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Harbell MW, Dumitrascu C, Bettini L, Yu S, Thiele CM, Koyyalamudi V. Anesthetic Considerations for Patients on Psychotropic Drug Therapies. Neurol Int 2021; 13:640-658. [PMID: 34940748 PMCID: PMC8708655 DOI: 10.3390/neurolint13040062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/08/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Psychotropic drugs are used in the treatment of psychiatric and non-psychiatric conditions. Many patients who are on psychotropic medications may present for procedures requiring anesthesia. Psychotropic medications can have dangerous interactions with drugs commonly used in anesthesia, some of which can be life-threatening. In this review, we describe the current anesthetic considerations for patients on psychotropic drug therapies, including antidepressants, antipsychotics, mood stabilizers, anxiolytics, and stimulants. The pharmacology, side effects, and potential drug interactions of the commonly prescribed psychotropic drug therapies with anesthetic agents are described. Further, we highlight the current recommendations regarding the cessation and continuation of these medications during the perioperative period.
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Affiliation(s)
- Monica W. Harbell
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
- Correspondence:
| | - Catalina Dumitrascu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | - Layne Bettini
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | - Soojie Yu
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
| | | | - Veerandra Koyyalamudi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA; (C.D.); (L.B.); (S.Y.); (V.K.)
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2
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İyilikçi L, Büyükçoban S, İnce İE, Kovalı M. Evaluation of Herbal Product Use and Preanaesthetic Questioning of Couples Undergoing In Vitro Fertilisation. Turk J Anaesthesiol Reanim 2021; 49:144-151. [PMID: 33997844 PMCID: PMC8098732 DOI: 10.5152/tjar.2020.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/04/2020] [Indexed: 11/22/2022] Open
Abstract
Objective This study aimed to determine the levels of herbal product use among couples in vitro fertilisation (IVF) treatment in Turkey and the status of questioning in terms of herbal product usage. Methods After ethics committee approval, the study included 257 people, which were the couples receiving treatment in Dokuz Eylül University IVF units from 1st August, 2018, to 28th February, 2019. The couples were given 16-questions survey form to determine their herbal product use. Vitamin and herbal product use in the past 3 months was separately questioned. Results Significant differences were identified between women and men only in terms of age group. The rate of answering yes to the question about herbal product use in the study group was 13.6%, whereas 40.8% participants marked at least 1 item on the list of herbal products. Most people stated that they used herbal products by increasing the amounts in daily consumption. The top 5 products included onion, garlic, thyme, cinnamon and carob. Of the female patients being treated with IVF, 62.5% used vitamin supplements and 48.6% used herbal products. Of the men undergoing the same treatment (partners of the female participants), 37.5% used vitamin supplements and 51.4% used herbal products. Conclusion Asking questions to patients receiving infertility treatment or anaesthesia is important in terms of medication interactions and treatment success. For a laborious and costly treatment, such as IVF, detailed history should be taken and herbal product used and cessation times must be searched in detail.
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Affiliation(s)
- Leyla İyilikçi
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Sibel Büyükçoban
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - İçten Ezgi İnce
- Department of Anaesthesiology and Reanimation, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Müge Kovalı
- IVF Unit, Dokuz Eylül University Hospital, İzmir, Turkey
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Cummings KC, Keshock M, Ganesh R, Sigmund A, Kashiwagi D, Devarajan J, Grant PJ, Urman RD, Mauck KF. Preoperative Management of Surgical Patients Using Dietary Supplements: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement. Mayo Clin Proc 2021; 96:1342-1355. [PMID: 33741131 DOI: 10.1016/j.mayocp.2020.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/10/2020] [Accepted: 08/11/2020] [Indexed: 01/11/2023]
Abstract
The widespread use of complementary products poses a challenge to clinicians in the perioperative period and may increase perioperative risk. Because dietary supplements are regulated differently from traditional pharmaceuticals and guidance is often lacking, the Society for Perioperative Assessment and Quality Improvement convened a group of experts to review available literature and create a set of consensus recommendations for the perioperative management of these supplements. Using a modified Delphi method, the authors developed recommendations for perioperative management of 83 dietary supplements. We have made our recommendations to discontinue or continue a dietary supplement based on the principle that without a demonstrated benefit, or with a demonstrated lack of harm, there is little downside in temporarily discontinuing an herbal supplement before surgery. Discussion with patients in the preoperative visit is a crucial time to educate patients as well as gather vital information. Patients should be specifically asked about use of dietary supplements and cannabinoids, as many will not volunteer this information. The preoperative clinic visit provides the best opportunity to educate patients about the perioperative management of various supplements as this visit is typically scheduled at least 2 weeks before the planned procedure.
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Affiliation(s)
- Kenneth C Cummings
- Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH.
| | - Maureen Keshock
- Department of Regional Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH
| | - Ravindra Ganesh
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Deanne Kashiwagi
- Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jagan Devarajan
- Department of Regional Anesthesiology, Anesthesiology Institute, Cleveland Clinic, OH
| | - Paul J Grant
- Division of Hospital Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Richard D Urman
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Karen F Mauck
- Division of General Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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Hegazy NH, Breitinger HG, Breitinger U. Kavalactones from Kava (Piper methysticum) root extract as modulators of recombinant human glycine receptors. Biol Chem 2020; 400:1205-1215. [PMID: 31141476 DOI: 10.1515/hsz-2019-0112] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
Roots of kava (Piper methysticum) plant are used in almost all Pacific Ocean cultures to prepare a drink with sedative, anesthetic and euphoric properties. One of the main active ingredients of the extract are kava lactones. Here, kava root CO2 extract and three kavalactones, DL-kavain, dihydrokavain and yangonin (isolated from whole extract by column chromatography) were tested for their inhibitory action on recombinant homomeric human α1 glycine receptors expressed in HEK293 cells. Kava CO2 root extract, as well as the individual components DL-kavain, dihydrokavain and yangonin inhibited glycine receptor activity in a dose-dependent manner. DL-kavain was the most potent inhibitor (IC50 = 0.077 ± 0.002 mm), followed by yangonin (IC50 = 0.31 ± 0.04 mm) and dihydrokavain (IC50 = 3.23 ± 0.10 mm) which were 4- and 40-fold less active than DL-kavain, respectively. Application of kava root extract did not reduce maximum currents, but increased EC50 of glycine. Simultaneous application of kava extract and strychnine showed additive inhibition, suggesting that binding of kavalactones and strychnine on the receptor is mutually exclusive. Overall, kavalactones exert a moderate inhibitory effect on the human α1 glycine receptor with DL-kavain being the most potent constituent.
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Affiliation(s)
- Nada Hany Hegazy
- Department of Biochemistry, German University in Cairo, Main Entrance of Al Tagamoa Al Khames, New Cairo 11835, Egypt
| | - Hans-Georg Breitinger
- Department of Biochemistry, German University in Cairo, Main Entrance of Al Tagamoa Al Khames, New Cairo 11835, Egypt
| | - Ulrike Breitinger
- Department of Biochemistry, German University in Cairo, Main Entrance of Al Tagamoa Al Khames, New Cairo 11835, Egypt
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Volgin A, Yang L, Amstislavskaya T, Demin K, Wang D, Yan D, Wang J, Wang M, Alpyshov E, Hu G, Serikuly N, Shevyrin V, Wappler-Guzzetta E, de Abreu M, Kalueff A. DARK Classics in Chemical Neuroscience: Kava. ACS Chem Neurosci 2020; 11:3893-3904. [PMID: 31904216 DOI: 10.1021/acschemneuro.9b00587] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Kava (kava kava, Piper methysticum) is a common drug-containing plant in the Pacific islands. Kavalactones, its psychoactive compounds, exert potent central nervous system (CNS) action clinically and in animal models. However, the exact pharmacological profiles and mechanisms of action of kava on the brain and behavior remain poorly understood. Here, we discuss clinical and experimental data on kava psychopharmacology and summarize chemistry and synthesis of kavalactones. We also review its societal impact, drug use and abuse potential, and future perspectives on translational kava research.
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Affiliation(s)
- Andrey Volgin
- School of Pharmacy, Southwest University, Chongqing 400700, China
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
| | - LongEn Yang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Tamara Amstislavskaya
- Scientific Research Institute of Physiology and Basic Medicine, Novosibirsk 630117, Russia
| | - Konstantin Demin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, St. Petersburg 194156, Russia
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
| | - Dongmei Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Dongni Yan
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Jingtao Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Mengyao Wang
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Erik Alpyshov
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Guojun Hu
- School of Pharmacy, Southwest University, Chongqing 400700, China
| | - Nazar Serikuly
- School of Pharmacy, Southwest University, Chongqing 400700, China
- The International Zebrafish Neuroscience Research Consortium (ZNRC), Slidell, Louisiana 70458, United States
| | | | - Edina Wappler-Guzzetta
- Department of Pathology, Loma Linda University Medical Center and School of Medicine, Loma Linda, California 92350, United States
| | - Murilo de Abreu
- Bioscience Institute, University of Passo Fundo, Passo Fundo, Brazil
| | - Allan Kalueff
- School of Pharmacy, Southwest University, Chongqing 400700, China
- Institute of Translational Biomedicine, St. Petersburg State University, St. Petersburg 199034, Russia
- Ural Federal University, Ekaterinburg 620002, Russia
- Russian Scientific Center of Radiology and Surgical Technologies, Ministry of Healthcare of Russian Federation, St. Petersburg 197758, Russia
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Wang CZ, Moss J, Yuan CS. Commonly Used Dietary Supplements on Coagulation Function during Surgery. MEDICINES (BASEL, SWITZERLAND) 2015; 2:157-185. [PMID: 26949700 PMCID: PMC4777343 DOI: 10.3390/medicines2030157] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Abstract
BACKGROUND Patients who undergo surgery appear to use dietary supplements significantly more frequently than the general population. Because they contain pharmacologically active compounds, dietary supplements may affect coagulation and platelet function during the perioperative period through direct effects, pharmacodynamic interactions, and pharmacokinetic interactions. However, in this regard, limited studies have been conducted that address the pharmacological interactions of dietary supplements. To avoid possible bleeding risks during surgery, information of potential complications of dietary supplements during perioperative management is important for physicians. METHODS Through a systematic database search of all available years, articles were identified in this review if they included dietary supplements and coagulation/platelet function, while special attention was paid to studies published after 1990. RESULTS Safety concerns are reported in commercially available dietary supplements. Effects of the most commonly used natural products on blood coagulation and platelet function are systematically reviewed, including 11 herbal medicines (echinacea, ephedra, garlic, ginger, ginkgo, ginseng, green tea, kava, saw palmetto, St John's wort, and valerian) and 4 other dietary supplements (coenzyme Q10, glucosamine and chondroitin sulfate, fish oil, and vitamins). Bleeding risks of garlic, ginkgo, ginseng, green tea, saw palmetto, St John's wort, and fish oil are reported. Cardiovascular instability was observed with ephedra, ginseng, and kava. Pharmacodynamic and pharmacokinetic interactions between dietary supplements and drugs used in the perioperative period are discussed. CONCLUSIONS To prevent potential problems associated with the use of dietary supplements, physicians should be familiar with the perioperative effects of commonly used dietary supplements. Since the effects of dietary supplements on coagulation and platelet function are difficult to predict, it is prudent to advise their discontinuation before surgery.
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Affiliation(s)
- Chong-Zhi Wang
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-773-702-0166; Fax: +1-773-834-0601
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Delayed emergence after anesthesia. J Clin Anesth 2015; 27:353-60. [PMID: 25912729 DOI: 10.1016/j.jclinane.2015.03.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 02/04/2015] [Accepted: 03/26/2015] [Indexed: 01/01/2023]
Abstract
In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports. In this review, we summarize and discuss less common and difficult to diagnose reasons for delayed emergence and present cases from our own experience or reference published case reports/case series. The goal is to draw attention to less common reasons for delayed emergence, identify patient populations that are potentially at risk and to help anesthesiologists identifying a possible cause why their patient is slow to wake up.
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Psychophytomedicine: an overview of clinical efficacy and phytopharmacology for treatment of depression, anxiety and insomnia. Holist Nurs Pract 2015; 28:275-80. [PMID: 24919098 DOI: 10.1097/hnp.0000000000000040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Nowadays, herbal medicines are widely used by most of the people, including the pre-surgical population. These medicines may pose numerous challenges during perioperative care. The objective of the current literature review is to dwell upon the impact of the use of herbal medicines during the perioperative period, and to review the strategies for managing their perioperative use. The data was generated from various articles of different journals, text books, web source, including, Entrez Pubmed, Medscape, WebMD, and so on. Selected only those herbal medicines for which information on, safety, usage, and precautions during the perioperative period was available. Thereafter, the information about safety, pharmacokinetics, and pharmacodynamics from selected literature was gathered and analyzed. The whole review focused on the fact that these commonly used alternative medicines could sometimes pose as a concern during the perioperative period, in various ways. These complications could be due to their direct action, pharmacodynamic effect, or pharmacokinetic effect. In view of the serious impacts of herbal medicine usage in perioperative care, the anesthesiologist should take a detailed history, especially stressing on the use of herbal medicine during the preoperative anesthetic assessment. The anesthesiologist should also be aware of the potential perioperative effects of those drugs. Accordingly, steps should to be taken to prevent, recognize, and treat the complications that may arise due to their use or discontinuation.
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Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Associate Professor, Department of Anesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Banur, Punjab, India
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10
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Rosen JE, Gardiner P, Lee SL. Complementary and Integrative Treatments. Otolaryngol Clin North Am 2013; 46:423-35. [DOI: 10.1016/j.otc.2013.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs 2013; 27:301-19. [PMID: 23653088 DOI: 10.1007/s40263-013-0059-9] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Research in the area of herbal psychopharmacology has revealed a variety of promising medicines that may provide benefit in the treatment of general anxiety and specific anxiety disorders. However, a comprehensive review of plant-based anxiolytics has been absent to date. Thus, our aim was to provide a comprehensive narrative review of plant-based medicines that have clinical and/or preclinical evidence of anxiolytic activity. We present the article in two parts. In part one, we reviewed herbal medicines for which only preclinical investigations for anxiolytic activity have been performed. In this current article (part two), we review herbal medicines for which there have been both preclinical and clinical investigations of anxiolytic activity. A search of MEDLINE (PubMed), CINAHL, Scopus and the Cochrane Library databases was conducted (up to 28 October 2012) for English language papers using the search terms 'anxiety' OR 'anxiety disorder' OR 'generalized anxiety disorder' OR 'social phobia' OR 'post-traumatic stress disorder' OR 'panic disorder' OR 'agoraphobia' OR 'obsessive compulsive disorder' in combination with the search terms 'Herb*' OR 'Medicinal Plants' OR 'Botanical Medicine' OR 'Chinese herb*', in addition to individual herbal medicines. This search of the literature revealed 1,525 papers, of which 53 plants were included in the review (having at least one study using the whole plant extract). Of these plants, 21 had human clinical trial evidence (reviewed here in part two), with the other 32 having solely preclinical evidence (reviewed in part one). Support for efficacy was found for chronic use (i.e. greater than one day) of the following herbs in treating a range of anxiety disorders in human clinical trials: Piper methysticum, Matricaria recutita, Ginkgo biloba, Scutellaria lateriflora, Silybum marianum, Passiflora incarnata, Withania somniferum, Galphimia glauca, Centella asiatica, Rhodiola rosea, Echinacea spp., Melissa officinalis and Echium amoenum. For several of the plants studied, conclusions need to be tempered due to methodological issues such as small sample sizes, brief intervention durations and non-replication. Current evidence does not support Hypericum perforatum or Valeriana spp. for any anxiety disorder. Acute anxiolytic activity was found for Centella asiatica, Salvia spp., Melissa officinalis, Passiflora incarnata and Citrus aurantium. Bacopa monnieri has shown anxiolytic effects in people with cognitive decline. The therapeutic application of psychotropic plant-based treatments for anxiety disorders is also discussed, specifically Psychotria viridis and Banisteriopsis caarti (ayahuasca), Psilocybe spp. and cannabidiol-enriched (low tetrahydrocannabinol (Δ(9)-THC)) Cannabis spp.
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Bodkin R, Schneider S, Rekkerth D, Spillane L, Kamali M. Rhabdomyolysis associated with kava ingestion. Am J Emerg Med 2012; 30:635.e1-3. [DOI: 10.1016/j.ajem.2011.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 01/26/2011] [Indexed: 11/17/2022] Open
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Braun LA, Cohen M. Use of Complementary Medicines by Cardiac Surgery Patients; Undisclosed and Undetected. Heart Lung Circ 2011; 20:305-11. [DOI: 10.1016/j.hlc.2011.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 01/10/2011] [Indexed: 10/18/2022]
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LaPorte E, Sarris J, Stough C, Scholey A. Neurocognitive effects of kava (Piper methysticum): a systematic review. Hum Psychopharmacol 2011; 26:102-11. [PMID: 21437989 DOI: 10.1002/hup.1180] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Accepted: 01/21/2011] [Indexed: 11/10/2022]
Abstract
RATIONALE Kava (Piper methysticum) elicits dose-dependent psychotropic effects and thus may potentially deleteriously affect cognitive performance. Clinical trials have assessed the effects of kava on cognition, however, to our knowledge no systematic review has been conducted in this area. OBJECTIVE To systematically review the effects of kava on cognition, providing an analysis of the individual study's methodological quality, results and effect sizes. METHODS A systematic review was conducted of publications up to June 15th 2010, using the electronic databases MEDLINE, PsychINFO, CINAHL, Web of Science and The Cochrane Library. The search criteria involved kava and cognition related terms, e.g. memory and attention. RESULTS Ten human clinical trials met inclusion criteria (acute n = 7, chronic n = 3). One acute study found that kava significantly improved visual attention and working memory processes while another found that kava increased body sway. One chronic study found that kava significantly impaired visual attention during high-cognitive demand. Potential enhanced cognition may be attributed to the ability of kava to inhibit re-uptake of noradrenaline in the pre-frontal cortex, while increased body sway may be due to GABA pathway modulation. CONCLUSIONS The majority of evidence suggests that kava has no replicated significant negative effects on cognition.
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Affiliation(s)
- E LaPorte
- Brain Sciences Institute, University of Technology, Melbourne, Victoria, Australia.
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Sarris J, LaPorte E, Schweitzer I. Kava: a comprehensive review of efficacy, safety, and psychopharmacology. Aust N Z J Psychiatry 2011; 45:27-35. [PMID: 21073405 DOI: 10.3109/00048674.2010.522554] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OVERVIEW Kava (Piper methysticum) is a South Pacific psychotropic plant medicine that has anxiolytic activity. This effect is achieved from modulation of GABA activity via alteration of lipid membrane structure and sodium channel function, monoamine oxidase B inhibition, and noradrenaline and dopamine re-uptake inhibition. Kava is available over the counter in jurisdictions such as the USA, Australia and New Zealand. Due to this, a review of efficacy, safety and clinical recommendations is advised. OBJECTIVE To conduct a comprehensive review of kava, in respect to efficacy, psychopharmacology, and safety, and to provide clinical recommendations for use in psychiatry to treat generalized anxiety disorder (GAD). METHODS A review was conducted using the electronic databases MEDLINE, CINAHL, PsycINFO and the Cochrane Library during mid 2010 of search terms relating to kava and GAD. A subsequent forward search was conducted of key papers using Web of Science cited reference search. RESULTS The current weight of evidence supports the use of kava in treatment of anxiety with a significant result occurring in four out of six studies reviewed (mean Cohen's d = 1.1). Safety issues should however be considered. Use of traditional water soluble extracts of the rhizome (root) of appropriate kava cultivars is advised, in addition to avoidance of use with alcohol and caution with other psychotropic medications. Avoidance of high doses if driving or operating heavy machinery should be mandatory. For regular users routine liver function tests are advised. CONCLUSIONS While current evidence supports kava for generalized anxiety, more studies are required to assess comparative efficacy and safety (on the liver, cognition, driving, and sexual effects) versus established pharmaceutical comparators.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Victoria, Australia.
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16
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Pescitelli G, Bilia AR, Bergonzi MC, Vincieri FF, Di Bari L. Cyclodextrins as carriers for kavalactones in aqueous media: spectroscopic characterization of (S)-7,8-dihydrokavain and beta-cyclodextrin inclusion complex. J Pharm Biomed Anal 2010; 52:479-83. [PMID: 20185265 DOI: 10.1016/j.jpba.2010.01.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 01/21/2010] [Accepted: 01/22/2010] [Indexed: 10/19/2022]
Abstract
Kavalactones represent the active constituents of kava-kava (Piper methysticum G. Forster), endowed with sedative and anaesthetic properties. Kavalactones are polar constituents, but poorly soluble in water with a low bioavailability. In this study, the formation of inclusion complexes of one of the most representative kavalactone isolated from kava-kava extract, (S)-7,8-dihydrokavain (DHK), with beta-cyclodextrin (beta-CyD) was investigated mainly by spectroscopic methods. NMR experiments were extensively used for the complete characterization of the complex and included (1)H NMR complexation shifts analysis, (1)H NMR diffusion measurements (DOSY), and ROESY experiments. In particular DOSY experiments demonstrated that in the presence of beta-CyD the translational diffusion of kavalactone is sizably slowed down (2.5x10(-10)m(2)/s) with respect to the free drug (4.4x10(-10)m(2)/s) according to the inclusion of DHK in the cavity of (beta-CyD). ROESY experiments confirmed the inclusion of DHK in the hydrophobic pocket of beta-CyD through the primary hydroxyl rim, being the most relevant interactions between the H3' of beta-CyD and the ortho protons on the phenyl ring of the DHK, and between H5' of beta-CyD and the meta/para protons of DHK phenyl ring. The inclusion of the phenyl ring of DHK, leaving the lactone moiety outside of CyD was also confirmed by the induced CD effects. The binary solution DHK/beta-CyD shows a 50% intensity increase of the negative band of the pi-pi* transitions of the phenyl ring with respect to the absorption observed with DHK alone. Molecular dynamics simulations results corroborated and further clarify observed spectroscopic data. It was found that the phenylethyl substituent at C6 has a preferential equatorial position in the free state, and an axial one in the complex, justifying the large downfield shift experienced by H6 of DHK upon binding. Finally the influence of beta-CyD on water solubility of DHK was investigated by phase-solubility studies. In the range 2-4mM of host, solubility of DHK was increased only two-fold, but being beta-CyD also a penetration enhancer, in vivo studies will be performed to clarify a possible role of the complex on the bioavailability of DHK.
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Affiliation(s)
- G Pescitelli
- University of Pisa, Department of Chemistry and Industrial Chemistry, via Risorgimento 35, 56126 Pisa, Italy
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Slavin SL, Rogers RG, Komesu Y, Omotosho T, Hammil S, Lewis C, Sapien R. Complementary and alternative medicine (CAM) use in women with pelvic floor disorders: a cohort study. Int Urogynecol J 2009; 21:431-7. [PMID: 19967336 DOI: 10.1007/s00192-009-1058-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 11/09/2009] [Indexed: 12/14/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective of this study was to compare complementary and alternative medicine (CAM) use in women with and without pelvic floor disorders (PFD). METHODS We conducted a survey of women presenting to a specialty urogynecology (Urogyn) and gynecology (Gyn) clinic that examined demographic data, CAM use, and the presence of PFD (validated questionnaires). T tests, Fisher's exact tests, and logistic regression were used for analysis. To detect a 20% difference between groups, 234 Urogyn and 103 Gyn patients were needed. RESULTS Participants included 234 Urogyn and 103 Gyn patients. Urogyn patients reported more CAM use than Gyn patients, even when controlled for differences between groups (51% vs. 32%, adjusted p = 0.006). Previous treatment (61% vs. 39%, adjusted p < 0.001) and increased number of PFD was associated with increased CAM use (adjusted p = 0.02). CONCLUSIONS Women with PFD use CAM more frequently than women without PFD.
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Affiliation(s)
- Shannon L Slavin
- Department of Obstetrics and Gynecology, University of New Mexico Health Sciences Center, 1 University of New Mexico, MSC 10-5580, Albuquerque, NM 87131-0001, USA
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18
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Perioperative Management of Antidepressants and Herbal Medications in Elective Plastic Surgery. Plast Reconstr Surg 2009; 123:377-386. [DOI: 10.1097/prs.0b013e3181934892] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kleinschmidt S, Rump G, Kotter J. [Herbal medications. Possible importance for anaesthesia and intensive care medicine]. Anaesthesist 2008; 56:1257-66. [PMID: 17898965 DOI: 10.1007/s00101-007-1264-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
There is a great enthusiasm for herbal medications with increasing and widespread use among the population in various countries. A certain scepticism towards the use of pharmaceutical drugs may promote the use of herbal medicines such as echinacea, ginger, garlic, ginkgo, cranberry, valerian or St. John's wort even in western countries. Although considered safe among users, adverse effects such as increased bleeding tendencies, hypertension and hepatotoxicity can occur. Physicians should caution patients on the adverse side effects of herbal medicines and interactions between herbal medicines and pharmaceutical drugs, leading to various and uncontrollable deterioration of vital functions in the perioperative period. Although evidence-based data are lacking, anaesthesiologists and surgeons should be familiar with the effects of herbal medicines and should enquire about the use of these agents in the preoperative assessment. Currently available data suggest that herbal medications should be discontinued up to 2 weeks before elective surgery, although no guidelines of scientific societies have yet been published.
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Affiliation(s)
- S Kleinschmidt
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland.
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Bilia AR, Scalise L, Bergonzi MC, Vincieri F. Effect of surfactants and solutes (glucose and NaCl) on solubility of Kavain--a technical note. AAPS PharmSciTech 2008; 9:444-8. [PMID: 18431659 DOI: 10.1208/s12249-008-9064-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 02/05/2008] [Indexed: 11/30/2022] Open
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Kaye AD, Baluch A, Kaye AJ, Frass M, Hofbauer R. Pharmacology of herbals and their impact in anesthesia. Curr Opin Anaesthesiol 2007; 20:294-9. [PMID: 17620834 DOI: 10.1097/aco.0b013e3281f8d0eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU School of Medicine, New Orleans, LA 70112, USA.
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Ulbricht C, Basch E, Boon H, Ernst E, Hammerness P, Sollars D, Tsourounis C, Woods J, Bent S. Safety review of kava (Piper methysticum) by the Natural Standard Research Collaboration. Expert Opin Drug Saf 2005; 4:779-94. [PMID: 16011454 DOI: 10.1517/14740338.4.4.779] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This systematic review discusses the proposed uses, dosing parameters, adverse effects, toxicology, interactions and mechanism of action of kava. The widespread concern regarding the potential hepatotoxicity of kava is discussed. A recommendation is made to consolidate and analyse available reports and to continue postmarket surveillance in an international repository to prevent duplicates and promote collection of thorough details at the time of each report so that any association with kava is clearly defined.
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Affiliation(s)
- Catherine Ulbricht
- Natural Standard Research Collaboration, 1 Broadway, 14th Floor, Cambridge, MA 02142, USA.
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De Baerdemaeker L, Audenaert K, Peremans K. Anaesthesia for patients with mood disorders. Curr Opin Anaesthesiol 2005; 18:333-8. [PMID: 16534359 DOI: 10.1097/01.aco.0000169243.03754.85] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Treatment of patients with mood disorders has changed over the past few years. It is not always clear how the anaesthesiologist has to incorporate these antidepressants and mood stabilizers in premedication or even how to anticipate any interaction with anaesthetic technique. RECENT FINDINGS The older generation of antidepressants (tricyclic antidepressants, monoamine oxidase inhibitors) is seldom used nowadays. Actually, treatment with selective serotonin-reuptake inhibitors, serotonin noradrenaline-reuptake inhibitors, noradrenaline-reuptake inhibitor, noradrenergic and specific serotonin antidepressants, or noradrenaline- and dopamine-reuptake inhibitors is common practice. Combination with atypical antipsychotics and newer antiepileptics is suggested as an add-on therapy or as monotherapy, while lithium and valproate therapy is still the first choice in bipolar mood stabilization. Electroconvulsive therapy is still used in therapy-resistant forms of depression; however, the anaesthesia technique herein has been increasingly well described in the last years. Electroencephalogram-derived monitoring such as bispectral index (BIS) can be used as a tool to predict seizure duration. Intoxications with these newer agents are not infrequent and deserve specific attention. In particular, serotonin syndrome is a life-threatening condition that requires great care by the anaesthesiologist. The chronic use of antidepressants does affect the anaesthetized patient: hypotension, arrhythmias, changed thermoregulation, altered postoperative pain, differences in surgical stress response and postoperative confusion. However, it is advised to continue these drugs in the perioperative period. SUMMARY Discontinuation of treatment with the new antidepressants in the perioperative period is not advised. Intoxication with the newer drugs appears to be safer. The anaesthesiologist must pay attention to serotonin syndrome. Electroconculsive therapy has gained renewed attention.
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Affiliation(s)
- Luc De Baerdemaeker
- Department of Anaesthesia, Ghent University Hospital, De Pintelaan 185, B-9000 Gent, Belgium.
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Abstract
Pain therapies from natural sources date back thousands of years to the use of plant and animal extracts for a variety of painful conditions and injuries. We certainly are all familiar with modern uses of plant-derived analgesic compounds such as opium derivatives from papaverum somniferum and salicylates from willow bark (Salix species). Local anesthetics were isolated from coca leaves in the late 1800s. Sarapin, derived from carnivorous pitcher plants, has been injected for regional analgesia in human and veterinary medicine, but efficacy is controversial. Biologic organisms can play important roles in developing an understanding of pain mechanisms, either from isolation of compounds that are analgesic or of compounds that produce pain, hyperalgesia, and allodynia.
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Affiliation(s)
- Lori Reisner
- University of California, San Francisco, Department of Clinical Pharmacy, 521 Parnassus, C-152, San Francisco, CA 94143-0622, USA.
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