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Kongkaew C, Phan DTA, Janusorn P, Mongkhon P. Estimating Adverse Events Associated With Herbal Medicines Using Pharmacovigilance Databases: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e63808. [PMID: 39208414 PMCID: PMC11393504 DOI: 10.2196/63808] [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: 07/01/2024] [Revised: 08/03/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Herbal medicines (HMs) are extensively used by consumers/patients worldwide. However, their safety profiles are often poorly reported and characterized. Previous studies have documented adverse events (AEs) associated with HMs, such as hepatotoxicity, renal failure, and allergic reactions. However, the prevalence rate of AEs related to HMs has been reported to be low. To date, no systematic review and meta-analysis has comprehensively analyzed the AEs of HMs using published data acquired from pharmacovigilance (PV) databases. OBJECTIVE This study aimed to (1) estimate the reporting rate of the AEs of HMs using PV databases and (2) assess the detailed data provided in AE reports. METHODS In this systematic review and meta-analysis, MEDLINE/PubMed, SCOPUS, EMBASE, and CINAHL were systematically searched for relevant studies (until December 2023). The DerSimonian-Laird random effects model was used for pooling the data, and subgroup analyses, the meta-regression model, and sensitivity analysis were used to explore the source of heterogeneity. Crombie's checklist was used to evaluate the risk of bias (ROB) of the included studies. RESULTS In total, 26 studies met the eligibility criteria. The reporting rate of the AEs of HMs ranged considerably, from 0.03% to 29.84%, with a median overall pooled estimate of 1.42% (IQR 1.12%-1.72%). Subgroup analyses combined with the meta-regression model revealed that the reporting rate of the AEs of HMs was associated with the source of the reporter (P=.01). None of the included studies provided full details of suspected herbal products, only the main ingredients were disclosed, and other potentially harmful components were not listed. CONCLUSIONS This systematic review and meta-analysis highlighted risks related to HMs, with a wide range of reporting rates, depending on the source of the reporter. Continuous efforts are necessary to standardize consumer reporting systems in terms of the reporting form, education, and follow-up strategy to improve data quality assurance, aiming to enhance the reliability and utility of PV data for monitoring the safety of HMs. Achieving effective monitoring and reporting of these AEs necessitates collaborative efforts from diverse stakeholders, including patients/consumers, manufacturers, physicians, complementary practitioners, sellers/distributors, and health authorities. TRIAL REGISTRATION PROSPERO (Prospective International Register of Systematic Reviews) CRD42021276492.
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Affiliation(s)
- Chuenjid Kongkaew
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Department of Pharmaceutical and Biological Chemistry, School of Pharmacy, University College London, London, United Kingdom
| | - Dang Thuc Anh Phan
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Faculty of Pharmacy, Hue University of Medicine and Pharmacy, Hue City, Vietnam
| | - Prathan Janusorn
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- Pharmacy Department, Soidao Hospital, Chantaburi, Thailand
| | - Pajaree Mongkhon
- Centre for Safety and Quality in Health, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
- School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
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Lertsakulbunlue S, Kittisarapong P, Pikulkaew S, Pusayapaibul P, Tangtongsoonthorn A, Wichaiboon C, Amornchatchawankul F, Marsook S, Mahaisawariya S, Subwongcharoen N, Petcharat P, Luksanasup B, Lortharaprasert T, Tieantanyatip B, Kantiwong A, Jongcherdchootrakul K. What Sustains Mask-Wearing Behavior among Elders in a Rural Community in the Post-COVID-19 Era: An Exploratory Mixed-Methods Study. Behav Sci (Basel) 2023; 13:678. [PMID: 37622818 PMCID: PMC10451204 DOI: 10.3390/bs13080678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/04/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
The current study investigates the factors influencing face-mask-wearing practices among elderly individuals in rural Thailand. A mixed-methods approach was employed, involving qualitative interviews with 15 elderly participants and a subsequent survey of 201 elders. Seven subthemes were identified, including the perceived benefits of mask-wearing, the perceived threat of COVID-19, mask-wearing enhancing attractiveness and self-confidence, social norms, misconceptions about COVID-19 prevention tools, perceived barriers to mask-wearing, and resources to afford face masks. The developed themes, codes, and quotes were utilized for creating a questionnaire. The survey revealed the adherence of 81.1% of the participants to mask-wearing. Structural equation modeling (SEM) analysis demonstrated that motivation, comprising (1) the perceived threat of COVID-19, (2) alternative threats aside from COVID-19, and (3) the perceived benefits of a face mask strongly affected mask-wearing practices (β = 0.68, p < 0.001) and the willingness to wear a face mask (β = 0.61, p < 0.001). Social norms had a negative direct effect on the perceived barrier (β = -0.48, p < 0.001) and a positive direct effect on mask-wearing practices (β = 0.25, p = 0.001). This study highlights that motivation and social norms play pivotal roles in sustaining mask-wearing behavior among rural elderly populations. Encouraging local cooperative actions through community rules could initiate behavioral changes within the community. These findings contribute to the understanding of factors influencing mask-wearing and provide insights into designing effective interventions to promote mask-wearing among elderly individuals in rural areas.
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Affiliation(s)
- Sethapong Lertsakulbunlue
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (S.L.); (A.K.)
| | - Pinyada Kittisarapong
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Sirikorn Pikulkaew
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Pree Pusayapaibul
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Apisit Tangtongsoonthorn
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Chanunpisut Wichaiboon
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Fasai Amornchatchawankul
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Suranuch Marsook
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Supakrit Mahaisawariya
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Nattasit Subwongcharoen
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Phitchayut Petcharat
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Bannawit Luksanasup
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Thakornphong Lortharaprasert
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Bavorn Tieantanyatip
- Medical Cadet, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (P.K.); (S.P.); (P.P.); (A.T.); (C.W.); (F.A.); (S.M.); (S.M.); (N.S.); (P.P.); (B.L.); (T.L.); (B.T.)
| | - Anupong Kantiwong
- Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok 10400, Thailand; (S.L.); (A.K.)
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Worakunphanich W, Suwankesawong W, Youngkong S, Thavorncharoensap M, Anderson C, Toh LS. Thai stakeholders' awareness and perceptions of the patient adverse event reporting system for herbal medicines: a qualitative study. Int J Clin Pharm 2023; 45:491-501. [PMID: 36745312 PMCID: PMC9901401 DOI: 10.1007/s11096-022-01533-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/20/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Thailand, the consumption of herbal medicines has been increasing. Adverse events (AEs) of herbal medicines have been identified through the spontaneous reporting system. However, the number of patients reporting AEs of herbal medicines remains limited. AIM To explore the awareness and perceptions about the patient reporting system and to explore attitudes towards safety of herbal medicines, experiences, and intention to report AEs of herbal medicines. METHOD Semi-structured in-depth interviews were conducted with stakeholders (patients, community pharmacists, village health volunteers, and consumers who had experienced submitting a complaint about health products to the Consumers Foundation). Additionally, a focus group discussion was held with stakeholders (academics, herbal medicine manufacturers, healthcare professionals, policy maker who was responsible for promoting the use of herbal medicines, pharmacovigilance staff, patient, and representative from patient organisations). The data were audio recorded, transcribed verbatim and analysed using thematic analysis. RESULTS Fifty participants were interviewed and the focus group discussion included 12 participants. Patients had positive attitudes towards the safety of herbal medicines. Lack of awareness of the patient reporting system was identified. Nevertheless, all stakeholders acknowledged the importance of the safety monitoring of herbal medicines and indicated a willingness to report AEs via the patient reporting system in the future. A simple reporting system, a variety of reporting channels, the provision of feedback, and providing rewards would motivate patients to report AEs. CONCLUSION Although there is a lack of awareness, this provides a great opportunity to improve patient AE reporting system for herbal medicines in Thailand.
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Affiliation(s)
- Wiwan Worakunphanich
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Department of Thai Traditional and Alternative Medicine, Thai Traditional Medicine Research Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Wimon Suwankesawong
- The College of Pharmaceutical and Health Consumer Protection of Thailand, Bangkok, Thailand
| | - Sitaporn Youngkong
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Montarat Thavorncharoensap
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Claire Anderson
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Li Shean Toh
- Division of Pharmacy Practice and Policy, School of Pharmacy, University of Nottingham, Nottingham, NG7 2RD, UK.
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Kaewdech A, Nawalerspanya S, Assawasuwannakit S, Chamroonkul N, Jandee S, Sripongpun P. The use of Andrographis paniculata and its effects on liver biochemistry of patients with gastrointestinal problems in Thailand during the COVID-19 pandemic: a cross sectional study. Sci Rep 2022; 12:18213. [PMID: 36309577 PMCID: PMC9617865 DOI: 10.1038/s41598-022-23189-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/26/2022] [Indexed: 12/31/2022] Open
Abstract
In the COVID-19 pandemic, healthcare facility supply and access are limited. There was an announcement promoting Andrographis paniculata (ADG) use for treatment of mild COVID-19 patients in Thailand, but misconception of taking for prevention might occur. Moreover, the effect of ADG on liver function test (LFT) has not been established. To study the ADG use and effect on LFT in patients with gastrointestinal (GI) problems, conducted a cross-sectional study including GI patients who voluntarily filled the ADG questionnaire in Aug-Sep 2021. LFT data at that visit and at the prior visit (if available) were obtained. The changes in LFT within the same person were analyzed and compared between patients with and without ADG consumption. During the study period, a total of 810 patients completed the survey, 168 patients (20.7%) took ADG within the past month. LFT data were available in 485 (59.9%) patients, the median alanine aminotransferase (ALT) change compared with the prior visit was higher in the ADG vs control group (+ 2 vs 0, p = 0.029), and 44.5% had increased ALT (> 3 U/L) vs 32.2% in the ADG and control group, respectively (p = 0.018). Factors independently associated with an increased ALT, from a multivariable logistic regression, were ADG exposure (adjusted OR 1.62, p = 0.042), and patients with NAFLD who gained weight (adjusted OR 2.37, p = 0.046). In conclusion, one-fifth of GI patients recently took ADG, even it is not recommended for COVID-19 prevention. Those who took ADG are more likely to experience an increased ALT than who did not. The potential risk of ADG consumption on liver function should be further assessed.
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Affiliation(s)
- Apichat Kaewdech
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Siwanon Nawalerspanya
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ,Department of Internal Medicine, Phaholponpayuhasena Hospital, Kanchanaburi, Thailand
| | - Suraphon Assawasuwannakit
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand ,grid.412739.a0000 0000 9006 7188Department of Medicine, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand
| | - Naichaya Chamroonkul
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sawangpong Jandee
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Pimsiri Sripongpun
- grid.7130.50000 0004 0470 1162Gastroenterology and Hepatology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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Ouoba K, Lehmann H, Pabst JY, Semde R. [Literature review on pharmacovigilance of medicines derived from traditional pharmacopoeias. Part II: risks assessment and prevention]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:635-645. [PMID: 34896380 DOI: 10.1016/j.pharma.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/06/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
After the initial stage of the pharmacovigilance process for medicines from traditional pharmacopoeias - which concerns the identification of the risks associated with their use - the risk assessment should now be approached. The latter makes it possible to detect potential signals early and to take preventive measures. We sought to understand, from a review of the literature, the steps and methods of risk assessment relating to traditional medicines, as well as the prevention strategies applied to them. All of the work carried out on the subject has shown that the steps and methods for assessing and preventing drug risks are the same for both conventional and traditional medicines. Risk assessment includes analysis of the quality of individual notifications, assessment of causality, detection and evaluation of signals. The World Health Organization method is the most widely used for causality assessment internationally, while disproportionality measures are the most applied for signal detection. Regarding prevention, risk communication is the main strategy for the risks associated with traditional medicines. This review suggests the involvement of traditional medicine practitioners both in the notification system and in the communication strategy on the risks associated with their products.
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Affiliation(s)
- Kampadilemba Ouoba
- Laboratoire du Développement du Médicament (LADME), Centre de Formation, de Recherche et d'Expertises en sciences du Médicament (CEA-CFOREM), Ecole doctorale sciences et santé (ED2S), université Joseph KI-ZERBO, 03 BP 7021 Ouagadougou, Burkina Faso; EA 7307, Centre d'études internationales et européennes (CEIE), faculté de pharmacie, université de Strasbourg, 74, route du Rhin, 67400 Illkirch, France.
| | - Hélène Lehmann
- EA 4487, Centre de recherches en droit et perspectives du droit, faculté de pharmacie, université de Lille, rue du Professeur-Laguesse, BP 53, 59006 Lille, France
| | - Jean-Yves Pabst
- EA 7307, Centre d'études internationales et européennes (CEIE), faculté de pharmacie, université de Strasbourg, 74, route du Rhin, 67400 Illkirch, France
| | - Rasmané Semde
- Laboratoire du Développement du Médicament (LADME), Centre de Formation, de Recherche et d'Expertises en sciences du Médicament (CEA-CFOREM), Ecole doctorale sciences et santé (ED2S), université Joseph KI-ZERBO, 03 BP 7021 Ouagadougou, Burkina Faso
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Ariffin SH, A Wahab I, Hassan Y, Abd Wahab MS. Adulterated Traditional-Herbal Medicinal Products and Its Safety Signals in Malaysia. Drug Healthc Patient Saf 2021; 13:133-140. [PMID: 34135639 PMCID: PMC8197568 DOI: 10.2147/dhps.s305953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Usage of traditional-herbal medicines (THM) for various illnesses has been increased around the world, so does the adulteration of these products with hazardous compounds. There are limited Malaysian data that have been published on the characteristics trend and adverse events associated with adulterated THM products. AIM This study described characteristics of adulterated THM products in Malaysia and aimed to quantify THM products' safety signals of adverse reactions (ARs). METHODS THM products that were seized by Pharmacy Enforcement Division between 2008 and 2014 were extracted and analysed for 59,440 THM products. Of these, only 6452 THM products with complete information were included in the final analyses. Safety signalling tools were used to measure AR signals from AR reports obtained from the National Pharmaceutical Regulatory Agency Adverse Drug Reaction Database. RESULTS More than half of adulterated THM products originated from countries outside of Malaysia, with the majority were from Indonesia. The most common claimed indication of adulterated THM products was for pain and fever relief, while steroids were the most common adulterant. AR signals were generated for cough and cold products for respiratory and thoracic disorders, weight-loss products for cardiac disorders, and women's health products for reproductive and breast disorders. CONCLUSION Health authorities from various fields can work collaboratively by implementing strategic actions that include the use of safety signalling tools to curb the increasing number of adulterated THM products in the Malaysian market.
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Affiliation(s)
- Suriana Hanim Ariffin
- Pharmacy Enforcement Division, National Pharmaceutical Regulatory Agency, Petaling Jaya, 46200, Selangor, Malaysia
| | - Izyan A Wahab
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, 50603, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Yahaya Hassan
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam, 42300, Selangor, Malaysia
| | - Mohd Shahezwan Abd Wahab
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM) Cawangan Selangor, Kampus Puncak Alam, Puncak Alam, 42300, Selangor, Malaysia
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Worakunphanich W, Thavorncharoensap M, Youngkong S, Thadanipon K, Thakkinstian A. Safety of Andrographis paniculata: A systematic review and meta-analysis. Pharmacoepidemiol Drug Saf 2021; 30:727-739. [PMID: 33372366 DOI: 10.1002/pds.5190] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 12/17/2020] [Indexed: 11/11/2022]
Abstract
PURPOSE Andrographis paniculata is one of the commonly used herbal medicines worldwide. Nevertheless, evidences on adverse events (AEs) associated with Andrographis paniculata are very limited. This systematic review and meta-analysis was conducted to estimate and to compare the AE incidence of oral monotherapy Andrographis paniculata with others among patients with upper respiratory tract infection, noninfective diarrhea, and autoimmune disease. METHODS Systematic search was performed through six databases from inception until August 2018. Randomized controlled trial (RCT), cohort, or intensive monitoring of AEs was eligible for review if AE incidence was examined. The incidence of AEs was, then, pooled across studies using meta-analysis. RESULTS Ten RCTs and 3 intensive monitoring studies were included. Incidence of serious AEs was very rare with the pooled incidence (95% CI) from RCTs of 0.02 per 1000 patients (0.0-0.5). However, the incidence of nonserious AEs was considered very common with the pooled incidence (95% CI) from RCTs of 102.6 per 1000 patients (10.7-256.1), and the pooled incidence (95% CI) from intensive monitoring of 34.2 per 1000 patients (0.0-229.6). The most common nonserious AEs were related to gastrointestinal disorder, and skin and subcutaneous disorder system. CONCLUSIONS Like other medicine, Andrographis paniculata can cause some AEs. However, it may be generally safe. Nevertheless, prospective patients who plan to use Andrographis paniculata should be thoroughly advised and closely monitored for common AEs. Due to the increasing use of Andrographis paniculata worldwide, larger studies with adequate methodological quality are warranted to monitor the safety of such product.
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Affiliation(s)
- Wiwan Worakunphanich
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.,Thai Traditional Medicine Research Institute, Department of Thai Traditional and Alternative Medicine, Ministry of Public Health, Nonthaburi, Thailand
| | - Montarat Thavorncharoensap
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Sitaporn Youngkong
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Social and Administrative Pharmacy Excellence Research (SAPER) unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Kunlawat Thadanipon
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand.,Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kim M, Woo Y, Han CH. Current status of the spontaneous reporting and classification/coding system for herbal and traditional medicine in pharmacovigilance. Integr Med Res 2020; 10:100467. [PMID: 32802741 PMCID: PMC7419327 DOI: 10.1016/j.imr.2020.100467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
Background While the use of herbal and traditional medicine (H&TM) has been extensive worldwide, the current status of H&TM management in pharmacovigilance remains to be investigated. To date, there is little information regarding the use of the classification/coding system (CCS) to detect signals for certain drugs within databases built on the basis of the spontaneous reporting system (SRS). The purpose of this study is to investigate the status of the SRS and CCS for H&TM in the pharmacovigilance systems of various countries around the world. Methods An e-mail survey was performed from late December 2018 to early January 2019 with 54 experts in pharmacovigilance. The results based on the information provided by the respondents were summarized. Results Fourteen experts from 13 countries responded to the survey. Eleven countries/regions were found to already include H&TM in their SRSs, managing only limited range of H&TM. Of the 9 countries/regions that provided the information on the status of CCS for H&TM in their domestic pharmacovigilance systems, only China had a separate CCS for H&TM. Conclusion Revising the current pharmacovigilance systems to include or expand the range of H&TM, and developing an internationally harmonized system to classify and code H&TM suitable to the unique characteristics of H&TM are critical and overall beneficial.
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Affiliation(s)
- Mikyung Kim
- Department of Internal Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Yeonju Woo
- Department of Physiology, College of Korean Medicine, Sangji University, Wonju, Republic of Korea
| | - Chang-Ho Han
- Department of Internal Medicine, College of Korean Medicine, Dongguk University, Gyeongju, Republic of Korea.,Research Institute for Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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Wang M, Ye X, Ruan Y, Xu J, Guo X, Dong D, Feng H, He J. Detection of cluster adverse drug events in the spontaneous reporting system of China using a disproportionality filter algorithm. J Clin Pharm Ther 2019; 44:952-957. [PMID: 31407823 DOI: 10.1111/jcpt.13021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/27/2019] [Accepted: 07/17/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Cluster adverse drug events (CADEs) are multiple ADEs with similar clinical manifestations involving the same drug, manufactured by the same company, that occur within a short time period. The disproportionality filter algorithm (DFA) is a promising tool for the identification of historical clusters related to ADEs. The Chinese spontaneous adverse drug reaction reporting system (SRS) may serve as an important database for the detection of CADEs. The objective of this study was to evaluate the usefulness of DFA as an approach to identify CADEs using SRS. METHODS Suspected adverse drug reaction (ADR) reports collected by the Chinese SRS in 2014-2015 were examined to identify potential CADEs. The reports were divided into 48 15-day subsets. Disproportionate excess reporting of ADEs for drugs from specific companies may be a signal for CADEs. The clusters were categorized as 'confirmed', 'potential', 'unlikely', 'indecisive' or 'information-loss' ADEs when evaluated by report units. Furthermore, early warning information in 2014-2015 from the Chinese early warning system (EWS) classified as 'concern', 'monitoring', 'ignorance' or 'rest' was compared with DFA to explore the applicability of the novel algorithm in Chinese SRS. RESULTS AND DISCUSSION In total, 2294 CADEs, comprising of 380 confirmed, 1753 potential, 15 unlikely and 59 indecisive clusters, were generated; 87 clusters were missing additional information. There were 263 'significant' clusters with DFA, but only 26 'significant' clusters in EWS. The sensitivity of DFA was 88.5%, but the specificity and positive predictive value were low. WHAT IS NEW AND CONCLUSION Spontaneous adverse drug reaction reporting system in China may be a potential database for the identification of CADEs engaging the DFA. This could supplement the EWS of CADEs in China. The DFA may be of value in detecting CADEs with high sensitivity, although expert screening is required given the low specificity and positive predictive value.
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Affiliation(s)
- Meng Wang
- Department of Health Statistics, Second Military Medical University, Shanghai, China.,General Hospital of Southern Theatre Command of PLA, Guangzhou, China
| | - Xiaofei Ye
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Yiming Ruan
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Jinfang Xu
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Xiaojing Guo
- Department of Health Statistics, Second Military Medical University, Shanghai, China
| | - Duo Dong
- National Center for ADR Monitoring, Beijing, China
| | - Hongyun Feng
- National Center for ADR Monitoring, Beijing, China
| | - Jia He
- Department of Health Statistics, Second Military Medical University, Shanghai, China
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Wang J, Zhang M, Li S, He B. Adapting and applying common methods used in pharmacovigilance to the environment: A possible starting point for the implementation of eco-pharmacovigilance. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2018; 61:67-70. [PMID: 29852371 DOI: 10.1016/j.etap.2018.05.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/22/2018] [Accepted: 05/23/2018] [Indexed: 06/08/2023]
Abstract
Now, the occurrence of pharmaceuticals in natural environment has been frequently reported around the world. As a kind of biologically active compounds specially designed to be effective even at very low concentration levels, pharmaceuticals in the environment could have adverse impacts to the health of human beings or other non-targeted organisms due to long-term exposures. To minimize the pharmaceutical pollution from the perspective of drug administration, a new concept called as eco-pharmacovigilance (EPV) has been proposed as a kind of pharmacovigilance(PV) for the environment. However, as a new and comprehensive science, EPV has not sophisticated methods in practice and formalized implementation model up to now. Since EPV is a special kind of PV, it could be feasible to draw on the experience of PV as a possible and reasonable starting point for EPV. In this paper, we discussed the common methods and activities used in PV including spontaneous reporting, intensive monitoring, database studies, and their potential applicability to the environment. And we concluded that these common methods in PV could be adapted and applied to EPV. But there is still the need for organizational, technical and financial supports of the EPV system.
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Affiliation(s)
- Jun Wang
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Mengya Zhang
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Shulan Li
- Department of Pharmacology, College of Medicine, Wuhan University of Science and Technology, Wuhan, China
| | - Bingshu He
- Hubei Woman and Child Hospital, Wuhan, 430070, China.
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The Epidemiology of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in China. J Immunol Res 2018; 2018:4320195. [PMID: 29607330 PMCID: PMC5828103 DOI: 10.1155/2018/4320195] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 11/08/2017] [Accepted: 11/28/2017] [Indexed: 01/31/2023] Open
Abstract
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are life-threatening disease. However, there are only few epidemiologic studies of SJS/TEN from China. To analyze the clinical characteristics, causality, and outcome of treatment for SJS/TEN in China, we reviewed case reports of patients with SJS/TEN from the China National Knowledge Infrastructure (CNKI) and Wanfang database from 2006 to 2016 and patients with SJS/TEN who were admitted to the First Affiliated Hospital of Fujian Medical University during the same period. There were 166 patients enrolled, including 70 SJS, 2 SJS/TEN overlap, and 94 TEN. The most common offending drugs were antibiotics (29.5%) and anticonvulsants (24.1%). Carbamazepine, allopurinol, and penicillins were the most common single offending drugs (17.5%, 9.6%, and 7.2%). Chinese patent medicines accounted for 5.4%. There were 76 (45.8%) patients receiving systemic steroid and intravenous immunoglobulin (IVIG) in combination therapy, especially for TEN (80.3%), and others were treated with systemic steroids alone. Mortality rate of combination treatment comparing with steroid alone in TEN patients had no statistical significance. In conclusion, carbamazepine and allopurinol were the leading causative drugs for SJS/TEN in China. Combination of IVIG and steroids is a common treatment for TEN, but its efficacy in improving mortality needs further investigation.
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Dorji C, Tragulpiankit P, Riewpaiboon A, Tobgay T. Knowledge of Adverse Drug Reaction Reporting Among Healthcare Professionals in Bhutan: A Cross-Sectional Survey. Drug Saf 2017; 39:1239-1250. [PMID: 27743333 DOI: 10.1007/s40264-016-0465-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The Bhutan National Pharmacovigilance Centre (NPC) became an official member of the WHO Programme for International Drug Monitoring in December 2014; however, the number of adverse drug reactions (ADRs) reported is very low (50 reports per 773,722 inhabitants over 10 years). Surveys of healthcare professionals (HCPs) in similar countries have indicated that adequate knowledge of both ADRs and ADR reporting is likely to increase the number of ADR reports submitted. OBJECTIVE The aim of this study was to investigate the level of knowledge of both ADRs and ADR reporting among HCPs, including traditional medicine practitioners. METHODS A cross-sectional survey was conducted, using a validated self-administered questionnaire. The questionnaires were distributed to 670 HCPs, including clinical doctors, nurses, pharmacists and traditional medicine practitioners from four referral hospitals. The survey consisted of 12 questions pertaining to ADRs and 10 questions pertaining to knowledge of ADR reporting. The collected response was then analysed descriptively and results presented as mean ± standard deviation (SD) using SPSS version 20. RESULTS The overall response rate was 434 (65 %) questionnaires, with HCPs consisting of clinical doctors (94, 22 %), nurses (257, 59 %), pharmacists (52, 12 %) and traditional medicine practitioners (31, 7 %). The overall mean ± SD score with regard to the level of knowledge of ADRs was 6.52 ± 2.81 out of a maximum score of 12, among which clinical doctors scored 7.48 ± 2.95, nurses 6.15 ± 2.47, pharmacists 8.15 ± 2.49 and traditional medicine practitioners 4.13 ± 3.18. The mean ± SD score with regard to the level of knowledge of ADR reporting among HCPs was 3.94 ± 1.89 out of a maximum score of 10, among which clinical doctors scored 3.93 ± 1.81, nurses 3.75 ± 1.74, pharmacists 5.00 ± 1.81 and traditional medicine practitioners 4.00 ± 1.77. CONCLUSION Clinical doctors and pharmacists have better knowledge of ADRs than nurses and traditional medicine practitioners, while knowledge of ADR reporting was low for all HCPs surveyed.
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Affiliation(s)
- Choki Dorji
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Road, Bangkok, 10400, Thailand.,Drug Regulatory Authority, Thimphu, Bhutan
| | - Pramote Tragulpiankit
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Road, Bangkok, 10400, Thailand.
| | - Arthorn Riewpaiboon
- Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayudhaya Road, Bangkok, 10400, Thailand
| | - Tashi Tobgay
- Khesar Gyalpo University of Medical Sciences, Thimphu, Bhutan
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Abstract
Dermatoses have been better characterized as hypochromic vitiligo in subjects with dark skin or the acquired racquet nails associated with hyperparathyroidism. The innate immunity has a central role in the new classification of auto inflammatory diseases, neutrophilic dermatoses, neutrophilic urticaria or pseudo-neutrophilic urticaria. Comorbidities have been studied e.g. cardiovascular co morbidities for psoriasis, IBD associated with hidradenitis suppurativa or neurological disorders associated with pemphigoid. Bullous pemphigoid could be renamed as cutaneous pemphigoid, it can be induced by drugs especially gliptins. Genetic predispositions are analyzed in auto inflammatory diseases, psoriasis (HLA), drug eruptions (HLA or cytokines). Telaprevir often induces rashes, which can be severe but other treatments against hepatitis C as interferon can also induce debilitating rashes, some eligible for drug tolerance induction. European guidelines for the definition, classification, diagnosis of chronic spontaneous urticaria have been published. Severe cutaneous adverse drug reactions may be associated with severe systemic symptoms such as organ involvement in AGEP or the occurrence of a shock in DRESS. Allover Europe, there is now an epidemic of contact allergies to methylisothiazolinone (MIT), contained in cosmetics, wet wipes but also in paints. MIT should be tested at 2.000 ppm in water, included in the standard series for patch tests. Its role has to be evoked in any case localized on the face or hand, airborne or generalized eczema. Among infectious diseases, skin manifestations due to Parvovirus have been specified, a febrile rash can be related to dengue infection or to Zika virus.
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Affiliation(s)
- A Barbaud
- Département de dermatologie et allergologie, bâtiment des spécialités médicales, hôpitaux de Brabois, centre hospitalo-universitaire de Nancy, 54500 Vandœuvre-les-Nancy, France.
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Detecting drug-herbal interaction using a spontaneous reporting system database: an example with benzylpenicillin and qingkailing injection. Eur J Clin Pharmacol 2015; 71:1139-45. [PMID: 26159784 DOI: 10.1007/s00228-015-1898-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 06/29/2015] [Indexed: 02/01/2023]
Abstract
PURPOSE The study aims to quantify anaphylaxis signal for combined exposure of benzylpenicilin and qingkailing injection (QI) compared with individual exposure of the two drugs and the background risk based on all other exposures in SRS database. METHODS Data used in this study were collected during 2003-2014 from China Guangdong Provincial Center of ADR Monitoring. We studied the suspected ADR reports using a case/non-case design. The cases were defined as the reactions coded by WHO-preferred terms of anaphylactic shock or anaphylactoid reaction. Reporting odds ratios (RORs) were used as a measure of disproportionality and were adjusted for age and gender to reduce confounding effects. An observed-to-expected ratio Ω was also used for interaction detection. RESULTS The crude RORs (95 % CIs) for anaphylaxis in patients who used only benzylpenicillin or QI and those who used the two drugs concomitantly compared with patients who used neither of the two drugs were 2.50 (2.34-2.68), 1.59 (1.46-1.73), and 6.22 (3.34-11.58), respectively. The adjusted RORs (95 % CIs) were 2.48 (2.31-2.65), 1.54 (1.41-1.67), and 6.01 (3.22-11.20), respectively, after being adjusted for age and gender. The measured Ω, Ω0, Ω025, and Ω975 was 1.03, 1.09, 0.14, and 1.71, respectively. CONCLUSIONS Case reports in the database are suggestive of a safety signal which indicates that an interaction between benzylpenicillin and QI resulting in excess risk of anaphylaxis may occur. SRS databases have a potential for signaling unknown drug-herbal interactions. More effort is needed to expand this potential.
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Bentele-Jaberg N, Guenova E, Mehra T, Nägeli M, Chang YT, Cozzio A, French LE, Hoetzenecker W. The Phytotherapeutic Fenugreek as Trigger of Toxic Epidermal Necrolysis. Dermatology 2015; 231:99-102. [DOI: 10.1159/000433423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 05/15/2015] [Indexed: 11/19/2022] Open
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