CHM) without a physician’s prescription among adults. Methods Using data from the 2005 National Health Interview Survey and National Health Insurance, we identified 16,756 individuals aged 20 years and older. Socio-demographic factors, lifestyle, medical services utilization and health behaviors were compared between people with and without a history of purchasing CHM by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) in a multiple logistic regression analysis. Results The one-month prevalence of purchasing CHM without a physician’ prescription was 5.2% in Taiwan. People more likely to purchase CHM included people aged ≥70 years (OR 2.84, 95% CI 2.03-3.99), women (OR 1.28, 95% CI 1.11-1.48), non-indigenous people (OR 2.61, 95% CI 1.29–5.30), and people with an illness not receiving medical care (OR 2.69, 95% CI 2.19-3.31). Conclusion The prevalence of purchasing CHM without a physician’s prescription is high in Taiwan and is correlated with factors such as socio-demographics, disease history, and behaviors surrounding the utilization of medical care.
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139
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Chiba T, Sato Y, Kobayashi E, Ide K, Yamada H, Umegaki K. Behaviors of consumers, physicians and pharmacists in response to adverse events associated with dietary supplement use. Nutr J 2017; 16:18. [PMID: 28315635 PMCID: PMC5357328 DOI: 10.1186/s12937-017-0239-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/07/2017] [Indexed: 12/26/2022] Open
Abstract
Background The prevalence of dietary supplements has increased in Japan, and, as a consequence, the adverse events associated with dietary supplement use have become more prominent. Severe adverse events must be reported to the Japanese government via public health centers. However, the number of cases reported to the Japanese government is limited. To clarify this discrepancy, we conducted an internet questionnaire, and surveyed how consumers, physicians and pharmacists acted when they or their patients developed adverse events due to dietary supplement use. Methods This study was completed by 2732 consumers, 515 physicians, and 515 pharmacist via internet surveillance on November 2015. Results Although 8.8% of consumers developed adverse events including diarrhea, constipation, stomachache, headache, and nausea and vomiting, most of them did not report their adverse events to public health centers. However, some consumers went to hospitals because of adverse events. We also surveyed how physicians and pharmacists acted when their patients developed adverse events due to dietary supplement use. Most physicians and pharmacists did not report these cases to public health centers because they were unable to definitively prove the cause-and-effect relationship of these adverse events. Furthermore, some physicians and pharmacists did not know how or where to report these adverse events. Conclusions We clarified the reasons for the limited number of reports of adverse events to the Japanese government in this survey. It is important to encourage not only consumers, but also physicians and pharmacists to report adverse events to public health centers. In addition, an analyzing tool of cause-and-effect relationships might be helpful for physicians and pharmacists. Electronic supplementary material The online version of this article (doi:10.1186/s12937-017-0239-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tsuyoshi Chiba
- Information Center, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.
| | - Yoko Sato
- Information Center, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Etsuko Kobayashi
- Information Center, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Kazuki Ide
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Hiroshi Yamada
- Department of Drug Evaluation & Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan
| | - Keizo Umegaki
- Information Center, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
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Pannu T, Sharkey S, Burek G, Cretu D, Hill MD, Hogan DB, Poulin MJ. Medication use by middle-aged and older participants of an exercise study: results from the Brain in Motion study. Altern Ther Health Med 2017; 17:105. [PMID: 28187744 PMCID: PMC5303244 DOI: 10.1186/s12906-017-1595-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/20/2017] [Indexed: 12/18/2022]
Abstract
Background Over the past 50 years, there has been an increase in the utilization of prescribed, over-the-counter (OTC) medications, and natural health products. Although it is known that medication use is common among older persons, accurate data on the patterns of use, including the quantity and type of medications consumed in a generally healthy older population from a Canadian perspective are lacking. In this study, we study the pattern of medication use in a sedentary but otherwise healthy older persons use and determined if there was an association between medication use and aerobic fitness level. Methods All participants enrolled in the Brain in Motion study provided the name, formulation, dosage and frequency of any medications they were consuming at the time of their baseline assessment. Maximal aerobic capacity (VO2max) was determined on each participant. Results Two hundred seventy one participants (mean age 65.9 ± 6.5 years; range 55–92; 54.6% females) were enrolled. Most were taking one or more (1+) prescribed medication (n = 204, 75.3%), 1+ natural health product (n = 221, 81.5%) and/or 1+ over-the-counter (OTC) drug (n = 174, 64.2%). The most commonly used prescribed medications were HMG-CoA reductase inhibitors (statins) (n = 52, 19.2%). The most common natural health product was vitamin D (n = 201, 74.2%). For OTC drugs, non-steroidal anti-inflammatories (n = 82, 30.3%) were the most common. Females were more likely than males to take 1+ OTC medications, as well as supplements. Those over 65 years of age were more likely to consume prescription drugs than their counterparts (p ≤ 0.05). Subjects taking more than two prescribed or OTC medications were less physically fit as determined by their VO2max. The average daily Vitamin D intake was 1896.3 IU per participant. Conclusions Medication use was common in otherwise healthy older individuals. Consumption was higher among females and those older than 65 years. Vitamin D intake was over two-fold higher than the recommended 800 IU/day for older persons, but within the tolerable upper intake of 4,000 IU/day. The appropriateness of the high rate of medication use in this generally healthy population deserves further investigation.
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141
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Turkanovic J, Ward MB, Gerber JP, Milne RW. Effect of Garlic, Gingko, and St. John's Wort Extracts on the Pharmacokinetics of Fexofenadine: A Mechanistic Study. Drug Metab Dispos 2017; 45:569-575. [PMID: 28188296 DOI: 10.1124/dmd.116.073528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 02/06/2017] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to determine the effects of garlic and ginkgo herbal extracts on the pharmacokinetics of the P-glycoprotein (P-gp)/organic anion-transporting polypeptides (Oatps) substrate fexofenadine. Male rats were dosed orally with garlic (120 mg/kg), ginkgo (17 mg/kg), St. John's wort (SJW; 1000 mg/kg; positive control), or Milli-Q water for 14 days. On day 15, rats either were administered fexofenadine (orally or i.v.), had their livers isolated and perfused with fexofenadine, or had their small intestines divided into four segments (SI-SIV) and analyzed for P-gp and Oatp1a5. In vivo, SJW increased the clearance of i.v. administered fexofenadine by 28%. Garlic increased the area under the curve0-∞ and maximum plasma concentration of orally administered fexofenadine by 47% and 85%, respectively. Ginkgo and SJW had no effect on the oral absorption of fexofenadine. In the perfused liver, garlic, ginkgo, and SJW increased the biliary clearance of fexofenadine with respect to perfusate by 71%, 121%, and 234%, respectively. SJW increased the biliary clearance relative to the liver concentration by 64%. The ratio of liver to perfusate concentrations significantly increased in all treated groups. The expression of Oatp1a5 in SI was increased by garlic (88%) and SJW (63%). There were no significant changes in the expression of P-gp. Induction of intestinal Oatp1a5 by garlic may explain the increased absorption of orally administered fexofenadine. Ginkgo had no effect on the expression of intestinal P-gp or Oatp1a5. A dual inductive effect by SJW on opposing intestinal epithelial transport by Oatp1a5 and P-gp remains a possibility.
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Affiliation(s)
- Jasmina Turkanovic
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Michael B Ward
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Jacobus P Gerber
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
| | - Robert W Milne
- School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
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142
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Di Minno A, Frigerio B, Spadarella G, Ravani A, Sansaro D, Amato M, Kitzmiller JP, Pepi M, Tremoli E, Baldassarre D. Old and new oral anticoagulants: Food, herbal medicines and drug interactions. Blood Rev 2017; 31:193-203. [PMID: 28196633 DOI: 10.1016/j.blre.2017.02.001] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 02/02/2017] [Indexed: 12/21/2022]
Abstract
The most commonly prescribed oral anticoagulants worldwide are the vitamin K antagonists (VKAs) such as warfarin. Factors affecting the pharmacokinetics of VKAs are important because deviations from their narrow therapeutic window can result in bleedings due to over-anticoagulation or thrombosis because of under-anticoagulation. In addition to pharmacodynamic interactions (e.g., augmented bleeding risk for concomitant use of NSAIDs), interactions with drugs, foods, herbs, and over-the-counter medications may affect the risk/benefit ratio of VKAs. Direct oral anticoagulants (DOACs) including Factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and thrombin inhibitor (dabigatran) are poised to replace warfarin. Phase-3 studies and real-world evaluations have established that the safety profile of DOACs is superior to those of VKAs. However, some pharmacokinetic and pharmacodynamic interactions are expected. Herein we present a critical review of VKAs and DOACs with focus on their potential for interactions with drugs, foods, herbs and over-the-counter medications.
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Affiliation(s)
| | | | - Gaia Spadarella
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy.
| | | | | | - Mauro Amato
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy.
| | - Elena Tremoli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
| | - Damiano Baldassarre
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
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143
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Cytochrome P450 and P-Glycoprotein-Mediated Interactions Involving African Herbs Indicated for Common Noncommunicable Diseases. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:2582463. [PMID: 28250793 PMCID: PMC5307007 DOI: 10.1155/2017/2582463] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/26/2016] [Accepted: 01/04/2017] [Indexed: 12/26/2022]
Abstract
Herbal remedies are regularly used to complement conventional therapies in the treatment of various illnesses in Africa. This may be because they are relatively cheap and easily accessible and are believed by many to be safe, cause fewer side effects, and are less likely to cause dependency. On the contrary, many herbs have been shown to alter the pharmacokinetics of coadministered allopathic medicines and can either synergize or antagonize therapeutic effects as well as altering the toxicity profiles of these drugs. Current disease burden data point towards epidemiological transitions characterised by increasing urbanization and changing lifestyles, risk factors for chronic diseases like hypertension, diabetes, and cancer which often present as multimorbidities. As a result, we highlight African herb-drug interactions (HDIs) modulated via cytochrome P450 enzyme family (CYP) and P-glycoprotein (P-gp) and the consequences thereof in relation to antihypertensive, antidiabetic, and anticancer drugs. CYPs are enzymes which account for to up to 70% of drug metabolism while P-gp is an efflux pump that extrudes drug substrates out of cells. Consequently, regulation of the relative activity of both CYP and P-gp by African herbs influences the effective drug concentration at the site of action and modifies therapeutic outcomes.
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144
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Amano H, Kazamori D, Itoh K. Evaluation of the Effects of S-Allyl-L-cysteine, S-Methyl-L-cysteine, trans-S-1-Propenyl-L-cysteine, and Their N-Acetylated and S-Oxidized Metabolites on Human CYP Activities. Biol Pharm Bull 2017; 39:1701-1707. [PMID: 27725449 DOI: 10.1248/bpb.b16-00449] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Three major organosulfur compounds of aged garlic extract, S-allyl-L-cysteine (SAC), S-methyl-L-cysteine (SMC), and trans-S-1-propenyl-L-cysteine (S1PC), were examined for their effects on the activities of five major isoforms of human CYP enzymes: CYP1A2, 2C9, 2C19, 2D6, and 3A4. The metabolite formation from probe substrates for the CYP isoforms was examined in human liver microsomes in the presence of organosulfur compounds at 0.01-1 mM by using liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis. Allicin, a major component of garlic, inhibited CYP1A2 and CYP3A4 activity by 21-45% at 0.03 mM. In contrast, a CYP2C9-catalyzed reaction was enhanced by up to 1.9 times in the presence of allicin at 0.003-0.3 mM. SAC, SMC, and S1PC had no effect on the activities of the five isoforms, except that S1PC inhibited CYP3A4-catalyzed midazolam 1'-hydroxylation by 31% at 1 mM. The N-acetylated metabolites of the three compounds inhibited the activities of several isoforms to a varying degree at 1 mM. N-Acetyl-S-allyl-L-cysteine and N-acetyl-S-methyl-L-cysteine inhibited the reactions catalyzed by CYP2D6 and CYP1A2, by 19 and 26%, respectively, whereas trans-N-acetyl-S-1-propenyl-L-cysteine showed weak to moderate inhibition (19-49%) of CYP1A2, 2C19, 2D6, and 3A4 activities. On the other hand, both the N-acetylated and S-oxidized metabolites of SAC, SMC, and S1PC had little effect on the reactions catalyzed by the five isoforms. These results indicated that SAC, SMC, and S1PC have little potential to cause drug-drug interaction due to CYP inhibition or activation in vivo, as judged by their minimal effects (IC50>1 mM) on the activities of five major isoforms of human CYP in vitro.
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Affiliation(s)
- Hirotaka Amano
- Drug Discovery Laboratory, Wakunaga Pharmaceutical Co., Ltd
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145
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Fan Y, He L, Zhang R. Classification of Use Status for Dietary Supplements in Clinical Notes. PROCEEDINGS. IEEE INTERNATIONAL CONFERENCE ON BIOINFORMATICS AND BIOMEDICINE 2017; 2016:1054-1061. [PMID: 28824824 DOI: 10.1109/bibm.2016.7822668] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Clinical notes contain rich information about dietary supplements, which are critical for detecting signals of dietary supplement side effects and interactions between drugs and supplements. One of the important factors of supplement documentation is usage status, such as started and discontinuation. Such information is usually stored in the unstructured clinical notes. We developed a rule-based classifier to identify supplement usage status in clinical notes. The categories referring to the patient's status of supplement use were classified into four classes: Continuing (C), Discontinued (D), Started (S), and Unclassified (U). Clinical notes containing 10 of the most commonly consumed supplements (i.e., alfalfa, echinacea, fish oil, garlic, ginger, ginkgo, ginseng, melatonin, St. John's Wort, and Vitamin E) were retrieved from the University of Minnesota Clinical Data Repository. The gold standard was defined by manually annotating 1000 randomly selected sentences or statements mentioning at least one of these 10 supplements. The rules in the classifier was initially developed on two-thirds of the set of 7 supplements (i.e., alfalfa, garlic, ginger, ginkgo, ginseng, St. John's Wort, and Vitamin E); the performance was evaluated on the remaining one-third of this set. To evaluate the generalizability of rules, we further validated the second testing set on other 3 supplements (i.e., echinacea, fish oil, and melatonin). The performance of the classifier achieved F-measures of 0.95, 0.97, 0.96, and 0.96 for status C, D, S, and U on 7 supplements, respectively. The classifier also showed good generalizability when it was applied to the other 3 supplements with F-measures of 0.96 for C, 0.96 for D, 0.95 for S, and 0.89 for U. This study demonstrated that the classifier can accurately classify supplement usage status, which can be further integrated as a module into the existing natural language processing pipeline for supporting dietary supplement knowledge discovery.
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Affiliation(s)
- Yadan Fan
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Lu He
- Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN, USA
| | - Rui Zhang
- Institute for Health Informatics, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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146
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Yun Y, Son J, Kim K, Jang BH, Choi I, Ko SG. Effectiveness and safety of combination treatment of herbal medicines and oral antihistamines for atopic dermatitis: a retrospective chart review. Integr Med Res 2017; 6:19-25. [PMID: 28462140 PMCID: PMC5395680 DOI: 10.1016/j.imr.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/07/2016] [Accepted: 01/09/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with atopic dermatitis (AD) exhibit various symptoms, especially itching. Recently, herbal medicines (HMs) are being used in combination with antihistamines for the treatment of AD in Korea. While oral antihistamines can alleviate itching, HMs appear to exert anti-inflammatory effects with minimal side effects. However, there is little evidence regarding the effectiveness and safety of using HMs in combination with antihistamines for AD. METHODS To observe the effectiveness and safety of combination treatment with HMs and antihistamines, we performed a retrospective chart review of inpatients with AD who received this combination treatment for at least 7 days in a hospital. RESULTS Of 163 inpatients, 40 met the inclusion criteria. All patients received HMs three times, and one or two antihistamines, a day after HM intake. A large proportion of patients received first-generation antihistamines. HMs comprised a mixture of an average of 20.69 different herbs in decoction. The mean total, objective, and subjective SCORing Atopic Dermatitis scores showed a significant decrease after combination treatment. Changes in the mean levels of aspartate transaminase, alanine transaminase, blood urea nitrogen, and creatinine were not statistically significant among treatments. There were no adverse events of pseudoaldosteronism or interstitial pneumonia. CONCLUSION We observed that the short-term use of HMs in combination with oral antihistamines was safe and effective, with a low risk of adverse reactions. This study was limited by its retrospective design, and prospective studies with long-term follow-up periods are warranted to further elucidate the safety of this combination treatment for AD.
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Affiliation(s)
- Younghee Yun
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Jaewoong Son
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Kyuseok Kim
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Bo-Hyeong Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Inhwa Choi
- Department of Ophthalmology, Otorhinolaryngology and Dermatology of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Seong-Gyu Ko
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
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147
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Ferreira ICFR, Martins N, Barros L. Phenolic Compounds and Its Bioavailability: In Vitro Bioactive Compounds or Health Promoters? ADVANCES IN FOOD AND NUTRITION RESEARCH 2017; 82:1-44. [PMID: 28427530 DOI: 10.1016/bs.afnr.2016.12.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Botanical preparations present a widespread and secular history of use. In fact, natural matrices possess a rich pool of phytochemicals, with promising biological effects. Among them, phenolic compounds have revealed to confer very important attributes to improve the well-being and longevity of worldwide population. Numerous in vitro studies have been carried out evaluating the wide spectrum of bioactivities of phenolic compounds, including its health effects, but through in vivo experiments some of these previous results cannot be properly confirmed, and considerable variations are observed. Pharmacokinetic parameters, including the assessment of bioavailability and bioefficacy of phenolic compounds, still continue to be largely investigated and considered a great hot topic among the food science and technology researchers. Thus, based on these crucial aspects, this chapter aims to provide an extensive approach about the question of the bioavailability of phenolic compounds, describing its biosynthetic routes and related mechanisms of action; to focus on the current facts and existing controversies, highlighting the importance of in vivo studies and the impact of phenolic compounds on the quality of life and longevity.
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Affiliation(s)
- Isabel C F R Ferreira
- Mountain Research Centre (CIMO), ESA, Polytechnic Institute of Bragança, Bragança, Portugal.
| | - Natália Martins
- Mountain Research Centre (CIMO), ESA, Polytechnic Institute of Bragança, Bragança, Portugal
| | - Lillian Barros
- Mountain Research Centre (CIMO), ESA, Polytechnic Institute of Bragança, Bragança, Portugal
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148
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Kesavadev J, Saboo B, Sadikot S, Das AK, Joshi S, Chawla R, Thacker H, Shankar A, Ramachandran L, Kalra S. Unproven Therapies for Diabetes and Their Implications. Adv Ther 2017; 34:60-77. [PMID: 27864668 PMCID: PMC5216071 DOI: 10.1007/s12325-016-0439-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Indexed: 12/11/2022]
Abstract
Diabetes is a chronic disease and is one of the leading causes of morbidity and mortality worldwide. Being an ancient disease, many individuals follow complementary and alternative medicinal (CAM) therapies for either the cure or prevention of the disease. The popularity of these practices among the general public is in no way a testimony to their safety and efficacy. Due to the possibility of undesirable interactions with conventional medicines, it is imperative that patients are asked about CAM use during patient assessment. Patient- and physician-targeted awareness programs on various aspects of CAM use must be initiated to create a better understanding of evidence-based use of these practices. In addition, there should be guidelines in place based on clinical trial outcomes, and stricter regulations need to be enforced on CAM practices to ensure their safety and effectiveness.
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Affiliation(s)
| | - Banshi Saboo
- Dia Care and Hormone Clinic, Ahmedabad, Gujarat, India
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ashok Kumar Das
- Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Shashank Joshi
- Department of Diabetology, Lilavati Hospital and Research Centre, Mumbai, India
| | | | - Hemant Thacker
- Department of Endocrinology, Bhatia Hospital, Mumbai, India
| | - Arun Shankar
- Jothydev's Diabetes Research Centre, Trivandrum, Kerala, India
| | | | - Sanjay Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, Haryana, India
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149
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Abstract
A number of drugs have been withdrawn from the market or severely restricted in their use because of unexpected toxicities that become apparent only after the launch of new drug entities. Circumstantial evidence suggests that, in most cases, reactive metabolites are responsible for these unexpected toxicities. In this review, a general overview of the types of reactive metabolites and the consequences of their formation are presented. The current approaches to evaluate bioactivation potential of new compounds with particular emphasis on the advantages and limitation of these procedures will be discussed. Reasonable reasons for the excellent safety record of certain drugs susceptible to bioactivation will also be explored and should provide valuable guidance in the use of reactive-metabolite assessments when nominating drug candidates for development. This will, in turn, help us to design and bring safer drugs to the market.
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Affiliation(s)
- Sabry M Attia
- Department of Pharmacology and Toxicology; College of Pharmacy; King Saud University; Riyadh, Saudi Arabia.
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150
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Berry-Bibee EN, Kim MJ, Tepper NK, Riley HEM, Curtis KM. Co-administration of St. John's wort and hormonal contraceptives: a systematic review. Contraception 2016; 94:668-677. [PMID: 27444983 PMCID: PMC11283811 DOI: 10.1016/j.contraception.2016.07.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 07/13/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVES St. John's wort (SJW) is a known strong inducer of the cytochrome P450 (CYP) 3 A4 enzyme, and both the ethinyl estradiol and progestin components of hormonal contraceptives are substrates of CYP3A4. This systematic review examined whether the co-administration of SJW and hormonal contraceptives leads to significant safety or efficacy concerns. STUDY DESIGN Systematic review. METHODS PubMed and Cochrane Library databases were searched for articles of any comparative study design (clinical or pharmacokinetic) that examined potential interactions between SJW and hormonal contraceptives in women of reproductive age. RESULTS Of the 48 identified articles, four studies met inclusion criteria and compared use of combined oral contraceptives (COCs) alone to the use of COCs co-administered with SJW. Two studies demonstrated no change in markers of ovulation, but one study demonstrated increased follicular growth and probable ovulation when COCs were co-administered with SJW. Three studies demonstrated an increased risk of breakthrough bleeding with COCs and SJW. Three studies showed changes in at least one pharmacokinetic parameter that suggested a significantly decreased exposure to hormone concentrations when COCs were co-administered with SJW. The only study that did not demonstrate any significant pharmacokinetic differences examined a SJW product containing a low amount of hypericin. CONCLUSION Limited evidence showing increased risk of ovulation and breakthrough bleeding raises concern for decreased contraceptive efficacy when COCs are co-administered with SJW. The pharmacokinetic evidence is mixed but suggests that SJW administration may be associated with weak to moderate induction of the metabolism of COCs.
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Affiliation(s)
- Erin N Berry-Bibee
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Myong-Jin Kim
- Office of Clinical Pharmacology, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Naomi K Tepper
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Halley E M Riley
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kathryn M Curtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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