Pharmacodynamic interaction of the sedative effects of Ternstroemia pringlei (Rose) Standl. with six central nervous system depressant drugs in mice

Herb-drug interactions: A short review on central and peripheral nervous system drugs

Herbal medicines are widely perceived as natural and safe remedies. However, their concomitant use with prescribed drugs is a common practice, often undertaken without full awareness of the potential risks and frequently without medical supervision. This practice introduces a tangible risk of herb-drug interactions, which can manifest as a spectrum of consequences, ranging from acute, self-limited reactions to unpredictable and potentially lethal scenarios. This review offers a comprehensive overview of herb-drug interactions, with a specific focus on medications targeting the Central and Peripheral Nervous Systems. Our work draws upon a broad range of evidence, encompassing preclinical data, animal studies, and clinical case reports. We delve into the intricate pharmacodynamics and pharmacokinetics underpinning each interaction, elucidating the mechanisms through which these interactions occur. One pressing issue that emerges from this analysis is the need for updated guidelines and sustained pharmacovigilance efforts. The topic of herb-drug interactions often escapes the attention of both consumers and healthcare professionals. To ensure patient safety and informed decision-making, it is imperative that we address this knowledge gap and establish a framework for continued monitoring and education. In conclusion, the use of herbal remedies alongside conventional medications is a practice replete with potential hazards. This review not only underscores the real and significant risks associated with herb-drug interactions but also underscores the necessity for greater awareness, research, and vigilant oversight in this often-overlooked domain of healthcare.

Ethnomedicine and neuropsychopharmacology in Mesoamerica

ETHNOPHARMACOLOGICAL RELEVANCE

The burden of disease caused by mental and neurological disorders is increasing globally, to a disproportionate degree in Latin America. In contrast to the many psychoactive plants with a use history in Mesoamerican cultures, the translation to the wider population of knowledge around numerous botanicals used contemporarily by indigenous Mesoamerican societies to treat psychological and neurological disorders did not receive the same attention.

MATERIAL AND METHODS

We used the previously published Mesoamerican Medicinal Plant Database to extract species and associated botanical drugs used as treatments for illnesses associated with the nervous system by Mesoamerican cultures in Belize, Guatemala, and Mexico. With the critical use of published pharmacological literature, the cross-culturally most salient genera are systematically reviewed.

RESULTS

From 2188 plant taxa contained in the database 1324 are used as treatments for illnesses associated with the nervous system. The ethnomedical data was critically confronted with the available biomedical literature for the 58 cross-culturally most salient genera. For a considerable proportion of the frequently used taxa, preclinical data are available, mostly validating ethnomedicinal uses.

CONCLUSION

This quantitative approach facilitates the prioritization of taxa for future pre-clinical, clinical and treatment outcome studies and gives patients, practitioners, and legislators a fundamental framework of evidence, on which to base decisions regarding phytomedicines.

Mucoadhesive effect of Curcuma longa extract and curcumin decreases the ranitidine effect, but not bismuth subsalicylate on ethanol-induced ulcer model

The study of pharmacological interactions between herbal remedies and conventional drugs is important because consuming traditional herbal remedies as supplements or alternative medicine is fairly common and their concomitant administration with prescribed drugs could either have a favorable or unfavorable effect. Therefore, this work aims to determine the pharmacological interactions of a turmeric acetone extract (TAE) and its main metabolite (curcumin) with common anti-ulcer drugs (ranitidine and bismuth subsalicylate), using an ethanol-induced ulcer model in Wistar rats. The analysis of the interactions was carried out via the Combination Index-Isobologram Equation method. The combination index (CI) calculated at 0.5 of the affected fraction (fa) indicated that the TAE or curcumin in combination with ranitidine had a subadditive interaction. The results suggest that this antagonistic mechanism is associated to the mucoadhesion of curcumin and the TAE, determined by rheological measurements. Contrastingly, both the TAE and curcumin combined with bismuth subsalicylate had an additive relationship, which means that there is no pharmacological interaction. This agrees with the normalized isobolograms obtained for each combination. The results of this study suggest that mucoadhesion of curcumin and the TAE could interfere in the effectiveness of ranitidine, and even other drugs.

Liver toxicity mechanisms of herbs commonly used in Latin America

Mexico owns approximately 4500 medicinal plants species, a great diversity that position it at the second place after China. According to the Mexican health department, 90% of common population consumes them to treat various diseases. Additionally, herbal remedies in Latin America (LA) are considered a common practice, but the frequency of use and the liver damage related to its consumption is still unknown. Despite the high prevalence and indiscriminate herbal consumption, the exact mechanism of hepatotoxicity and adverse effects is not fully clarified and is still questioned. Some herb products associated with herb induced liver injury (HILI) are characterized by presenting a different chemical composition that may vary from batch to batch, also the biological activity of many medicinal plants and other natural products are directly related to their most active component and its concentration. There are two main biological components that are associated with liver damage, alkaloids, and flavonoids, which are frequent constituents of commonly used herbs. The interaction with the different cytochrome P-450 isoforms, inflammatory, and oxidative activities seem to be the main damage pathway involved in the liver. It is important to know the herbal adverse effects and mechanisms involved; therefore, this article is focused on the beneficial and deleterious effects as well as the possible toxicity mechanisms and interactions of the herbs that are frequently used in LA, since the herb-host interaction may not always be the expected or desired depending on the clinical context in which it is administered.

A Comprehensive Review of Recent Studies on Herb-Drug Interaction: A Focus on Pharmacodynamic Interaction

OBJECTIVES

The concomitant use of herbal and conventional drugs accelerates the possibility of clinically significant herb-drug interactions (HDIs). This paper aims to analyze the current status of HDI studies worldwide and to review studies on HDI-induced pharmacodynamic (PD) interactions.

METHODS

HDI studies published from 2000 to 2014 and indexed in PubMed were categorized according to publication year, area/country, study methods and objectives, and disease categories. The reviewed studies focused on HDI-induced PD; each PD interaction with concurrent use of approximately 100 herbal drugs and 70 conventional drugs was summarized. All PD-related articles were categorized according to four characteristics: herbal drugs, conventional drugs, types of PD interaction, and type of study. Among them, 17 well-designed clinical studies were evaluated by using the Jadad Quality Assessment Scale.

RESULTS

The number of HDI reports has gradually increased since 2000, with a primary focus on neoplasms and diseases of the circulatory system. Most of these investigated pharmacokinetic reactions, such as cytochrome P450 enzyme metabolism, with fewer reports investigating PD. Most PD interaction studies investigated warfarin, ginkgo leaves, and St. John's wort. An evaluation of 17 studies revealed a generally positive view of PD effects involving synergism or reduced toxicity and a high average quality score (>3 points on a 0-5 scale).

CONCLUSIONS

These results demonstrate that most HDI studies so far have examined PK interactions and have been limited to very few conventional drugs and herbal drugs. This suggests that more studies focusing on PD are necessary to understand interactions between commonly used herbal and conventional drugs.

Herbal Insomnia Medications that Target GABAergic Systems: A Review of the Psychopharmacological Evidence

Insomnia is a common sleep disorder which is prevalent in women and the elderly. Current insomnia drugs mainly target the γ-aminobutyric acid (GABA) receptor, melatonin receptor, histamine receptor, orexin, and serotonin receptor. GABA_A receptor modulators are ordinarily used to manage insomnia, but they are known to affect sleep maintenance, including residual effects, tolerance, and dependence. In an effort to discover new drugs that relieve insomnia symptoms while avoiding side effects, numerous studies focusing on the neurotransmitter GABA and herbal medicines have been conducted. Traditional herbal medicines, such as Piper methysticum and the seed of Zizyphus jujuba Mill var. spinosa, have been widely reported to improve sleep and other mental disorders. These herbal medicines have been applied for many years in folk medicine, and extracts of these medicines have been used to study their pharmacological actions and mechanisms. Although effective and relatively safe, natural plant products have some side effects, such as hepatotoxicity and skin reactions effects of Piper methysticum. In addition, there are insufficient evidences to certify the safety of most traditional herbal medicine. In this review, we provide an overview of the current state of knowledge regarding a variety of natural plant products that are commonly used to treat insomnia to facilitate future studies.

Toxic rather than neuropharmacological effect of Ternstroemia sylvatica fruits and identification of 28-O-[β-l-6-rhamnopyranosyl]-R1-barrigenol as a new compound with toxic effects in mice

CONTEXT

Fruits of Ternstroemia sylvatica Schltdl. and Cham. (Theaceae) are used in Mexican traditional medicine to alleviate anxiety, sleep disorders and seizures; however, the active principles have not been identified.

OBJECTIVE

To identify the neuroactive principles of T. sylvatica fruits using neuropharmacological tests on mice.

MATERIALS AND METHODS

The methanol and aqueous extracts of pericarp or seeds of T. sylvatica fruits were intraperitoneally administered (1-562 mg/kg, single doses) to mice. The exploratory cylinder, hole board, open field, Rota-rod and sodium pentobarbital-induced hypnosis tests were used to evaluate the CNS depressant effect after 30 min single administration of extracts. From aqueous seeds extract, triterpene glycoside 28-O-[β-l-6-rhamnopyranosyl]-R1-barrigenol was isolated an active compound.

RESULTS

Crude extracts of T. sylvatica fruits, separated from seed and pericarp, showed sedative effect in mice. The aqueous (ED50 = 4.9 ± 0.8 mg/kg) seed extracts is the most active among them. This extract also decrease locomotor activity and disrupt motor coordination of mice. This extract was also the most toxic extract (LD50 = 5.0 ± 1.4 mg/kg; i.p.). The triterpene glycoside 28-O-[β-l-6-rhamnopyranosyl]-R1-barrigenol was identified in this extract as one of the active sedative compounds (ED50 = 0.12 ± 0.01 mg/kg) also with toxic effect (LD50 = 1.11 ± 0.23 mg/kg).

CONCLUSION

The results suggest that T. sylvatica fruits has toxic activity rather than CNS depressant activity in mice and that this effect might be related to the presence of 28-O-[β-l-6-rhamnopyranosyl]-R1-barrigenol, one of the active principles of T. sylvatica fruits with sedative and toxic effect.

An overview of the evidence and mechanisms of herb-drug interactions

Despite the lack of sufficient information on the safety of herbal products, their use as alternative and/or complementary medicine is globally popular. There is also an increasing interest in medicinal herbs as precursor for pharmacological actives. Of serious concern is the concurrent consumption of herbal products and conventional drugs. Herb-drug interaction (HDI) is the single most important clinical consequence of this practice. Using a structured assessment procedure, the evidence of HDI presents with varying degree of clinical significance. While the potential for HDI for a number of herbal products is inferred from non-human studies, certain HDIs are well established through human studies and documented case reports. Various mechanisms of pharmacokinetic HDI have been identified and include the alteration in the gastrointestinal functions with consequent effects on drug absorption; induction and inhibition of metabolic enzymes and transport proteins; and alteration of renal excretion of drugs and their metabolites. Due to the intrinsic pharmacologic properties of phytochemicals, pharmacodynamic HDIs are also known to occur. The effects could be synergistic, additive, and/or antagonistic. Poor reporting on the part of patients and the inability to promptly identify HDI by health providers are identified as major factors limiting the extensive compilation of clinically relevant HDIs. A general overview and the significance of pharmacokinetic and pharmacodynamic HDI are provided, detailing basic mechanism, and nature of evidence available. An increased level of awareness of HDI is necessary among health professionals and drug discovery scientists. With the increasing number of plant-sourced pharmacological actives, the potential for HDI should always be assessed in the non-clinical safety assessment phase of drug development process. More clinically relevant research is also required in this area as current information on HDI is insufficient for clinical applications.

Isolation of jacaranone, a sedative constituent extracted from the flowers of the Mexican tree Ternstroemia pringlei

ETHNOPHARMACOLOGICAL RELEVANCE

Ternstroemia pringlei represents one of the most widely employed and commercially exploited medicinal plant in Mexico, used popularly as a tranquilizer and for the treatment of insomnia.

AIM OF THE STUDY

To investigate the sedative constituents of the plant through a bio-guided fractionation of extracts derived from calyx and fruits.

MATERIALS AND METHODS

Crude extracts with different polarities (CHCl(3), AcOEt, MeOH, aqueous) were prepared and subjected to chromatographic fractionation, leading to the isolation of the sedative compound (1) from the MeOH crude extract. The identity of 1 was unequivocally established by means of 1D and 2D NMR spectroscopic analysis. The sleeping time induced by sodium pentobarbital and the elevated plus-maze models were performed on mice to determine the sedative and anxiolytic activities, respectively. Bioactivity was also investigated though in vitro GABA release experiments using mice brain slices.

RESULTS

The sedative compound was established as jacaranone (1), and its effect was clearly demonstrated through a dose-dependent response analysis (ED(50) = 25 mg/kg mouse weight). When tested in the elevated plus-maze model, none of the extracts from Ternstroemia pringlei displayed anxiolytic activity. GABA release experiments showed that the MeOH and aqueous crude extracts released this neurotransmitter at a ratio of 217 and 179 pmol/g protein, respectively, evidencing the presence of other bioactive constituents in the extracts apart of 1, whose activity was absent in this model.

CONCLUSIONS

Although 1 has been isolated and identified in a number of plant species, this is the first time that its sedative effect has been demonstrated. No previous record exists of other sedative compounds having been isolated from Ternstroemia pringlei.