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Dores AR, Peixoto M, Castro M, Sá C, Carvalho IP, Martins A, Maia E, Praça I, Marques A. Knowledge and Beliefs about Herb/Supplement Consumption and Herb/Supplement-Drug Interactions among the General Population, including Healthcare Professionals and Pharmacists: A Systematic Review and Guidelines for a Smart Decision System. Nutrients 2023; 15:nu15102298. [PMID: 37242184 DOI: 10.3390/nu15102298] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/03/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
The increased consumption of a variety of herbs/supplements has been raising serious health concerns. Owing to an inadequate understanding of herb/supplement-drug interactions, the simultaneous consumption of these products may result in deleterious effects and, in extreme cases, even fatal outcomes. This systematic review is aimed at understanding the knowledge and beliefs about the consumption of herbs/supplements and herb/drug-supplement interactions (HDIs). The study follows the PRISMA guidelines. Four online databases (Web of Science; PubMed; Cochrane; and EBSCOhost) were searched, and a total of 44 studies were included, encompassing 16,929 participants. Herb and supplement consumption is explained mostly by the reported benefits across multiple conditions and ease of use. Regarding HDIs, most people take both herbs/supplements and prescription drugs simultaneously. Only a small percentage of participants have knowledge about their interaction effects, and many reported adverse interactions or side effects. Nevertheless, the main reason for stopping the prescribed drug intake is the perceived lack of its effect, and not due to interactions. Therefore, it is important to increase the knowledge about supplement use so that further strategies can be elaborated to better detect or be alert for whenever a potentially dangerous reaction and/or interaction may occur. This paper raises awareness regarding the need for developing a decision support system and ends with some considerations about the development of a technological solution capable of detecting HDIs and, thereby, aiding in the improvement of pharmacy services.
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Affiliation(s)
- Artemisa R Dores
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Miguel Peixoto
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Maria Castro
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Catarina Sá
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
| | - Irene P Carvalho
- Clinical Neurosciences and Mental Health Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Andreia Martins
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - Eva Maia
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - Isabel Praça
- Research Group on Intelligent Engineering and Computing for Advanced Innovation and Development (GECAD), School of Engineering, Polytechnic of Porto (ISEP/IPP), 4249-015 Porto, Portugal
| | - António Marques
- Laboratório de Reabilitação Psicossocial, Centro de Investigação em Reabilitação (CIR), Escola Superior de Saúde, Instituto Politécnico do Porto (ESS-IPP), 4200-072 Porto, Portugal
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Muñoz-Blanco A, Gómez-Huelgas R, Gómez-Cerezo JF. Statin-associated muscle symptoms: Myth or reality? Rev Clin Esp 2022; 222:602-611. [PMID: 35810133 DOI: 10.1016/j.rceng.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 12/14/2022]
Abstract
Statin-associated muscle symptoms is an entity that encompasses a constellation of various clinical manifestations of variyng severity. Since the introduction of the first statins, numerous studies have been published regarding its incidence, pathophysiology, diagnosis and treatment; however, to this day these aspects are still controversial. With the progressive increase in the use of statins in the general population, notifications of adverse reactions related to its use have multiplied, particularly those related to muscular toxicity. Nevertheless, the differences between the published studies, both in methodology and in the results obtained, make this relationship a complex issue of great interest for clinicians and patients. The integration of the evidence that we currently have can help us understand better this entity and facilitate its management in clinical practice.
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Affiliation(s)
- A Muñoz-Blanco
- Servicio de Medicina Interna, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
| | - R Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - J F Gómez-Cerezo
- Servicio de Medicina Interna, Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
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3
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Osula D, Wu B, Schesing K, Das SR, Moss E, Alvarez K, Clark C, Halm EA, Brown NJ, Vongpatanasin W. Comparison of Pharmacy Refill Data With Chemical Adherence Testing in Assessing Medication Nonadherence in a Safety Net Hospital Setting. J Am Heart Assoc 2022; 11:e027099. [PMID: 36193931 PMCID: PMC9673714 DOI: 10.1161/jaha.122.027099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pharmacy fill data are a practical tool for assessing medication nonadherence. However, previous studies have not compared the accuracy of pharmacy fill data to measurement of plasma drug levels, or chemical adherence testing (CAT). Methods and Results We performed a cross-sectional study in patients with uncontrolled hypertension in outpatient clinics in a safety net health system. Plasma samples were obtained for measurement of common cardiovascular drugs, including calcium channel blockers, thiazide diuretics, beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and statins, using liquid chromatography mass spectrometry. Proportion of days covered (PDC), a method for tracking pharmacy fill data, was calculated via linkages with Surescripts, and its diagnostic test characteristics were compared with CAT. Among 77 patients with uncontrolled hypertension, 13 (17%) were nonadherent to at least 1 antihypertensive drug and 23 (37%) were nonadherent to statins by CAT. PDC was significantly lower in the nonadherent versus the adherent group by CAT only among patients prescribed an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker or statin (all P<0.05) but not in patients prescribed other drug classes. The sensitivity and specificity of PDC in detecting nonadherence to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statin drugs by CAT were 75% to 82% and 56% to 79%, respectively. The positive predictive value of PDC in detecting nonadherence was only 11% to 27% for antihypertensive drugs and 45% for statins. Conclusions PDC is useful in detecting nonadherence to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and statins but has limited usefulness in detecting nonadherence to calcium channel blockers, beta blockers, or thiazide diuretics and has a low positive predictive value for all drug classes.
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Affiliation(s)
- David Osula
- Department of Internal MedicineParkland Health & Hospital SystemDallasTX
| | - Bryan Wu
- Department of Internal MedicineParkland Health & Hospital SystemDallasTX
| | - Kevin Schesing
- Department of Internal MedicineParkland Health & Hospital SystemDallasTX
| | - Sandeep R. Das
- Cardiology DivisionParkland Health & Hospital SystemDallasTX
| | - Elizabeth Moss
- UT Southwestern Medical Center, Department of MedicineParkland Health & Hospital SystemDallasTX
| | - Kristin Alvarez
- UT Southwestern Medical Center, Department of MedicineParkland Health & Hospital SystemDallasTX
| | - Christopher Clark
- UT Southwestern Medical Center, Department of MedicineParkland Health & Hospital SystemDallasTX
| | - Ethan A. Halm
- Department of MedicineRobert Wood Johnson Medical SchoolNew BrunswickNJ
| | | | - Wanpen Vongpatanasin
- Cardiology DivisionParkland Health & Hospital SystemDallasTX
- Hypertension SectionUT Southwestern Medical CenterDallasTX
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A Review of Statin Intolerance: a Focus on Statin-Attributed Muscle Symptoms. Curr Atheroscler Rep 2022; 24:839-847. [PMID: 36001213 DOI: 10.1007/s11883-022-01059-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To provide a systematic approach to management of the patient with statin-attributed muscle symptoms. RECENT FINDINGS We examined the prevalence of statin intolerance, the role of the nocebo effect, key findings in the patient's history and laboratory studies, the potential value of coronary calcium scoring, and the importance of shared decision-making in considering statin re-initiation. Most patients with statin-attributed muscle symptoms can be successfully treated with statins or a combination of statins and non-statins to achieve successful ASCVD risk reduction.
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Sintomatología muscular asociada a estatinas: ¿mito o realidad? Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Guttman Y, Kerem Z. Dietary Inhibitors of CYP3A4 Are Revealed Using Virtual Screening by Using a New Deep-Learning Classifier. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2022; 70:2752-2761. [PMID: 35104412 PMCID: PMC8895463 DOI: 10.1021/acs.jafc.2c00237] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 05/29/2023]
Abstract
CYP3A4 is the main human enzyme responsible for phase I metabolism of dietary compounds, prescribed drugs and xenobiotics, steroid hormones, and bile acids. The inhibition of CYP3A4 activity might impair physiological mechanisms, including the endocrine system and response to drug admission. Here, we aimed to discover new CYP3A4 inhibitors from food and dietary supplements. A deep-learning model was built that classifies compounds as either an inhibitor or noninhibitor, with a high specificity of 0.997. We used this classifier to virtually screen ∼60,000 dietary compounds. Of the 115 identified potential inhibitors, only 31 were previously suggested. Many herbals, as predicted here, might cause impaired metabolism of drugs, and endogenous hormones and bile acids. Additionally, by applying Lipinski's rules of five, 17 compounds were also classified as potential intestine local inhibitors. New CYP3A4 inhibitors predicted by the model, bilobetin and picropodophyllin, were assayed in vitro.
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Traccis F, Presciuttini R, Pani PP, Sinclair JMA, Leggio L, Agabio R. Alcohol-medication interactions: A systematic review and meta-analysis of placebo-controlled trials. Neurosci Biobehav Rev 2021; 132:519-541. [PMID: 34826511 DOI: 10.1016/j.neubiorev.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 09/20/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
Alcohol and other xenobiotics may limit the therapeutic effects of medications. We aimed at investigating alcohol-medication interactions (AMI) after the exclusion of confounding effects related to other xenobiotics. We performed a systematic review and meta-analysis of controlled studies comparing the effects induced by alcohol versus placebo on pharmacodynamic and/or pharmacokinetic parameters of approved medications. Certainty in the evidence of AMI was assessed when at least 3 independent studies and at least 200 participants were available. We included 107 articles (3097 participants): for diazepam, cannabis, opioids, and methylphenidate, we found significant AMI and enough data to assign the certainty of evidence. Alcohol consumption significantly increases the peak plasma concentration of diazepam (low certainty; almost 290 participants), cannabis (high certainty; almost 650 participants), opioids (low certainty; 560 participants), and methylphenidate (moderate certainty; 290 participants). For most medications, we found some AMI but not enough data to assign them the certainty grades; for some medications, we found no differences between alcohol and placebo in any outcomes evaluated. Our results add further evidence for interactions between alcohol and certain medications after the exclusion of confounding effects related to other xenobiotics. Physicians should advise patients who use these specific medications to avoid alcohol consumption. Further studies with appropriate control groups, enough female participants to investigate sex differences, and elderly population are needed to expand our knowledge in this field. Short phrases suitable for indexing terms.
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Affiliation(s)
- Francesco Traccis
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| | - Riccardo Presciuttini
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| | - Pier Paolo Pani
- Health Social Services Public Health Trust Sardinia, Cagliari, Italy.
| | | | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism, Division of Intramural Clinical and Basic Research, National Institutes of Health, Baltimore and Bethesda, MD, United States; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, United States; Center for Alcohol and Addiction Studies, Brown University, Providence, RI, United States; Division of Addiction Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Neuroscience, Georgetown University, Washington, DC, United States.
| | - Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
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Vinci P, Panizon E, Tosoni LM, Cerrato C, Pellicori F, Mearelli F, Biasinutto C, Fiotti N, Di Girolamo FG, Biolo G. Statin-Associated Myopathy: Emphasis on Mechanisms and Targeted Therapy. Int J Mol Sci 2021; 22:11687. [PMID: 34769118 PMCID: PMC8583847 DOI: 10.3390/ijms222111687] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 12/25/2022] Open
Abstract
Hyperlipidemia is a major risk factor for cardiovascular morbidity and mortality. Statins are the first-choice therapy for dyslipidemias and are considered the cornerstone of atherosclerotic cardiovascular disease (ASCVD) in both primary and secondary prevention. Despite the statin-therapy-mediated positive effects on cardiovascular events, patient compliance is often poor. Statin-associated muscle symptoms (SAMS) are the most common side effect associated with treatment discontinuation. SAMS, which range from mild-to-moderate muscle pain, weakness, or fatigue to potentially life-threatening rhabdomyolysis, are reported by 10% to 25% of patients receiving statin therapy. There are many risk factors associated with patient features and hypolipidemic agents that seem to increase the risk of developing SAMS. Due to the lack of a "gold standard", the diagnostic test for SAMS is based on a clinical criteria score, which is independent of creatine kinase (CK) elevation. Mechanisms that underlie the pathogenesis of SAMS remain almost unclear, though a high number of risk factors may increase the probability of myotoxicity induced by statin therapy. Some of these, related to pharmacokinetic properties of statins and to concomitant therapies or patient characteristics, may affect statin bioavailability and increase vulnerability to high-dose statins.
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Affiliation(s)
- Pierandrea Vinci
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Emiliano Panizon
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Letizia Maria Tosoni
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Carla Cerrato
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Federica Pellicori
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Filippo Mearelli
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Chiara Biasinutto
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, 34149 Trieste, Italy;
| | - Nicola Fiotti
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
| | - Filippo Giorgio Di Girolamo
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
- SC Assistenza Farmaceutica, Cattinara Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, 34149 Trieste, Italy;
| | - Gianni Biolo
- Clinica Medica, Cattinara Hospital, Department of Medical Surgical ad Health Science, University of Trieste, 34149 Trieste, Italy; (E.P.); (L.M.T.); (C.C.); (F.P.); (F.M.); (N.F.); (F.G.D.G.); (G.B.)
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Baraka MA, Elnaem MH, Elkalmi R, Sadeq A, Elnour AA, Joseph Chacko R, ALQarross AH, Moustafa MMA. Awareness of statin–food interactions using grapefruit as an example: a cross-sectional study in Eastern Province of Saudi Arabia. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Objectives
The purpose of this study is to assess patients’ knowledge regarding statin–grapefruit interactions, to identify any pertinent demographic characteristics that may influence knowledge of this drug–food interaction, and to identify preferred patient sources of health information.
Methods
A cross-sectional study was conducted to collect data from statins users about the awareness regarding drug interaction with foods. Self-administered questionnaires have been distributed to collect data from statins users regardless of the type and the reason they administer these medications. Respondents were statins users visiting the King Fahd Hospital’s outpatient clinic (KFHU) and community pharmacies in the Eastern province of Saudi Arabia.
Key findings
Our study revealed that 62% of statin users never heard about the statin–grapefruit interaction. Only 11% have correctly recognized the interaction effect. Only 11, 21 and 6% of users have reported that they often/always received information on drug–food interaction from pharmacists, physicians and nurses, respectively. Users aged above 60 years had lower awareness than those aged <40 (6.0% vs. 14.1%). Similarly, the proportion was lower among users who had primary or lower educational attainment, unemployed or had income lower than 5000 SAR compared with that among the contrary groups. However, only income showed a statistically significant association (P = 0.007).
Conclusions
The majority of statin users have never heard about their interaction with food. Geriatrics, low-income and less educated patients had a lower level of awareness compared with their counterparts. Many patients may end up discontinuing their medications because of that interaction and the consequent side effects. Pharmacists are requested to play their expected role in providing adequate patient counselling to help improve patients’ awareness regarding safety concerns of statins medication.
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Affiliation(s)
- Mohamed A Baraka
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University – Al Ain Campus, Al Ain, United Arab Emirates
- Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Ramadan Elkalmi
- Department of Pharmacology, Faculty of Medicine, Sabha University, Sabha, Libya
| | - Adel Sadeq
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University – Al Ain Campus, Al Ain, United Arab Emirates
| | - Asim Ahmed Elnour
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University – Abu Dhabi Campus, Abu Dhabi, United Arab Emirates
| | - Royes Joseph Chacko
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah H ALQarross
- Pharmacy Director of Al Zahra General Hospital Outpatient Pharmacy, Dammam, Saudi Arabia
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Kanwal U, Mukhtar S, Waheed M, Mehreen A, Abbas N, Shamim R, Hussain K, Rasool F, Hussain A, Bukhari NI. Fixed Dose Single Tablet Formulation with Differential Release of Amlodipine Besylate and Simvastatin and Its Pharmacokinetic Profile: QbD and Risk Assessment Approach. Drug Des Devel Ther 2021; 15:2193-2210. [PMID: 34079222 PMCID: PMC8164448 DOI: 10.2147/dddt.s240506] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 03/12/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose A differential release fixed dose matrix tablet of amlodipine besylate (AML-B) and simvastatin (SIM) was formulated to enhance patient compliance. Material and Method In the first phase, release controlling parameters of AML-B and SIM granules were identified and in the second phase a fixed dose AML-B and SIM tablet formulation was prepared and optimized for a differential release of the drugs using a quality by design (QbD) and risk assessment approach. A validated HPLC method was employed for simultaneous determination of AML-B and SIM for FDC formulation. A pharmacokinetics of the above drugs was studied in healthy dogs in the third phase. Results In QbD-based optimized formulation, Eudragit® RSPO-dicalcium phosphate (DCP) blend controlled the release of AML-B over 8 h, though this diffusion-controlled release assumed first order kinetics. DCP and Eudragit® RS 100 also retarded release of SIM causing SIM release over 8 h after AML-B release from the optimized FDC tablet formulation. The HPLC retention times of AML-B and SIM were 2.10 and 15.52 min, respectively. Linearity for AML-B was 5.0–50 ng/mL and 0.01–2.0 µg/mL for SIM with percent recoveries of 92.85–101.53% and 94.51–117.75% for AML-B and SIM. AUC0-∞ of AML-B was increased 3 fold, while AUC0-∞ of SIM was decreased 2 fold. The tmax values for AML-B and SIM were 12 and 6 h, respectively. AML-B was absorbed without any lag time (tlag) while tlag was 6.33 ± 0.81 h for SIM, thus met the study objective. Conclusion The pharmacokinetic study showed an immediate absorption of AML-B while that of SIM was withheld for 6 h, close to the desired delay time of 8 h.
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Affiliation(s)
- Ummarah Kanwal
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Shahid Mukhtar
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | | | | | - Nasir Abbas
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Rahat Shamim
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Fatima Rasool
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Amjad Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Nadeem Irfan Bukhari
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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Mamoshina P, Rodriguez B, Bueno-Orovio A. Toward a broader view of mechanisms of drug cardiotoxicity. CELL REPORTS MEDICINE 2021; 2:100216. [PMID: 33763655 PMCID: PMC7974548 DOI: 10.1016/j.xcrm.2021.100216] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiotoxicity, defined as toxicity that affects the heart, is one of the most common adverse drug effects. Numerous drugs have been shown to have the potential to induce lethal arrhythmias by affecting cardiac electrophysiology, which is the focus of current preclinical testing. However, a substantial number of drugs can also affect cardiac function beyond electrophysiology. Within this broader sense of cardiotoxicity, this review discusses the key drug-protein interactions known to be involved in cardiotoxic drug response. We cover adverse effects of anticancer, central nervous system, genitourinary system, gastrointestinal, antihistaminic, anti-inflammatory, and anti-infective agents, illustrating that many share mechanisms of cardiotoxicity, including contractility, mitochondrial function, and cellular signaling.
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Affiliation(s)
| | - Blanca Rodriguez
- Department of Computer Science, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Alfonso Bueno-Orovio
- Department of Computer Science, BHF Centre of Research Excellence, University of Oxford, Oxford, UK
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Abstract
The choice of lipid-modifying treatment is largely based on the absolute level of cardiovascular risk and baseline lipid profile. Statins are the first-line treatment for most patients requiring reduction of low-density-lipoprotein cholesterol (LDL-C) and ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors can be added to reach LDL-C targets. Statins have some adverse effects that are somewhat predictable based on phenotypic and genetic factors. Fibrates or omega-3 fatty acids can be added if triglyceride levels remain elevated. The RNA-targeted therapeutics in development offer the possibility of selective liver targeting for specific lipoproteins such as lipoprotein(a) and long-term reduction of LDL-C with infrequent administration of a small-interfering RNA may help to overcome the problem of adherence to therapy.
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Affiliation(s)
- Brian Tomlinson
- Faculty of Medicine, Macau University of Science & Technology, Macau 999078, PR China
| | - Chen-Hsiu Lin
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Paul Chan
- Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
| | - Christopher Wk Lam
- Faculty of Medicine, Macau University of Science & Technology, Macau 999078, PR China
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Stern BD, Hegedus EJ, Lai YC. State dependence: Does a prior injury predict a future injury? Phys Ther Sport 2021; 49:8-14. [PMID: 33550203 DOI: 10.1016/j.ptsp.2021.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/20/2022]
Abstract
The sports medicine literature is filled with associations between injury and causal factors. However, those results have been inconsistent. We're left wondering which of our athletes might need more attention and where our efforts might be best spent. Resistance to injury is the result of interaction between many variables. These variables are interdependent with dynamic relationships which can be sometimes correlated, at times anti-correlated and from time to time show no relationship with injury risk. Relationships we may have seen yesterday do not necessarily hold true for today and we should not use those to infer what will happen. This perspective piece builds on prior works and describes how the complex interaction between injury determinants presents in other systems, why determinants are not stable and instead vary over time due to internal and external forcing and why our prediction ability remains limited even when determinants are identified. Patterns built from frequent time series data in conjunction with nonlinear dynamical methods can offer us a new approach to thinking about injury prediction.
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Affiliation(s)
- Benjamin D Stern
- Department of Outpatient Rehabilitation, HonorHealth, Scottsdale, AZ, USA.
| | - Eric J Hegedus
- Physical Therapy Program, School of Medicine, Tufts University, Boston, MA, USA
| | - Ying-Cheng Lai
- School of Electrical, Computer and Energy Engineering, Arizona State University, Tempe, AZ, USA
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14
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Tomlinson B, Chan P, Lam CWK. Statin Controversies Continued: Response to the Letter from Azemawah et al. Cardiovasc Drugs Ther 2020; 34:887-888. [DOI: 10.1007/s10557-020-07049-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/29/2022]
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15
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Statin Controversies: Response to the Letter from Tomlinson et al. Cardiovasc Drugs Ther 2020; 34:437-438. [DOI: 10.1007/s10557-020-06964-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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16
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Liang L, Su W, Zhou L, Cao Y, Zhou X, Liu S, Zhao Y, Ding X, Wang Q, Zhang H. Statin downregulation of miR-652-3p protects endothelium from dyslipidemia by promoting ISL1 expression. Metabolism 2020; 107:154226. [PMID: 32277945 DOI: 10.1016/j.metabol.2020.154226] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/01/2020] [Accepted: 04/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Aberrant endothelial function is a major contributing factor in cardiovascular disease. Dyslipidemia leads to decreased nitric oxide (NO) bioavailability, an early sign of endothelial failure. Low insulin gene enhancer protein (ISL1) levels decrease healthy NO bioavailability. We hypothesized that the microRNA miR-652-3p negatively regulates endothelial ISL1 expression and that dyslipidemia-induced miR-652-3p upregulation induces aberrant endothelial functioning via ISL1 downregulation. METHODS Various in vitro experiments were conducted in human umbilical vein endothelial cells (HUVECs). Luciferase assays were performed in HEK293 cells. We constructed a high-fat diet (HFD) Apoe-/- murine model of dyslipidemia and a rat model of low-density lipoprotein (LDL)-induced dyslipidemia to conduct in vivo and ex vivo experiments. RESULTS Luciferase assays confirmed miR-652-3p's targeting of the ISL1 3'-untranslated region (3'-UTR). Simvastatin blocked oxidized LDL (ox-LDL)-induced increases in miR-652-3p and ox-LDL-induced decreases in ISL1 protein expression, endothelial NO synthase (eNOS) activation, and NO production. Simvastatin's effects were abrogated by miR-652-3p overexpression and phenocopied by miR-652-3p inhibition. The dyslipidemic mouse model exhibited increased miR-652-3p and decreased ISL1 protein levels in the endothelium, effects opposed by simvastatin or miR-652-3p inhibition. The impact of simvastatin in vivo was abolished by overexpressing miR-652-3p or knocking-down ISL1. The rat model of dyslipidemia exhibited a similar pattern of miR-652-3p upregulation, attenuated ISL1 protein levels, decreased eNOS activation, and decreased NO production, effects mitigated by simvastatin. CONCLUSIONS Dyslipidemia upregulates endothelial miR-652-3p, which decreases ISL1 protein levels, eNOS activation, and NO production. Simvastatin therapy lowers endothelial miR-652-3p expression to protect endothelial function under dyslipidemic conditions.
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Affiliation(s)
- Liwen Liang
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Wenhua Su
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Liang Zhou
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Yu Cao
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Xiuli Zhou
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Shiqi Liu
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Yan Zhao
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Xiaoxue Ding
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Qian Wang
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China
| | - Hong Zhang
- Department of Cardiology, First People's Hospital of Yunnan Province, Kunming, China.
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17
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Azemawah V, Movahed MR, Centuori P, Penaflor R, Riel PL, Situ S, Shadmehr M, Hashemzadeh M. State of the Art Comprehensive Review of Individual Statins, Their Differences, Pharmacology, and Clinical Implications. Cardiovasc Drugs Ther 2020; 33:625-639. [PMID: 31773344 DOI: 10.1007/s10557-019-06904-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Statins are currently the primary treatment for hyperlipidemia, particularly for the treatment of high levels of low-density lipoprotein cholesterol (LDL-C), as many studies have proven benefit in a variety of populations. The benefits of statin treatment for high cholesterol have been proven in many trials. Forefront among different adverse events is statin-induced myopathy, which still eludes complete understanding, and may range anywhere from muscle soreness or fatigue to potentially extremely rare occurrence of rhabdomyolysis.As most adverse events are rare and not life-threatening, in high-risk patients, a high-dose statin should be started initially as data suggests that clinicians rarely up titrate statin therapy after initial prescription leading to under-treatment of many patients requiring high-dose statin therapy. As we will discuss in this paper, musculoskeletal side effects are the main concern and reason for discontinuing statin therapy. The occurrence and true association of other adverse events in patients on statin such as new onset of diabetes, hepatic toxicity, or cognitive impairment are rare, controversial, and not proven. In placebo-controlled studies, abnormal liver function occurs to a similar degree in statin- and placebo-treated patients. This led to FDA removal of the requirement to monitor liver function tests in patients on statin therapy.The combination of statins with other compounds such as ezetimibe or PCSK9 inhibitors has shown some additional benefits in the treatment of hypercholesterolemia. The goal of this manuscript is to conduct a comprehensive review about most commonly used statins and compare data on their history, structures, benefits, adverse effects, and clinical outcomes.
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Affiliation(s)
- Veronica Azemawah
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,Pima College, Tucson, AZ, USA
| | - Mohammad Reza Movahed
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,CareMore, Tucson, AZ, USA
| | - Patrick Centuori
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,Pima College, Tucson, AZ, USA
| | - Ryan Penaflor
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,Pima College, Tucson, AZ, USA
| | - Pascal L Riel
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,Pima College, Tucson, AZ, USA
| | - Steven Situ
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA.,Pima College, Tucson, AZ, USA
| | - Mehrdad Shadmehr
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA
| | - Mehrnoosh Hashemzadeh
- University of Arizona, 1501 N Campbell Avenue, Tucson, AZ, 85724, USA. .,Pima College, Tucson, AZ, USA.
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18
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Ricci G, Ciccone MM, Giordano P, Cortese F. Statins: Pharmacokinetics, Pharmacodynamics and Cost-Effectiveness Analysis. Curr Vasc Pharmacol 2020; 17:213-221. [PMID: 29984667 DOI: 10.2174/1570161116666180706144824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/22/2018] [Accepted: 01/23/2018] [Indexed: 11/22/2022]
Abstract
Cardiovascular diseases secondary to atherosclerosis are the primary causes of early death and disability worldwide and dyslipidaemia represents one of the most important modifiable risk factors. Among lipid abnormalities that define it, low-density lipoprotein cholesterol (LDL-C) is the primary target of therapy, since multiple randomized controlled trials have shown the positive impact of its reduction on atherosclerosis development. For their ability to lower LDL-C levels, statins are the most studied drugs in cardiovascular disease prevention, of proven utility in slowing the progression or even determining regression of atherosclerosis. In addition, they have ancillary proprieties, with positive effects on the mechanisms involved in the development of atherosclerosis and cardiovascular morbidity and mortality, the so-called "pleiotropic mechanisms". Although sharing the same mechanism of action, the different chemical and pharmacological characteristics of each kind of statins affect their absorption, bioavailability, plasma protein binding properties, excretion and solubility. In this overview, we analysed pharmacokinetic and pharmacodynamic mechanisms of this class of drugs, specifying the differences among the molecules, along with the economic aspects. Detailed knowledge of characteristics and differences of each kind of available statin could help the physician in the correct choice, based also on patient's clinical profile, of this essential tool with a demonstrated high cost-effectiveness both in primary than in the secondary prevention of cardiovascular disease.
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Affiliation(s)
- Gabriella Ricci
- Cardiovascular Diseases Section, "Monsignor Dimiccoli" Hospital, Barletta, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Diseases Section, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Paola Giordano
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Francesca Cortese
- Cardiovascular Diseases Section, "Monsignor Dimiccoli" Hospital, Barletta, Italy
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19
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Guttman Y, Yedidia I, Nudel A, Zhmykhova Y, Kerem Z, Carmi N. New grapefruit cultivars exhibit low cytochrome P4503A4-Inhibition activity. Food Chem Toxicol 2020; 137:111135. [PMID: 31968226 DOI: 10.1016/j.fct.2020.111135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/06/2020] [Accepted: 01/15/2020] [Indexed: 12/12/2022]
Abstract
Furanocoumarins are the main compounds responsible for the food-drug interactions known as the grapefruit effect, which is caused by the inhibition of CYP3A4-mediated drug metabolism. We evaluated the effects of two new, low-furanocoumarin grapefruit cultivars on CYP3A4 activity and the roles of different furanocoumarins, individually and together with other juice compounds, in the inhibition of CYP3A4 by grapefruit. Whereas a standard grapefruit cultivar inhibited CYP3A4 activity in a dose-dependent manner, neither of the two examined low-furanocoumarin cultivars had an inhibitory effect. Despite the fact that bergamottin and 6',7'-dihydroxybergamottin are weak inhibitors of CYP3A4, their relatively high levels in grapefruit make them the leading cause of the grapefruit effect. We found that furanocoumarins together with other juice compounds inhibit CYP3A4 in an additive manner. In silico docking simulation was employed, and differentiated between high- and low-potency inhibitors, suggesting that modeling may be useful for identifying potentially harmful food-drug interactions.
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Affiliation(s)
- Yelena Guttman
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Iris Yedidia
- Institute of Plant Sciences, Agricultural Research Organization, Volcani Center, Bet Dagan, Israel.
| | - Adi Nudel
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Yuliya Zhmykhova
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Zohar Kerem
- Institute of Biochemistry, Food Science and Nutrition, The Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel.
| | - Nir Carmi
- Institute of Plant Sciences, Agricultural Research Organization, Volcani Center, Bet Dagan, Israel.
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20
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The Herb-Drug Pharmacokinetic Interaction of Fluoxetine and Its Metabolite Norfluoxetine with a Traditional Chinese Medicine in Rats by LC-MS/MS. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:2471870. [PMID: 31871472 PMCID: PMC6907063 DOI: 10.1155/2019/2471870] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 10/22/2019] [Accepted: 11/01/2019] [Indexed: 12/26/2022]
Abstract
Background Fluoxetine (FLU) is the first-line and widely used medication for depression. The combination of Chaihu Shugan san (CSGS) and FLU is commonly used to enhance antidepressant effects and reduce side effects. Objective The primary objective of this study was to investigate the potential pharmacokinetic effect of CSGS on FLU. Materials and Methods Thirty-two healthy adult male Sprague-Dawley (SD) rats were randomly divided into four groups, the fluoxetine group and multiple dose groups A, B, and C. The rats in the different groups were orally administered with a combination of FLU and different doses of CSGS for 14 d. On the fifteenth day, serial blood samples were taken from the caudal vein before the administration and at 0.25, 0.5, 0.75, 1, 2, 4, 6, 8, 10, 12, 24, 36, and 48 h after the administration. A liquid-liquid extraction method was applied to extract the analytes from serum. Then, the concentrations of FLU and its metabolite, norfluoxetine (NOF), were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The pharmacokinetic parameters were calculated by DAS 3.2.8 program and compared by statistic analysis. Results Compared with the FLU group, the FLU and NOF area under the plasma concentration-time curve (AUC) (0–∞) in multiple dose group C was significantly increased, while the NOF AUCs (0–∞) in multiple dose group A and multiple dose group B were decreased. Compared with the FLU group, the NOF clearance (CL) in multiple dose group C was decreased, while the CL in multiple dose groups A and B was increased. Discussion and Conclusion There were some differences in pharmacokinetic parameters between the FLU group and multiple dose groups, and CSGS can affect the pharmacokinetics of fluoxetine.
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21
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Costache II, Miron A, Hăncianu M, Aursulesei V, Costache AD, Aprotosoaie AC. Pharmacokinetic Interactions between Cardiovascular Medicines and Plant Products. Cardiovasc Ther 2019; 2019:9402781. [PMID: 32089733 PMCID: PMC7012273 DOI: 10.1155/2019/9402781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022] Open
Abstract
The growing use of plant products among patients with cardiovascular pharmacotherapy raises the concerns about their potential interactions with conventional cardiovascular medicines. Plant products can influence pharmacokinetics or/and pharmacological activity of coadministered drugs and some of these interactions may lead to unexpected clinical outcomes. Numerous studies and case reports showed various pharmacokinetic interactions that are characterized by a high degree of unpredictability. This review highlights the pharmacokinetic clinically relevant interactions between major conventional cardiovascular medicines and plant products with an emphasis on their putative mechanisms, drawbacks of herbal products use, and the perspectives for further well-designed studies.
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Affiliation(s)
- Irina-Iuliana Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Anca Miron
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Monica Hăncianu
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Viviana Aursulesei
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Ana Clara Aprotosoaie
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
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22
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Domínguez-Avila JA, Wall-Medrano A, Velderrain-Rodríguez GR, Chen CYO, Salazar-López NJ, Robles-Sánchez M, González-Aguilar GA. Gastrointestinal interactions, absorption, splanchnic metabolism and pharmacokinetics of orally ingested phenolic compounds. Food Funct 2018; 8:15-38. [PMID: 28074953 DOI: 10.1039/c6fo01475e] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The positive health effects of phenolic compounds (PCs) have been extensively reported in the literature. An understanding of their bioaccessibility and bioavailability is essential for the elucidation of their health benefits. Before reaching circulation and exerting bioactions in target tissues, numerous interactions take place before and during digestion with either the plant or host's macromolecules that directly impact the organism and modulate their own bioaccessibility and bioavailability. The present work is focused on the gastrointestinal (GI) interactions that are relevant to the absorption and metabolism of PCs and how these interactions impact their pharmacokinetic profiles. Non-digestible cell wall components (fiber) interact intimately with PCs and delay their absorption in the small intestine, instead carrying them to the large intestine. PCs not bound to fiber interact with digestible nutrients in the bolus where they interfere with the digestion and absorption of proteins, carbohydrates, lipids, cholesterol, bile salts and micronutrients through the inhibition of digestive enzymes and enterocyte transporters and the disruption of micelle formation. PCs internalized by enterocytes may reach circulation (through transcellular or paracellular transport), be effluxed back into the lumen (P-glycoprotein, P-gp) or be metabolized by phase I and phase II enzymes. Some PCs can inhibit P-gp or phase I/II enzymes, which can potentially lead to drug-nutrient interactions. The absorption and pharmacokinetic parameters are modified by all of the interactions within the digestive tract and by the presence of other PCs. Undesirable interactions have promoted the development of nanotechnological approaches to promote the bioaccessibility, bioavailability, and bioefficacy of PCs.
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Affiliation(s)
- J Abraham Domínguez-Avila
- Coordinación de Tecnología de Alimentos de Origen Vegetal, Centro de Investigación en Alimentación y Desarrollo, A.C. Carretera a la Victoria Km 0.6. C.P. 83304, Hermosillo, Sonora, Mexico.
| | - Abraham Wall-Medrano
- Departamento de Ciencias Químico-Biológicas, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Anillo Envolvente del Pronaf y Estocolmo s/n, CP 32310, Cd. Juárez, Chihuahua, Mexico.
| | - Gustavo R Velderrain-Rodríguez
- Coordinación de Tecnología de Alimentos de Origen Vegetal, Centro de Investigación en Alimentación y Desarrollo, A.C. Carretera a la Victoria Km 0.6. C.P. 83304, Hermosillo, Sonora, Mexico.
| | - C-Y Oliver Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, 711 Washington Street, Boston, Massachusetts 02111, USA.
| | - Norma Julieta Salazar-López
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N Col. Centro, C.P. 83000, Hermosillo, Sonora, Mexico.
| | - Maribel Robles-Sánchez
- Departamento de Investigación y Posgrado en Alimentos, Universidad de Sonora, Blvd. Luis Encinas y Rosales S/N Col. Centro, C.P. 83000, Hermosillo, Sonora, Mexico.
| | - Gustavo A González-Aguilar
- Coordinación de Tecnología de Alimentos de Origen Vegetal, Centro de Investigación en Alimentación y Desarrollo, A.C. Carretera a la Victoria Km 0.6. C.P. 83304, Hermosillo, Sonora, Mexico.
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23
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Piotti G, Gandolfini I, Palmisano A, Maggiore U. Metabolic risk profile in kidney transplant candidates and recipients. Nephrol Dial Transplant 2018; 34:388-400. [DOI: 10.1093/ndt/gfy151] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/01/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Giovanni Piotti
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Ilaria Gandolfini
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alessandra Palmisano
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
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24
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Zha W. Transporter-mediated natural product-drug interactions for the treatment of cardiovascular diseases. J Food Drug Anal 2017; 26:S32-S44. [PMID: 29703385 PMCID: PMC9326887 DOI: 10.1016/j.jfda.2017.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 11/18/2017] [Accepted: 11/21/2017] [Indexed: 12/17/2022] Open
Abstract
The growing use of natural products in cardiovascular (CV) patients has been greatly raising the concerns about potential natural product–CV drug interactions. Some of these may lead to unexpected cardiovascular adverse effects and it is, therefore, essential to identify or predict potential natural product–CV drug interactions, and to understand the underlying mechanisms. Drug transporters are important determinants for the pharmacokinetics of drugs and alterations of drug transport has been recognized as one of the major causes of natural product–drug interactions. In last two decades, many CV drugs (e.g., angiotensin II receptor blockers, beta-blockers and statins) have been identified to be substrates and inhibitors of the solute carrier (SLC) transporters and the ATP-binding cassette (ABC) transporters, which are two major transporter superfamilies. Meanwhile, in vitro and in vivo studies indicate that a growing number of natural products showed cardioprotective effects (e.g., gingko biloba, danshen and their active ingredients) are also substrates and inhibitors of drug transporters. Thus, to understand transporter-mediated natural product–CV drug interactions is important and some transporter-mediated interactions have already shown to have clinical relevance. In this review, we review the current knowledge on the role of ABC and SLC transporters in CV therapy, as well as transporter modulation by natural products used in CV diseases and their induced natural product–CV drug interactions through alterations of drug transport. We hope our review will aid in a comprehensive summary of transporter-mediated natural product–CV drug interactions and help public and physicians understand these type of interactions.
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Affiliation(s)
- Weibin Zha
- MyoKardia, South San Francisco, CA, USA.
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25
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Jargin SV. Grapefruit: Some perspectives in pharmacology and nutrition. JOURNAL OF COMPLEMENTARY MEDICINE RESEARCH 2017; 6:339-341. [PMID: 28894634 PMCID: PMC5580961 DOI: 10.5455/jice.20170511061624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 05/02/2017] [Indexed: 11/26/2022]
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26
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Jia Y, Liu J, Xu J. Influence of grapefruit juice on pharmacokinetics of triptolide in rats grapefruit juice on the effects of triptolide. Xenobiotica 2017; 48:407-411. [PMID: 28359180 DOI: 10.1080/00498254.2017.1313470] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Yuzhen Jia
- Department of Pediatrics, Yidu Central Hospital of Weifang, China,
| | - Jie Liu
- Yidu Central Hospital of Weifang, China, and
| | - Jisen Xu
- Department of Neurology, Yidu Central Hospital of Weifang, China
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27
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Abstract
Natural foods and vegetal supplements have recently become increasingly popular for their roles in medicine and as staple foods. This has, however, led to the increased risk of interaction between prescribed drugs and the bioactive ingredients contained in these foods. These interactions range from pharmacokinetic interactions (absorption, distribution, metabolism, and excretion influencing blood levels of drugs) to pharmacodynamic interactions (drug effects). In a quantitative respect, these interactions occur mainly during metabolism. In addition to the systemic metabolism that occurs mainly in the liver, recent studies have focused on the metabolism in the gastrointestinal tract endothelium before absorption. Inhibition of metabolism causes an increase in the blood levels of drugs and could have adverse reactions. The food-drug interactions causing increased blood levels of drugs may have beneficial or detrimental therapeutic effects depending on the intensity and predictability of these interactions. It is therefore important to understand the potential interactions between foods and drugs should and the specific outcomes of such interactions.
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Affiliation(s)
- Jong Hwan Choi
- Department of Biochemistry, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Chang Mann Ko
- Department of Pharmacology, Yonsei University Wonju College of Medicine, Wonju, Korea
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28
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Lee JW, Morris JK, Wald NJ. The Reply. Am J Med 2016; 129:e303. [PMID: 27770846 DOI: 10.1016/j.amjmed.2016.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/06/2016] [Indexed: 11/15/2022]
Affiliation(s)
- Jonathan W Lee
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Joan K Morris
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Nicholas J Wald
- Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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29
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Bailey DG. Better to Avoid Grapefruit with Certain Statins. Am J Med 2016; 129:e301. [PMID: 27770845 DOI: 10.1016/j.amjmed.2016.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 10/20/2022]
Affiliation(s)
- David G Bailey
- Lawson Health Research Institute and Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ont, Canada
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Wang Y, Klass E. Grapefruit with Your Statin? Am J Med 2016; 129:e159. [PMID: 27453391 DOI: 10.1016/j.amjmed.2016.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Yunwei Wang
- Department of Medicine, University of Nevada School of Medicine, Reno
| | - Evan Klass
- Department of Medicine, University of Nevada School of Medicine, Reno
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Bioactivity of Polyphenols: Preventive and Adjuvant Strategies toward Reducing Inflammatory Bowel Diseases-Promises, Perspectives, and Pitfalls. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2016; 2016:9346470. [PMID: 27478535 PMCID: PMC4958438 DOI: 10.1155/2016/9346470] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/13/2016] [Accepted: 05/24/2016] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases (IBDs) are characterized by autoimmune and inflammation-related complications of the large intestine (ulcerative colitis) and additional parts of the digestive tract (Crohn's disease). Complications include pain, diarrhoea, chronic inflammation, and cancer. IBD prevalence has increased during the past decades, especially in Westernized countries, being as high as 1%. As prognosis is poor and medication often ineffective or causing side effects, additional preventive/adjuvant strategies are sought. A possible approach is via diets rich in protective constituents. Polyphenols, the most abundant phytochemicals, have been associated with anti-inflammatory, antioxidant, immunomodulatory, and apoptotic properties. Locally reducing oxidative stress, they can further act on cellular targets, altering gene expression related to inflammation, including NF-κB, Nrf-2, Jak/STAT, and MAPKs, suppressing downstream cytokine formation (e.g., IL-8, IL-1β, and TNF-α), and boosting the bodies' own antioxidant status (HO-1, SOD, and GPx). Moreover, they may promote, as prebiotics, healthy microbiota (e.g., Bifidobacteria, Akkermansia), short-chain fatty acid formation, and reduced gut permeability/improved tight junction stability. However, potential adverse effects such as acting as prooxidants, or perturbations of efflux transporters and phase I/II metabolizing enzymes, with increased uptake of undesired xenobiotics, should also be considered. In this review, we summarize current knowledge around preventive and arbitrary actions of polyphenols targeting IBD.
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Abdlekawy KS, Donia AM, Elbarbry F. Effects of Grapefruit and Pomegranate Juices on the Pharmacokinetic Properties of Dapoxetine and Midazolam in Healthy Subjects. Eur J Drug Metab Pharmacokinet 2016; 42:397-405. [DOI: 10.1007/s13318-016-0352-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hannabass K, Olsen KR. Fat burn X: burning more than fat. BMJ Case Rep 2016; 2016:bcr-2015-213374. [PMID: 26811412 DOI: 10.1136/bcr-2015-213374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 50-year-old man presented with a 2-day history of bilateral lower extremity cramping and dark urine. The patient was found to have a creatine phosphokinase (CPK) elevated of up to 2306 U/L, a serum uric acid of 9.7 mg/dL and 101 red blood cell's per high-powered field on urinalysis. On questioning, the patient endorsed daily exercise with free weights. There were no changes in his regular exercise and medication regimen, no muscle trauma, no recent drug use and no illness. The patient did mention using a new fat burner known as 'Fat Burn X', which he had begun taking 2 days prior to the onset of his muscle cramps. The patient was given normal saline intravenous fluid resuscitation for 48 h with resultant normalisation of his CPK and creatinine, and was discharged with primary care follow-up.
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Affiliation(s)
| | - Kevin Robert Olsen
- Department of Anesthesiology, University of Florida, Gainesville, Florida, USA
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