1
|
Vázquez-Carrillo DI, Ocampo-Ruiz AL, Báez-Meza A, Ramírez- Hernández G, Adán-Castro E, García-Rodrigo JF, Dena-Beltrán JL, de los Ríos EA, Sánchez-Martínez MK, Ortiz MG, Martínez de la Escalera G, Clapp C, Macotela Y. Dopamine D2 receptor antagonist counteracts hyperglycemia and insulin resistance in diet-induced obese male mice. PLoS One 2024; 19:e0301496. [PMID: 38635745 PMCID: PMC11025782 DOI: 10.1371/journal.pone.0301496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Obesity leads to insulin resistance (IR) and type 2 diabetes. In humans, low levels of the hormone prolactin (PRL) correlate with IR, adipose tissue (AT) dysfunction, and increased prevalence of T2D. In obese rats, PRL treatment promotes insulin sensitivity and reduces visceral AT adipocyte hypertrophy. Here, we tested whether elevating PRL levels with the prokinetic and antipsychotic drug sulpiride, an antagonist of dopamine D2 receptors, improves metabolism in high fat diet (HFD)-induced obese male mice. Sulpiride treatment (30 days) reduced hyperglycemia, IR, and the serum and pancreatic levels of triglycerides in obese mice, reduced visceral and subcutaneous AT adipocyte hypertrophy, normalized markers of visceral AT function (PRL receptor, Glut4, insulin receptor and Hif-1α), and increased glycogen stores in skeletal muscle. However, the effects of sulpiride reducing hyperglycemia were also observed in obese prolactin receptor null mice. We conclude that sulpiride reduces obesity-induced hyperglycemia by mechanisms that are independent of prolactin/prolactin receptor activity. These findings support the therapeutic potential of sulpiride against metabolic dysfunction in obesity.
Collapse
Affiliation(s)
- Dina I. Vázquez-Carrillo
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Ana Luisa Ocampo-Ruiz
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Arelí Báez-Meza
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Gabriela Ramírez- Hernández
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Elva Adán-Castro
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - José Fernando García-Rodrigo
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - José Luis Dena-Beltrán
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Ericka A. de los Ríos
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | | | - María Georgina Ortiz
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | | | - Carmen Clapp
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM), Campus UNAM-Juriquilla, Querétaro, México
| |
Collapse
|
2
|
Tandon VR, Ismail SH, Singh A. Fixed drug combination (levosulpiride and rabeprazole)-induced atypical Parkinsonian's disorders with associated anxiety and low-lying depression. Indian J Pharmacol 2024; 56:52-54. [PMID: 38454589 PMCID: PMC11001173 DOI: 10.4103/ijp.ijp_929_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/07/2023] [Accepted: 01/29/2024] [Indexed: 03/09/2024] Open
Abstract
We hereby describe a rare case of levosulpiride-induced atypical parkinsonism presenting with sluggish movements, atypical kinetic tremors (tremors with voluntary movement), periorbital tremors, dystonia, difficulty in speech and coordination, postural imbalance, with additional features of difficulty in swallowing and drooling with associated recent onset psychiatric disturbances such as anxiety and low-lying depression. The dechallenge of levosulpiride and medications for associated anxiety and low-lying depression caused a complete remission of the disease within 2 ½ months.
Collapse
Affiliation(s)
- Vishal R. Tandon
- Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Sheikh Hanan Ismail
- Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India
| | - Amarjeet Singh
- Department of Pharmacology, Government Medical College, Jammu, Jammu and Kashmir, India
| |
Collapse
|
3
|
Alnaim AS, Shah H, Nair AB, Mewada V, Patel S, Jacob S, Aldhubiab B, Morsy MA, Almuqbil RM, Shinu P, Shah J. Qbd-Based Approach to Optimize Niosomal Gel of Levosulpiride for Transdermal Drug Delivery. Gels 2023; 9:gels9030213. [PMID: 36975662 PMCID: PMC10048649 DOI: 10.3390/gels9030213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/04/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023] Open
Abstract
Poor aqueous solubility besides extensive hepatic first effect significantly decreases the oral absorption of levosulpiride, which in turn minimizes its therapeutic effectiveness. Niosomes have been extensively investigated as a transdermal vesicular nanocarrier to increase the delivery of low permeable compounds into and across the skin. This research work was to design, develop and optimize levosulpiride-loaded niosomal gel and to evaluate its prospects for transdermal delivery. The Box-Behnken design was used to optimize niosomes by analyzing the impact of three factors (cholesterol; X1, Span 40; X2, and sonication time; X3) on the responses (particle size, Y1, and entrapment efficiency, Y2). Optimized formulation (NC) was incorporated into gel and evaluated for pharmaceutical properties, drug release study, ex vivo permeation, and in vivo absorption. The design experiment data suggest that all three independent variables influence both response variables significantly (p < 0.01). Pharmaceutical characteristics of NC vesicles showed the absence of drug excipient interaction, nanosize (~102.2 nm), narrow distribution (~0.218), adequate zeta potential (−49.9 mV), and spherical shape, which are suitable for transdermal therapy. The levosulpiride release rates varied significantly (p < 0.01) between niosomal gel formulation and control. Greater flux (p < 0.01) was observed with levosulpiride-loaded niosomal gel than with control gel formulation. Indeed, the drug plasma profile of niosomal gel was significantly higher (p < 0.005), with ~3 folds higher Cmax and greater bioavailability (~500% higher; p < 0.0001) than its counterpart. Overall, these findings imply that the use of an optimized niosomal gel formulation can increase the therapeutic efficacy of levosulpiride and may represent a promising alternative to conventional therapy.
Collapse
Affiliation(s)
- Ahmed S. Alnaim
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Correspondence: (A.S.A.); (J.S.)
| | - Hiral Shah
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Anroop B. Nair
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Vivek Mewada
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India
| | - Smit Patel
- Department of Pharmaceutics, Arihant School of Pharmacy & BRI, Adalaj, Gandhinagar 382421, India
| | - Shery Jacob
- Department of Pharmaceutical Sciences, College of Pharmacy, Gulf Medical University, Ajman 4184, United Arab Emirates
| | - Bandar Aldhubiab
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Mohamed A. Morsy
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Department of Pharmacology, Faculty of Medicine, Minia University, El-Minia 61511, Egypt
| | - Rashed M. Almuqbil
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - Jigar Shah
- Department of Pharmaceutics, Institute of Pharmacy, Nirma University, Ahmedabad 382481, India
- Correspondence: (A.S.A.); (J.S.)
| |
Collapse
|
4
|
Akrab SNA, Al Gawhary NE, Shafik AN, Morcos GNB, Wissa MY. The role of mosapride and levosulpiride in gut function and glycemic control in diabetic rats. Arab J Gastroenterol 2023:S1687-1979(23)00009-6. [PMID: 36878815 DOI: 10.1016/j.ajg.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 03/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Gastroparesis is a well-known consequence of long-standing diabetes that presents with gastric dysmotility in the absence of gastric outlet obstruction. This study aimed to evaluate the therapeutic effects of mosapride and levosulpiride on improving gastric emptying in type 2 diabetes mellitus (T2DM) while regulating glycemic levels. MATERIAL AND METHODS Rats were divided into the normal control, untreated diabetic, metformin-treated (100 mg/kg/day), mosapride-treated (3 mg/kg/day), levosulpiride-treated (5 mg/kg/day), metformin (100 mg/kg/day) + mosapride (3 mg/kg/day)-treated, and metformin (100 mg/kg/day) + levosulpiride (5 mg/kg/day)-treated diabetic groups. T2DM was induced by a streptozotocin-nicotinamide model. Fourweeks from diabetes onset, the treatment was started orally daily for 2 weeks. Serum glucose, insulin, and glucagon-like peptide 1 (GLP-1) levels were measured. Gastric motility study was performed using isolated rat fundus and pylorus strip preparations. Moreover, the intestinal transit rate was measured. RESULTS Mosapride and levosulpiride administration showed a significant decrease in serum glucose levels with improvement of gastric motility and intestinal transit rate. Mosapride showed a significant increase in serum insulin and GLP-1 levels. Metformin with mosapride and levosulpiride co-administration showed better glycemic control and gastric emptying than either drug administered alone. CONCLUSION Mosapride and levosulpiride showed comparable prokinetic effects. Metformin administration with mosapride and levosulpiride showed better glycemic control and prokinetic effects. Mosapride provided better glycemic control than levosulpiride. Metformin + mosapride combination provided superior glycemic control and prokinetic effects.
Collapse
Affiliation(s)
- Sara N A Akrab
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt.
| | - Nawal E Al Gawhary
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt.
| | - Amani N Shafik
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt.
| | - George N B Morcos
- Department of Medical Biochemistry & Molecular Biology, Faculty of Medicine, Cairo University, Egypt; Basic Medical Science Department, Faculty of Medicine, King Salman International University, South Sinai, Egypt.
| | - Marian Y Wissa
- Department of Medical Pharmacology, Faculty of Medicine, Cairo University, Egypt.
| |
Collapse
|
5
|
Arif ST, Zaman SU, Khan MA, Tabish TA, Sohail MF, Arshad R, Kim JK, Zeb A. Augmented Oral Bioavailability and Prokinetic Activity of Levosulpiride Delivered in Nanostructured Lipid Carriers. Pharmaceutics 2022; 14:2347. [PMID: 36365165 PMCID: PMC9695558 DOI: 10.3390/pharmaceutics14112347] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 09/29/2023] Open
Abstract
The present study is aimed to develop and optimize levosulpiride-loaded nanostructured lipid carriers (LSP-NLCs) for improving oral bioavailability and prokinetic activity of LSP. LSP-NLCs were optimized with D-optimal mixture design using solid lipid, liquid lipid and surfactant concentrations as independent variables. The prepared LSP-NLCs were evaluated for physicochemical properties and solid-state characterization. The in vivo oral pharmacokinetics and prokinetic activity of LSP-NLCs were evaluated in rats. LSP-NLCs formulation was optimized at Precirol® ATO 5/Labrasol (80.55/19.45%, w/w) and Tween 80/Span 80 concentration of 5% (w/w) as a surfactant mixture. LSP-NLCs showed a spherical shape with a particle size of 152 nm, a polydispersity index of 0.230 and an entrapment efficiency of 88%. The DSC and PXRD analysis revealed conversion of crystalline LSP to amorphous state after loading into the lipid matrix. LSP-NLCs displayed a 3.42- and 4.38-flods increase in AUC and Cmax after oral administration compared to LSP dispersion. In addition, LSP-NLCs showed enhanced gastric emptying (61.4%), intestinal transit (63.0%), and fecal count (68.8) compared to LSP dispersion (39.7%, 38.0% and 51.0, respectively). Taken together, these results show improved oral bioavailability and prokinetic activity of LSP-NLCs and presents a promising strategy to improve therapeutic activity of LSP for efficient treatment of gastric diseases.
Collapse
Affiliation(s)
- Sadia Tabassam Arif
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Shahiq uz Zaman
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Muhammad Ayub Khan
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| | - Tanveer A. Tabish
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Headington, Oxford OX37BN, UK
| | - Muhammad Farhan Sohail
- Riphah Institute of Pharmaceutical Sciences, Riphah International University Lahore Campus, Lahore 54000, Pakistan
| | - Rabia Arshad
- Faculty of Pharmacy, University of Lahore, Lahore 54000, Pakistan
| | - Jin-Ki Kim
- College of Pharmacy, Institute of Pharmaceutical Science and Technology, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan 15588, Gyeonggi, Korea
| | - Alam Zeb
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad 44000, Pakistan
| |
Collapse
|
6
|
Joe J. Levosulpiride-Induced Neurological Adverse Effects: A Prospective Study from a Tertiary Care Center. Ann Indian Acad Neurol 2020; 23:174-176. [PMID: 32189857 PMCID: PMC7061517 DOI: 10.4103/aian.aian_449_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/16/2018] [Accepted: 11/17/2018] [Indexed: 11/04/2022] Open
Abstract
Background Levosulpiride (LS) is a prokinetic drug increasingly used for the gastric motility disorders. Despite its common use for the gastric motility disorder, the tendency to cause parkinsonism and acute dystonias are under-recognized as the major adverse effects. This study was aimed to evaluate the adverse effects of this drug in patients attending neurology clinics. Methods Patients presenting with new-onset extrapyramidal symptoms with respect to LS therapy were selected for the study. A detailed history had been taken using a questionnaire. All the patients were tested for neurological manifestations. The number of cases was then statistically analyzed. Results A total of 30 patients were diagnosed with LS-induced movement disorders. The average age of patients was 65 ± 12 years with 17 males and remaining females. Major presentations were tremor, stiffness, dystonia, neck or back pain, dysarthria, and abnormal feelings. Stiffness, tremor, or both were among the most common signs. A statistically significant (P = 0.0154) positive correlation (r = 0.8295) was found between the duration of LS treatment and incidence of tremor/stiffness. Among them, 19 patients were started with dopaminergic drugs and five were given symptomatic measures. Six patients had no follow-up. Conclusion The LS treatment was found to produce adverse effects such as tremor and stiffness. Early recognition of this condition is essential for its complete cure and better prognosis. Therefore, one should be cautious about the LS as one of the etiologies for acute recent-onset extrapyramidal syndromes while working up patients.
Collapse
Affiliation(s)
- Jacob Joe
- Department of Neurology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
| |
Collapse
|
7
|
SAMIE M, BASHIR S, ABBAS J, KHAN S, AMAN N, JAN H, MUHAMMAD N. Design, Formulation and In Vitro Evaluation of Sustained-release Tablet Formulations of Levosulpiride. Turk J Pharm Sci 2018; 15:309-318. [PMID: 32454675 PMCID: PMC7227831 DOI: 10.4274/tjps.29200] [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] [Received: 08/28/2017] [Accepted: 11/02/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Levosulpiride is a widely used gastroprokinetic agent in the treatment of various gastric disorders; however, its short half-life and increased dosage frequency leads to non-compliance and possible adverse effects. The prime objective of the current study was to develop a sustained-release formulation of Levosulpiride incorporating bioresorbable cellulose derivatives. MATERIALS AND METHODS Sustained-release formulations of Levosulpiride were prepared through direct compression using various cellulose derivatives such as CMC sodium, HPC, and HPMC in different polymer-to-drug weight ratios as release-modifying polymers. The powder blends and compressed tablets were then subjected to pre-compressional and post-compressional evaluation, as well as FTIR analysis. In vitro release studies were performed for all formulations of the model drug in buffer solution of pH 6.8 at a wave length of 214 nm by a UV-visible light spectrophotometer. RESULTS The FTIR results confirmed that the interaction between components was physical, and from the different kinetic models data, the release profile was best expressed by the Higuchi model because the results showed high linearity. The results also showed formulation F9 to be the ideal one among the developed formulations, exhibiting sustained- release behavior. CONCLUSION Levosulpiride sustained-release matrices were prepared successfully using CMC sodium, HPC, and HPMC as the release-retarding polymer/carrier.
Collapse
Affiliation(s)
- Muhammad SAMIE
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Sajid BASHIR
- Sargodha University, Faculty of Pharmacy, Sargodha, Pakistan
| | - Jabbar ABBAS
- People’s University of Medical and Health Sciences for Women, Institute of Pharmaceutical Sciences, Shaheed Benazir Abad, Pakistan
| | - Samiullah KHAN
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Nargis AMAN
- COMSATS Institute of Information Technology, Department of Pharmacy, Abbottabad, Pakistan
| | - Habibullah JAN
- Abdul Wali Khan University Mardan, Department of Pharmacy, Mardan, Pakistan
| | - Naveed MUHAMMAD
- Abdul Wali Khan University Mardan, Department of Pharmacy, Mardan, Pakistan
| |
Collapse
|
8
|
Fukui H, Xu X, Miwa H. Role of Gut Microbiota-Gut Hormone Axis in the Pathophysiology of Functional Gastrointestinal Disorders. J Neurogastroenterol Motil 2018; 24:367-386. [PMID: 29969855 PMCID: PMC6034676 DOI: 10.5056/jnm18071] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 05/21/2018] [Indexed: 12/13/2022] Open
Abstract
Gut microbiota exert a pivotal influence on various functions including gastrointestinal (GI) motility, metabolism, nutrition, immunity, and the neuroendocrine system in the host. These effects are mediated by not only short-chain fatty acids produced by microbiota but also gut hormones and inflammatory signaling by enteroendocrine and immune cells under the influence of the microbiota. GI motility is orchestrated by the enteric nervous system and hormonal networks, and disturbance of GI motility plays an important role in the pathophysiology of functional gastrointestinal disorders (FGIDs). In this context, microbiota-associated mediators are considered to act on specific receptors, thus affecting the enteric nervous system and, subsequently, GI motility. Thus, the pathophysiology of FGIDs is based on alterations of the gut microbiota/gut hormone axis, which have crucial effects on GI motility.
Collapse
Affiliation(s)
- Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
| | - Xin Xu
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
- Department of Digestive Diseases, Tianjin Medical University General Hospital, Tianjin,
China
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Mukogawa, Nishinomiya,
Japan
| |
Collapse
|
9
|
Kulkarni RR. Low-dose Amisulpride for Debilitating Clozapine-induced Sialorrhea: Case Series and Review of Literature. Indian J Psychol Med 2015; 37:446-8. [PMID: 26702180 PMCID: PMC4676214 DOI: 10.4103/0253-7176.168592] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Clozapine-induced sialorrhea (CIS) affects about one-third of patients treated with clozapine, at times can be stigmatizing, socially embarrassing, disabling, affect quality-of-life, cause poor compliance and can be potentially life-threatening adverse effect. Prompt and effective treatment of CIS may assist treatment tolerability, adherence, and better outcomes in patients with treatment nonresponsive schizophrenia. The beneficial effect of amisulpride augmentation of clozapine therapy for such patients may be enhanced by its anti-salivatory effect on CIS. Current series of five subjects who developed CIS that responded poorly to anticholinergic drugs found drastic improvement in daytime and nocturnal CIS with very low-dose (50-100 mg/day) of amisulpride. Low-dose amisulpride augmentation may also provide strong ameliorating effect on CIS. Nevertheless, a long-term, large-scale study with a broader dose range is warranted to evaluate the stability of this effect across time.
Collapse
Affiliation(s)
- Ranganath R Kulkarni
- Department of Psychiatry, SDM College of Medical Sciences and Hospital, Dharwad, Karnataka, India
| |
Collapse
|
10
|
Sebastián-Domingo JJ. La medicina integrativa en el manejo de la dispepsia funcional. Papel del preparado herbal STW5. GASTROENTEROLOGIA Y HEPATOLOGIA 2014; 37:256-61. [DOI: 10.1016/j.gastrohep.2013.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 09/30/2013] [Accepted: 10/08/2013] [Indexed: 02/07/2023]
|
11
|
Cheung CKY, Lee YY, Chan Y, Cheong PK, Law WT, Lee SF, Sung JJY, Chan FKL, Wu JCY. Decreased Basal and postprandial plasma serotonin levels in patients with functional dyspepsia. Clin Gastroenterol Hepatol 2013; 11:1125-9. [PMID: 23591288 DOI: 10.1016/j.cgh.2013.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with diarrhea-predominant irritable bowel syndrome (IBS) have been found to have increased postprandial levels of serotonin (5-HT). Functional dyspepsia (FD) and IBS have been proposed to have common methods of pathogenesis, but little is known about the role of 5-HT in FD. METHODS We measured postprandial levels of 5-HT in 54 patients with FD (based on Rome III criteria) and 28 asymptomatic healthy individuals (controls). Patients with gastroesophageal reflux disease and IBS as their predominant symptom were excluded. After an overnight fast, the subjects drank a liquid meal (Ensure; 1.06 kcal/mL at 30 mL/min) and underwent a (13)C-octanoic acid breath test to measure gastric emptying times. Blood samples were collected at 0, 30, 60, 90, and 120 minutes after the liquid meal for the 5-HT assay. RESULTS Thirty-five patients with FD (65%) had postprandial distress syndrome, and 6 (11%) had a combination of postprandial distress syndrome and epigastric pain syndrome. There were no differences in rates of gastric emptying between patients with FD (103.6 ± 19.4 minutes) and controls (83.1 ± 4.0 minutes; P = .30). However, patients with FD had lower caloric intake (823.40 ± 44.1 kcal) than controls (1021 ± 68.2 kcal; P = .026). Patients with FD also had lower basal (P = .03) and postprandial plasma levels of serotonin at 30 minutes (P = .04), 60 minutes (P = .01), 90 minutes (P = .02), and 120 minutes (P = .002) than controls, as well as area under the curve values over the 120-minute time period (P = .005). Repeated-measures analysis of variance correlated 5-HT level with FD (P < .001). CONCLUSIONS In contrast to patients with diarrhea-predominant IBS, those with FD have decreased basal and postprandial plasma levels of 5-HT. These findings indicate that the pathogenic mechanism of FD differs from that of diarrhea-predominant IBS, and that strategies to alter 5-HT levels or activity might be developed to treat patients with FD.
Collapse
Affiliation(s)
- Cynthia K Y Cheung
- Institute of Digestive Disease, the Chinese University of Hong Kong, Hong Kong, China
| | | | | | | | | | | | | | | | | |
Collapse
|