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Tirupathi S, Gopalakrishnan D, Deshkar S. Herbal topical anesthetics in dentistry: an exploratory review. J Dent Anesth Pain Med 2022; 22:419-426. [PMID: 36601130 PMCID: PMC9763823 DOI: 10.17245/jdapm.2022.22.6.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/23/2022] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
Topical anesthetics are routinely used in dental practice for various purposes. They are usually available at higher dosages and have serious potential adverse reactions, such as seizures, anaphylaxis, and acquired methemoglobinemia. To date, the scope of application of herbal plants and their extracts, which have medicinal properties, has been elaborated in the field of dentistry. The growing interest in herbal medication can be attributed to the increased safety profile of herbal agents, in contrast to synthetic preparations that have a higher risk of systemic complications. Herbal preparations can induce topical anesthesia with minimal side effects. Recently, many studies have reported the use of topical herbal preparations. The current review aimed to evaluate data from various articles comparing the capacity of herbal topical anesthetic formulations and conventional synthetic anesthetics in reducing pain perception when used as local anesthesia before dental procedures.
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Affiliation(s)
- Sunnypriyatham Tirupathi
- Department of Pediatric and Preventive Dentistry, Dr.D.Y. Patil Dental College and Hospital, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Dharmarajan Gopalakrishnan
- Department of Periodontology, Dr.D.Y. Patil Dental College and Hospital, Dr.D.Y. Patil Vidyapeeth, Pimpri, Pune, Maharashtra, India
| | - Sanjeevani Deshkar
- Department of Pharmaceutics, Dr.D.Y. Patil Institute of Pharmaceutical Sciences & Research, Dr.D.Y. Patil Unitech Society, Pimpri, Pune, Maharashtra, India
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Borges R, Kai KC, Lima CA, Zezell DM, de Araujo DR, Marchi J. Bioactive glass/poloxamer 407 hydrogel composite as a drug delivery system: The interplay between glass dissolution and drug release kinetics. Colloids Surf B Biointerfaces 2021; 206:111934. [PMID: 34182428 DOI: 10.1016/j.colsurfb.2021.111934] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/31/2021] [Accepted: 06/18/2021] [Indexed: 12/15/2022]
Abstract
Since patients suffer pain in the post-surgery of bone repair interventions, bioactive glass/hydrogel drug delivery systems containing local anesthetics, such as ropivacaine, could improve patient life quality by combining bone regeneration with anesthetics. However, poloxamer-based hydrogel properties are sensitive to ions, temperature, and water contents and could be structurally influenced by the ionic dissolution products from bioactive glasses of different compositions. Therefore, this study evaluated the interplay between bioactive glass dissolution kinetics and poloxamer 407 properties, establishing a correlation between changes in the hydrogel and drug release kinetics. Three glass compositions were produced, yielding Ca-rich, Na-rich, and an intermediate glass composition. The influence of Ca/Na ratios on the glass structure and dissolution was investigated. Further, the glasses and ropivacaine were incorporated in the poloxamer hydrogel, and the self-assembly ability of poloxamer, the degradation rate, and the drug release kinetics of the composites were evaluated. The results suggested that glass connectivity affected the early-stage of glass dissolution, while sodium mobility influenced the long-term. The dissolution products from the glasses interact with the supramolecular structure of the poloxamer, causing structural changes responsible for hydrogel degradation. Consequently, by changing the Ca/Na ratio in the glasses, it is possible to modulate glass dissolution that, in turn, influences the ropivacaine release. Thus, we propose that the Ca/Na ratio in quaternary bioactive glasses can be used to modulate drug-delivery properties from systems based on bioactive glasses and poloxamer 407.
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Affiliation(s)
- Roger Borges
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Avenida Estados Unidos 5001, Bairro Bangu, Santo André, SP, Brazil.
| | - Karen C Kai
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Avenida Estados Unidos 5001, Bairro Bangu, Santo André, SP, Brazil.
| | - Cassio A Lima
- Centro de Lasers e Aplicações, Instituto de Pesquisas Energéticas e Nucleares, Avenida Prof. Almeida Prado 2242, Butantã, São Paulo, SP, Brazil; Institute of Integrative Biology, University of Liverpool, Crown Street, Liverpool, L69 7ZB, United Kingdom.
| | - Denise M Zezell
- Centro de Lasers e Aplicações, Instituto de Pesquisas Energéticas e Nucleares, Avenida Prof. Almeida Prado 2242, Butantã, São Paulo, SP, Brazil.
| | - Daniele R de Araujo
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Avenida Estados Unidos 5001, Bairro Bangu, Santo André, SP, Brazil.
| | - Juliana Marchi
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Avenida Estados Unidos 5001, Bairro Bangu, Santo André, SP, Brazil.
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Eskandarani RM, Alghamdi FS. Naphthalene Toxicity in a Three-Year-Old Child Complicated by Severe Hemolytic Anemia and Mild Methemoglobinemia: A Case Report. J Emerg Med 2020; 59:e113-e117. [PMID: 32682642 DOI: 10.1016/j.jemermed.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/13/2020] [Accepted: 06/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Exposure to naphthalene, which is widely used in mothballs, does not usually produce adverse effects. However, naphthalene can be toxic, especially in individuals with underlying conditions such as glucose-6-phosphate-dehydrogenase (G6PD) deficiency. CASE REPORT A 3-year-old boy was brought to our Emergency Department after accidentally ingesting naphthalene mothballs 3 days prior to presentation. Laboratory investigations revealed that he had severe hemolytic anemia and mild methemoglobinemia (6%), which were treated with ascorbic acid and N-acetylcysteine. The patient tested positive for G6PD deficiency after stabilization and completion of his treatment. All provided treatments were administered empirically; test results were available only after the patient was discharged. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Naphthalene exposure is a common pediatric presentation with various complications that can occur in certain high-risk individuals, such as those with G6PD deficiency. Emergency physicians should be aware of this to anticipate and be able to treat worsening toxicity.
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Abstract
Methemoglobinemia can cause life-threatening hypoxia associated with cyanosis and dyspnea not responsive to oxygen. We present a case of recurrent methemoglobinemia because of occult use of topical benzocaine to the vulva. A 47-year-old female with medical history of vulvar cancer and HIV undergoing chemoradiation was sent by the oncology clinic to the emergency department for worsening dyspnea, fatigue, hypoxia to 78% on room air, and gradual onset of cyanosis over the past week. A methemoglobin (MetHb) level was 49%. She received methylene blue, and repeat MetHb levels initially decreased but later increased to 56% despite continued treatment. Additional interviews with the patient revealed she was applying vagicaine (20% benzocaine), an over the counter preparation to the vulvar area for analgesia, and she continued application while hospitalized. She received a total of 6 mg/kg methylene blue and underwent vaginal lavage with 60 mL of sterile saline and cleansed with soapy water. Cyanosis, hypoxia, and dyspnea resolved, and the MetHb level decreased to 5.4% on the day of discharge. Benzocaine is a frequent cause of iatrogenic methemoglobinemia. In this case, additional medication inquiries were helpful in making the diagnosis. Many patients do not consider over-the-counter medications to be potentially harmful. Methemoglobinemia from occult topical benzocaine administration to the vulva is an uncommon exposure route. Occult medication use can be a source of methemoglobinemia.
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Vohra R, Huntington S, Koike J, Le K, Geller RJ. Pediatric Exposures to Topical Benzocaine Preparations Reported to a Statewide Poison Control System. West J Emerg Med 2017; 18:923-927. [PMID: 28874945 PMCID: PMC5576629 DOI: 10.5811/westjem.2017.6.33665] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/17/2017] [Accepted: 06/29/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Topical benzocaine is a local anesthetic commonly used to relieve pain caused by teething, periodontal irritation, burns, wounds, and insect bites. Oral preparations may contain benzocaine concentrations ranging from 7.5% to 20%. Pediatric exposure to such large concentrations may result in methemoglobinemia and secondarily cause anemia, cyanosis, and hypoxia. Methods This is a retrospective study of exposures reported to a statewide poison control system. The electronic health records were queried for pediatric exposures to topical benzocaine treated at a healthcare facility from 2004 to 2014. Cases of benzocaine exposure were reviewed for demographic and clinical information, and descriptive statistical analysis was performed. Results The query resulted in 157 cases; 58 were excluded due to co-ingestants, or miscoding of non-benzocaine exposures. Children four years of age and younger represented the majority of cases (93%) with a median age of 1 year. There were 88 cases of accidental/ exploratory exposure, while 6 cases resulted from therapeutic application or error, 4 cases from adverse reactions, and 1 case from an unknown cause. Asymptomatic children accounted for 75.5% of cases, but major clinical effects were observed in 5 patients. Those with serious effects were exposed to a range of benzocaine concentrations (7.5–20%), with 4 cases reporting methemoglobin levels between 20.2%–55%. Methylene blue was administered in 4 of the cases exhibiting major effects. Conclusion The majority of exposures were accidental ingestions by young children. Most exposures resulted in minor to no effects. However, some patients required treatment with methylene blue and admission to a critical care unit. Therapeutic application by parents or caregivers may lead to adverse effects from these commonly available products.
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Affiliation(s)
- Rais Vohra
- California Poison Control System, Valley Children's Hospital, Madera, California.,University of California San Francisco, Fresno Medical Education and Research Program, Fresno, California
| | - Serena Huntington
- California Poison Control System, Valley Children's Hospital, Madera, California
| | - Jennifer Koike
- University of California, San Francisco, School of Pharmacy, San Francisco, California
| | - Kevin Le
- University of California, San Francisco, School of Pharmacy, San Francisco, California
| | - Richard J Geller
- California Poison Control System, Valley Children's Hospital, Madera, California
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Lipton M, Szlam SM, Barker K, Benitez JG. Methemoglobinemia Secondary to Topical Benzocaine Application to Gastrostomy Site. Pediatr Emerg Care 2016; 32:312-4. [PMID: 27139292 DOI: 10.1097/pec.0000000000000800] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Benzocaine is a common topical anesthetic that has the ability to induce methemoglobinemia (MetHgb) in large doses. We describe a 4-year-old girl who received a standard dose of topical benzocaine to her gastrostomy mucosa that resulted in rapid, severe MetHgb. She required intubation, mechanical ventilation, and multiple doses of methylene blue for treatment. The resultant tissue hypoxia from MetHgb caused profound confusion, cyanosis, and myocardial infarction. Although the patient did not sustain any permanent disability, this case demonstrates the need for emergency providers to rapidly identify and treat MetHgb to reverse tissue hypoxia and prevent long-term sequelae.
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Affiliation(s)
- Matthew Lipton
- From the *Department of Emergency Medicine, Vanderbilt University Medical Center; †Department of Pediatric Emergency Medicine, Monroe Carell Jr. Children's Hospital at Vanderbilt; ‡Tennessee Poison Center, Vanderbilt University Medical Center; §Department of Pharmacy Practice, Lipscomb University College of Pharmacy; and ∥Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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An Atypical Case of Methemoglobinemia due to Self-Administered Benzocaine. Case Rep Emerg Med 2015; 2015:670979. [PMID: 25874137 PMCID: PMC4383305 DOI: 10.1155/2015/670979] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 03/06/2015] [Indexed: 11/18/2022] Open
Abstract
Acquired methemoglobinemia is an uncommon hemoglobinopathy that results from exposure to oxidizing agents, such as chemicals or medications. Although, as reported in the adult population, it happens most often due to prescribed medication or procedural anesthesia and not due to easily accessed over-the-counter medications, the authors will describe an otherwise healthy male adult with no known medical history and no prescribed medications, who presented to the emergency department reporting generalized weakness, shortness of breath, headache, dizziness, and pale gray skin. In addition, the patient reported that he also had a severe toothache for several days, which he had been self-treating with an over-the-counter oral benzocaine gel. Ultimately, the diagnosis of methemoglobinemia was made by clinical history, physical examination, and the appearance of chocolate-colored blood and arterial blood gas (ABG) with cooximetry. After 2 mg/kg of intravenous methylene blue was administered, the patient had complete resolution of all signs and symptoms. This case illustrates that emergency physicians should be keenly aware of the potential of toxic hemoglobinopathy secondary to over-the-counter, nonprescribed medications. Discussion with patients regarding the dangers of inappropriate use of these medicines is imperative, as such warnings are typically not evident on product labels.
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Spiller HA, Russell JL, Casavant MJ, Ho RY, Gerona RR. Identification of N-Hydroxy-para-aminobenzoic acid in a cyanotic child after benzocaine exposure. Clin Toxicol (Phila) 2014; 52:976-9. [PMID: 25211007 DOI: 10.3109/15563650.2014.958615] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Methemoglobinemia (MetHb) after exposure to benzocaine (BZC) has been reported for more than 50 years, however the pathophysiologic mechanism has not been previously established. Direct administration of BZC to blood does not produce MetHb. After topical use, due to the lipophilicity and rapid acetylation in the tissue, little BZC reaches the liver for hepatic biotransformation. However, isolated human livers have been shown to produce MetHb forming N-hydroxyl metabolites from BZC. We report a case of BZC-induced MetHb with the first identification and quantification of the reactive metabolite responsible for the oxidative stress: N-Hydroxy-Para-amino benzoic acid (N-OH-PABA). CASE DETAILS An 8 year old male was admitted to a hospital for an appendectomy. Several applications of BZC spray were used during multiple attempts at nasogastric tube placement. In various attempts to achieve local anesthesia, benzocaine spray was used in both nares and through the mouth aimed at the posterior oropharynx. The patient subsequently became cyanotic with an initial MetHb level of 32.9 %. Methylene blue was administered and the patient promptly responded with resolution of cyanosis. Blood taken within 20 min of the initial symptoms contained benzocaine (5.2ug/mL), bupivacaine (740ng/mL), lidocaine (530ng/mL), acetaminophen (12ug/mL), midazolam (60ng/mL), PABA and N-OH-PABA (35ng/mL). Serum was analyzed using Liquid Chromatography- Quadrupole Time-of-Flight Mass Spectrometry. Mass spectrometry was done using an electrospray ionization source run in negative and positive polarities. A reference standard for N-OH-PABA was synthesized for confirmation and quantification. DISCUSSION The rare and idiopathic nature of methemoglobinemia after benzocaine use has made study of the pathophysiologic mechanism in humans difficult. Lack of understanding has brought calls for restriction of use of the widely used medication that may not be based on evidence. Our case presents several unique features: 1) benzocaine absorption after topical administration was documented with serum concentrations 2) confirmation of an in vivo formation of MetHb-forming n-hydroxyl-metabolite after benzocaine use and 3) the documentation of N-OH-PABA in humans within 20 min of MetHb post-benzocaine administration.
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Affiliation(s)
- H A Spiller
- Central Ohio Poison Center, Nationwide Children's Hospital , Columbus, OH , USA
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An evaluation of 10 percent and 20 percent benzocaine gels in patients with acute toothaches: efficacy, tolerability and compliance with label dose administration directions. J Am Dent Assoc 2014; 144:517-26. [PMID: 23633700 DOI: 10.14219/jada.archive.2013.0154] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief of toothache pain. They also assessed the compliance with the label dose administration directions on the part of participants with toothache pain. METHODS Under double-masked conditions, 576 participants self-applied study gel to an open tooth cavity and surrounding oral tissues. Participants evaluated their pain intensity and pain relief for 120 minutes. The authors determined the amount of gel the participants applied. RESULTS The responders' rates (the primary efficacy parameter), defined as the percentage of participants who had an improvement in pain intensity as exhibited by a pain score reduction of at least one unit on the dental pain scale from baseline for two consecutive assessments any time between the five- and 20-minute points, were 87.3 percent, 80.7 percent and 70.4 percent, respectively, for 20 percent benzocaine gel, 10 percent benzocaine gel and vehicle gel. Both benzocaine gels were significantly (P ≤ .05) better than vehicle gel; the 20 percent benzocaine gel also was significantly (P ≤ .05) better than the 10 percent benzocaine gel. The mean amount of gel applied was 235.6 milligrams, with 88.2 percent of participants applying 400 mg or less. CONCLUSIONS Both 10 percent and 20 percent benzocaine gels were more efficacious than the vehicle gel, and the 20 percent benzocaine gel was more efficacious than the 10 percent benzocaine gel. All treatments were well tolerated by participants. Practical Implications. Patients can use 10 percent and 20 percent benzocaine gels to temporarily treat toothache pain safely.
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Afzal A, Collazo R, Fenves AZ, Schwartz J. Methemoglobinemia precipitated by benzocaine used during intubation. Proc (Bayl Univ Med Cent) 2014; 27:133-5. [PMID: 24688201 DOI: 10.1080/08998280.2014.11929087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Methemoglobinemia is a rare cause of tissue hypoxia that can quickly become fatal without immediate recognition and prompt treatment. It refers to an increase in methemoglobin in the red blood cells, which can be due to genetic deficiency of the enzymes responsible for reducing hemoglobin or can develop after exposure to oxidizing agents or xenobiotics. Local anesthetics, particularly benzocaine, have long been implicated in the formation of methemoglobin. Benzocaine is used for teething pain as well as before invasive procedures such as intubation and transesophageal echocardiogram. In this case report, we describe a patient with acute appendicitis who developed severe methemoglobinemia following use of benzocaine during an emergent intubation. Our objective is to increase awareness of this rare but potentially fatal complication associated with the use of this anesthetic.
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Affiliation(s)
- Aasim Afzal
- Department of Internal Medicine, Baylor University Medical Center at Dallas (Afzal, Collazo, Schwartz); and the Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts (Fenves)
| | - Ruth Collazo
- Department of Internal Medicine, Baylor University Medical Center at Dallas (Afzal, Collazo, Schwartz); and the Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts (Fenves)
| | - Andrew Z Fenves
- Department of Internal Medicine, Baylor University Medical Center at Dallas (Afzal, Collazo, Schwartz); and the Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts (Fenves)
| | - John Schwartz
- Department of Internal Medicine, Baylor University Medical Center at Dallas (Afzal, Collazo, Schwartz); and the Massachusetts General Hospital, Harvard Medical School, Boston Massachusetts (Fenves)
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Acquired methemoglobinemia due to contaminated Holi colors - a rare but preventable complication. Indian J Pediatr 2013; 80:351-2. [PMID: 22700388 DOI: 10.1007/s12098-012-0823-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2011] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Jodi Lehr
- Wayne State University, Detroit, MI, USA.
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Abstract
Perioral ulcerated hemangiomas in infants can present a therapeutic challenge to clinicians, especially when associated with severe pain and difficulty feeding. Topical and oral pain medications can be beneficial, but feeding difficulties may still occur while awaiting healing of the ulceration with the use of systemic or topical agents. We present a case of an infant with an ulcerated lip hemangioma treated with an over-the-counter topical sealant in combination with systemic corticosteroid therapy who showed dramatic improvement in pain and tolerance to feeding, resulting in healing of the ulceration.
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Affiliation(s)
- Megan Strand
- Department of Dermatology, University of New Mexico, Albuquerque, New Mexico 87131, USA
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Bergamaschi MM, Alcantara GKS, Valério DAR, Queiroz RHC. Curcumin could prevent methemoglobinemia induced by dapsone in rats. Food Chem Toxicol 2011; 49:1638-41. [PMID: 21426920 DOI: 10.1016/j.fct.2011.03.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 12/21/2022]
Abstract
The curcumin's effect given orally by gavage in single- or multiple-dose regimens on methemoglobinemia induced by dapsone (DDS) was investigated in male Wistar rats. In the single-dose regimen, groups of 10 rats received either vehicle alone, or curcumin at 0.1, 1.0, 10, or 30 mg/kg body weight (bw), or curcumin at 0.02, 0.1, 1, 10, or 30 mg/kg bw plus DDS at 40 mg/kg bw, intraperitoneally (i.p.), 2 hours after. In the multiple-dose regimen, groups of 10 rats received either vehicle alone, or curcumin at 0.1, 1.0, 10, or 30 mg/kg bw for 5 days, with or without DDS (40 mg/kg bw, i.p.) 2 hours after on the fifth day. In both regimens, further groups of 10 rats were given DDS alone (positive controls) or normal saline (negative controls) i.p. Single-dose treatment with curcumin at 0.02 and 0.1 mg/kg bw significantly reduced DDS-induced methemoglobin formation, while the higher doses showed a pro-oxidant effect, significantly increasing DDS-induced methemoglobinemia. In the multiple-dose regimen, treatment with curcumin at 0.1 mg/kg bw significantly reduced DDS-induced methemoglobin formation, but the higher doses were without significant effect compared to DDS alone. It is concluded that curcumin at low doses mitigates methemoglobinemia induced by dapsone in rats, both in single- and multiple-dose regimens.
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Affiliation(s)
- Mateus M Bergamaschi
- Department of Clinical, Toxicological and Food Sciences Analysis, School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Av. do Café s/n, 14040-903 Ribeirão Preto, SP, Brazil.
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Chocolate-colored blood with normal artery oxygen: methemoglobinemia related to phenazopyridine. Am J Med Sci 2010; 341:337. [PMID: 20467292 DOI: 10.1097/maj.0b013e3181df9369] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bouziri A, Khaldi A, Menif K, Ben Jaballah N. Unusual cause of severe toxic methemoglobinemia in an infant: a case report. Int J Emerg Med 2010; 3:57-9. [PMID: 20414384 PMCID: PMC2850983 DOI: 10.1007/s12245-009-0149-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 11/26/2009] [Indexed: 11/29/2022] Open
Abstract
Toxic methemoglobinemia is an uncommon blood disorder induced by exposure to certain oxidizing agents and drugs. In severe cases, this condition may rapidly lead to major cardiopulmonary compromise and constitutes an emergency requiring prompt recognition and early management. We report an unusual case of severe toxic methemoglobinemia following wide cutaneous application of a pomade containing benzocaine, resorcin, and oxyquinoline (Nestosyl®) in an infant.
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Affiliation(s)
- Asma Bouziri
- Paediatric Intensive Care Unit, Children's Hospital of Tunis, Tunis, Tunisia.
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