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Bernardo J, Valentão P. Herb-drug interactions: A short review on central and peripheral nervous system drugs. Phytother Res 2024; 38:1903-1931. [PMID: 38358734 DOI: 10.1002/ptr.8120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/24/2023] [Accepted: 12/27/2023] [Indexed: 02/16/2024]
Abstract
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.
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Affiliation(s)
- João Bernardo
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Patrícia Valentão
- REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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Differences in the Perception of Dietary Supplements between Dietary Supplement/Medicine Users and Non-Users. Nutrients 2022; 14:nu14194114. [PMID: 36235766 PMCID: PMC9572052 DOI: 10.3390/nu14194114] [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: 09/01/2022] [Revised: 09/20/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
Some patients use dietary supplements and medicines concomitantly, with an inappropriate perception of their safety and efficacy. To clarify the perception between dietary supplement and medicine users and non-users, we conducted an internet survey. In this survey, 38.9% of participants used dietary supplements, 32.6% used prescription medicines, and 14.7% used dietary supplements and prescription medicines concomitantly. Then, we conducted a further survey on four groups, dietary supplement and prescription medicine users, dietary supplement only users, prescription medicine only users, and non-users (500 each). Dietary supplement users had favorable outcomes in terms of both the safety and efficacy of dietary supplements compared to dietary supplement non-users. This perception of dietary supplements was independent from medicine use. The awareness of the Health Food Network consumer navigation site, which provides information about dietary supplements for consumers, was the highest among dietary supplement and prescription medicine users, but it was still low (2.2%). In conclusion, consumers who use dietary supplement and prescription medicine concomitantly have favorable outcomes for their safety and efficacy and a low awareness of their interaction. There is a need to provide information, especially regarding the risk of interaction, that takes into account the consumer's situation.
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Jiao F, Varghese K, Wang S, Liu Y, Yu H, Booz GW, Roman RJ, Liu R, Fan F. Recent Insights Into the Protective Mechanisms of Paeoniflorin in Neurological, Cardiovascular, and Renal Diseases. J Cardiovasc Pharmacol 2021; 77:728-734. [PMID: 34001724 PMCID: PMC8169546 DOI: 10.1097/fjc.0000000000001021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 12/12/2022]
Abstract
ABSTRACT The monoterpene glycoside paeoniflorin (PF) is the principal active constituent of the traditional Chinese herbal medicines, Radix Paeoniae Alba and Radix Paeoniae Rubra, which have been used for millennia to treat cardiovascular diseases (eg, hypertension, bleeding, and atherosclerosis) and neurological ailments (eg, headaches, vertigo, dementia, and pain). Recent evidence has revealed that PF exerts inhibitory effects on inflammation, fibrosis, and apoptosis by targeting several intracellular signaling cascades. In this review, we address the current knowledge about the pharmacokinetic properties of PF and its molecular mechanisms of action. We also present results from recent preclinical studies supporting the utility of PF for the treatment of pain, cerebral ischemic injury, and neurodegenerative diseases, such as Alzheimer's and Parkinson's diseases. Moreover, new evidence suggests a general protective role of PF in heart attack, diabetic kidney, and atherosclerosis. Mechanistically, PF exerts multiple anti-inflammatory actions by targeting toll-like receptor-mediated signaling in both parenchymal and immune cells (in particular, macrophages and dendritic cells). A better understanding of the molecular actions of PF may lead to the expansion of its therapeutic uses.
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Affiliation(s)
- Feng Jiao
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
- Department of Neurosurgery, Peking University People’s Hospital, Beijing, 100044, China
| | - Kevin Varghese
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Shaoxun Wang
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Yedan Liu
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Hongwei Yu
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA
| | - George W. Booz
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Richard J. Roman
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Ruen Liu
- Department of Neurosurgery, Peking University People’s Hospital, Beijing, 100044, China
| | - Fan Fan
- Department of Pharmacology and Toxicology, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Abushammala IM, El-Shaikh Ali FK, Abu Shammaleh KF, Taha MM, Miqdad MY. Effect of Panax ginseng on Carbamazepine Pharmacokinetics in Rabbits. Turk J Pharm Sci 2021; 18:17-20. [PMID: 33631926 DOI: 10.4274/tjps.galenos.2019.24993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Objectives Carbamazepine (CBZ) is a well-known drug prescribed to treat epilepsy and the preferred drug for trigeminal neuralgia. This study was conducted to investigate the effect of Panax ginseng extract (PGE) on the disposition of CBZ, a CYP3A4 substrate, in rabbits. Materials and Methods An in vivo randomized parallel design was used to examine herb-drug interactions in 12 male rabbits distributed into 2 groups. In the 1st group (control group), 6 rabbits (control group) were administered orally with CBZ suspension (30 mg/kg/day) as a single daily dose for 10 days. In the 2nd group (test group), 6 rabbits was treated concomitantly with CBZ and a dose of PGE (2.5 mg/kg/day) at the same time as in the 1st group. Blood samples were withdrawn from the marginal ear vein of the rabbits at intervals of 0.0, 0.5, 1.0, 1.5, 2.0, 2.5, 3.0, 4.0, 6.0, 12.0, and 24.0 h. Results CBZ had no significantly different pharmacokinetic (PK) parameters, namely, Cmax, tmax, AUC0-24, AUC0-∞, t½, and Ke, when it was given alone or concurrently with PGE (p≥0.05). Conclusion PGE may unlikely interfere with the PK of CBZ when it is co-administered with CBZ. Therefore, PGE can be used safely without precautions or dose monitoring.
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Affiliation(s)
- Issam Mohammed Abushammala
- Al-Azhar University Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Gaza Strip, Palestine
| | - Fatma Khaled El-Shaikh Ali
- Al-Azhar University Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Gaza Strip, Palestine
| | - Kamal Fakher Abu Shammaleh
- Al-Azhar University Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Gaza Strip, Palestine
| | - Mohammed Mahmoud Taha
- Al-Azhar University Faculty of Pharmacy, Department of Pharmaceutics and Industrial Pharmacy, Gaza Strip, Palestine
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Impacts of Drug Interactions on Pharmacokinetics and the Brain Transporters: A Recent Review of Natural Compound-Drug Interactions in Brain Disorders. Int J Mol Sci 2021; 22:ijms22041809. [PMID: 33670407 PMCID: PMC7917745 DOI: 10.3390/ijms22041809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/29/2021] [Accepted: 02/09/2021] [Indexed: 12/15/2022] Open
Abstract
Natural compounds such as herbal medicines and/or phyto-compounds from foods, have frequently been used to exert synergistic therapeutic effects with anti-brain disorder drugs, supplement the effects of nutrients, and boost the immune system. However, co-administration of natural compounds with the drugs can cause synergistic toxicity or impeditive drug interactions due to changes in pharmacokinetic properties (e.g., absorption, metabolism, and excretion) and various drug transporters, particularly brain transporters. In this review, natural compound–drug interactions (NDIs), which can occur during the treatment of brain disorders, are emphasized from the perspective of pharmacokinetics and cellular transport. In addition, the challenges emanating from NDIs and recent approaches are discussed.
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Amponsah SK, N'guessan BB, Akandawen M, Aning A, Agboli SY, Danso EA, Opuni KFM, Asiedu-Gyekye IJ, Appiah-Opong R. Effect of Cellgevity® Supplement on Selected Rat Liver Cytochrome P450 Enzyme Activity and Pharmacokinetic Parameters of Carbamazepine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2020; 2020:7956493. [PMID: 32714422 PMCID: PMC7354648 DOI: 10.1155/2020/7956493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is considerable evidence that many patients concurrently administer dietary supplements with conventional drugs, creating a risk for potential drug-supplement interaction. The aim of this study was to determine the effect of Cellgevity® supplement on selected rat liver cytochrome P450 (CYP) enzymes. Also, based on our previous finding, we sought to determine the effect of Cellgevity® on the pharmacokinetics of carbamazepine, a CYP3A4 substrate. METHODS Male Sprague-Dawley (SD) rats were randomly put into 5 groups and administered either distilled water (negative control), Cellgevity® (3 separate doses), or phenobarbital (positive control), per os. Modulation of liver CYP enzyme activity was evaluated after 30 days of treatment, using probe substrates, spectroscopic, and high-performance liquid chromatographic methods. In the pharmacokinetic study, 12 SD rats were put into 2 groups and administered carbamazepine plus normal saline (group 1) or carbamazepine plus Cellgevity® (group 2), per os, both over a period of 14 days. Blood samples from rats in the same group were collected after treatment. Serum samples were prepared and pooled together at each specific sampling time point. Levels of carbamazepine were determined using a fluorescence polarization immunoassay. RESULTS Activities of rat liver CYP1A1/2, CYP2C9, and CYP2D6 were significantly increased by Cellgevity® after 30-day treatment. Pharmacokinetic parameters for rats administered carbamazepine with Cellgevity® vis-a-vis carbamazepine with normal saline were as follows: C max; 20 μmol/L vs 11 μmol/L, AUC0⟶24; 347 μmol h/L vs 170 μmol h/L, K e; 0.28 h-1 vs 0.41 h-1, and t 1/2; 2.3 h vs 1.7 h, respectively. CONCLUSIONS Cellgevity® increased the activity of rat CYP1A1/2, CYP2C9, and CYP2D6 enzymes and was found to alter the pharmacokinetics of carbamazepine in rats.
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Affiliation(s)
- Seth Kwabena Amponsah
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Benoit Banga N'guessan
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Martin Akandawen
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Abigail Aning
- 2Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Sedem Yawa Agboli
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Eunice Ampem Danso
- 2Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwabena Frimpong-Manso Opuni
- 3Department of Pharmaceutical Chemistry, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Isaac Julius Asiedu-Gyekye
- 1Department of Pharmacology and Toxicology, School of Pharmacy, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Regina Appiah-Opong
- 2Department of Clinical Pathology, Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Accra, Ghana
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Raish M, Ahmad A, Ansari MA, Alkharfy KM, Ahad A, Al-Jenoobi FI, Al-Mohizea AM, Khan A, Ali N. Effects of sinapic acid on hepatic cytochrome P450 3A2, 2C11, and intestinal P-glycoprotein on the pharmacokinetics of oral carbamazepine in rats: Potential food/herb-drug interaction. Epilepsy Res 2019; 153:14-18. [PMID: 30927680 DOI: 10.1016/j.eplepsyres.2019.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/10/2019] [Accepted: 03/20/2019] [Indexed: 02/06/2023]
Abstract
Dietary supplements, herbal medicines, and other foods may affect the pharmacokinetics and/or pharmacodynamics of carbamazepine (CBZ), which may possibly lead to potential drug-drug/herb-drug interactions, as CBZ has a narrow therapeutic window. Sinapic acid (SA) is a bioactive phytoconstituent used as a dietary supplement for the treatment of epilepsy. This study determined the effects of SA on the pharmacokinetics of CBZ and proposed a possible interaction mechanism in twenty-four male wistar rats (180-210 g). A single CBZ dose (80 mg/kg) was administered orally to rats with or without SA pretreatment (20 mg/kg p.o. per day for 7 days, n = 6). The CBZ concentration in plasma samples was determined by using a sensitive reversed-phase high-performance liquid chromatography assay. The pharmacokinetic parameters were calculated by using non-compartmental analysis. Significance was determined through Dunnett's multiple comparison test or one-way analysis of variance as appropriate; p < 0.05 were considered significant. The change in the pharmacokinetic parameters (Cmax, Tmax, AUC0-t, AUC0-∞, T½, and kel) of CBZ was evaluated after the administration of CBZ alone or after CBZ co-administration with SA pretreatment. The plasma concentration of CBZ was higher after SA pretreatment than that without pretreatment. The pharmacokinetics of orally administered CBZ were found to be significantly altered (p < 0.05) in rats pretreated with SA compared to those in rats administered CBZ alone. The increases in the Cmax, AUC0-t, T1/2, and MRT of CBZ were 29.79%, 57.18%, 77.18%, and 58.31%, respectively, whereas the kel and apparent oral CL/F were significantly reduced (p < 0.05) in rats pretreated with SA compared to those in rats not pretreated with SA (43.87% and 42.50%, respectively). However, no significant change was observed in the Tmax of CBZ in rats pretreated with SA compared to that in rats that did not receive pretreatment. The enhancement in Cmax, AUC0-t, T1/2, and MRT and the reduction in Kel and CL/F values resulted from the significant inhibition of CYP3 A2, the CYP2C11-mediated metabolism of CBZ in the liver, and the inhibition of intestinal P-glycoprotein/MDR1, which enhanced the rate of CBZ absorption. Further studies are required to determine the clinical relevance of these observations.
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Affiliation(s)
- Mohammad Raish
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia.
| | - Ajaz Ahmad
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Mushtaq Ahmad Ansari
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Khalid M Alkharfy
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdul Ahad
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Fahad I Al-Jenoobi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Abdullah M Al-Mohizea
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Altaf Khan
- Department of Pharmacology and Toxicology, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Naushad Ali
- Quality Assurance Unit, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
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Kim B, Jo C, Choi HY, Lee K. Vasorelaxant and Hypotensive Effects of Cheonwangbosimdan in SD and SHR Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:6128604. [PMID: 30108659 PMCID: PMC6077565 DOI: 10.1155/2018/6128604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/26/2018] [Indexed: 01/17/2023]
Abstract
Historically, traditional herbal medicines (THMs) have been the conventional treatment strategy in the Korean medical system for treating many diseases. However, THMs have rarely been used to treat hypertension, and moreover few studies have investigated the interaction of blood pressure with the coadministration of synthetic antihypertensives. We aimed to evaluate the vasorelaxant and hypotensive effects of the traditional herbal prescription Cheonwangbosimdan (CWBSD; "Tianwangbuxindan" in Chinese) and the combination of CWBSD with amlodipine. CWBSD was extracted with distilled water at 100°C for 2 h. To investigate vasorelaxant activities, CWBSD with amlodipine (10 μg/ml) was added cumulatively (10-1,000 μg/ml) to isolated rat aortic rings precontracted using phenylephrine or potassium chloride in organ chambers. To investigate hypotensive effects, CWBSD (2,476 mg/kg) was orally administered with or without amlodipine (5 mg/kg) to spontaneously hypertensive rats (SHRs). CWBSD increased the relaxation of rat aortic rings induced by amlodipine (P < 0.01). In vivo, CWBSD coadministration with amlodipine also significantly decreased the blood pressure of SHRs compared to the amlodipine-treated group. These results suggested that CWBSD could be a useful herbal prescription to treat hypertension and we recommend establishing guidelines for the use of herbal medicines in conjunction with antihypertensive drugs, including amlodipine.
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Affiliation(s)
- Bumjung Kim
- Department of Herbology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Cheolmin Jo
- Department of Herbology, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Ho-Young Choi
- Department of Herbology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Kyungjin Lee
- Department of Herbology, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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Bedada SK, Neerati P. Modulation of CYP3A enzyme activity by diosmin and its consequence on carbamazepine pharmacokinetics in rats. Naunyn Schmiedebergs Arch Pharmacol 2017; 391:115-121. [PMID: 29134244 DOI: 10.1007/s00210-017-1439-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/03/2017] [Indexed: 11/28/2022]
Abstract
Diosmin is a widely used flavonoid for the treatment of varicose veins and hemorrhoids. Epileptic patients with hemorrhoids and varicose veins may use diosmin along with carbamazepine (CBZ) therapy, which leads to pharmacokinetic interaction between diosmin and CBZ. Therefore, the present study was performed to evaluate the effect of diosmin on the pharmacokinetics of CBZ in rats. Diosmin-mediated altered CYP3A enzyme activity in human and rat liver microsomes was examined using CYP3A dependent erythromycin N-demethylase assay. Further, an in vivo pharmacokinetic study of oral administered CBZ in rats with and without diosmin pretreatment was performed. The CYP3A enzyme activity in human and rat liver microsomes was significantly (p < 0.05) decreased by diosmin when compared to control. Pretreatment with diosmin significantly (p < 0.05) enhanced maximum plasma concentration (C max), area under the curve (AUC), and half life (t 1/2), while significantly (p < 0.05) decreased elimination rate constant (k el) and apparent oral clearance (CL/F) of CBZ as compared to control rats. On the other hand, C max, AUC, and t 1/2 of carbamazepine 10, 11-epoxide (CBZE) were significantly (p < 0.05) decreased after diosmin pretreatment. Furthermore, diosmin pretreatment significantly (p < 0.05) decreased metabolic ratios of C max and AUC when compared to control, suggesting reduced formation of CBZ to CBZE. The results suggest that diosmin pretreatment might have inhibited CYP3A-mediated metabolism of CBZ. Accordingly, caution should be taken when diosmin is used in combination with therapeutic drugs metabolized by CYP3A enzyme in addition to CBZ.
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Affiliation(s)
- Satish Kumar Bedada
- Drug Metabolism and Pharmacokinetics Division, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana State, 506009, India
| | - Prasad Neerati
- Drug Metabolism and Pharmacokinetics Division, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, Telangana State, 506009, India.
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Serrano-Falcón B, Rey E. The safety of available treatments for chronic constipation. Expert Opin Drug Saf 2017; 16:1243-1253. [DOI: 10.1080/14740338.2017.1361402] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Blanca Serrano-Falcón
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
| | - Enrique Rey
- Department of Digestive Diseases, Hospital Clinico San Carlos, Complutense University, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain
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Raish M, Ahmad A, Alkharfy KM, Jan BL, Mohsin K, Ahad A, Al-Jenoobi FI, Al-Mohizea AM. Effects of Paeonia emodi on hepatic cytochrome P450 (CYP3A2 and CYP2C11) expression and pharmacokinetics of carbamazepine in rats. Biomed Pharmacother 2017; 90:694-698. [PMID: 28419964 DOI: 10.1016/j.biopha.2017.04.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 03/30/2017] [Accepted: 04/10/2017] [Indexed: 11/16/2022] Open
Abstract
Herbal medicines, dietary supplements, and other foods may pharmacokinetically and/or pharmacodynamically interact with carbamazepine (CBZ), which could lead to potential clinical consequences. Paeonia emodi (PE) is one of the herbs used as complementary therapy in the treatment of epileptic patients in some cultures, and may also be co-administered with CBZ. This study evaluates the effects of PE on the pharmacokinetics of CBZ and determines a possible mechanism of interaction. Rats were administered vehicle saline or PE (200mg/kg, p.o. daily for 7days), then administered a single CBZ dose (80mg/kg, p.o.) on day 7. Plasma samples were analyzed for CBZ concentrations using a sensitive reversed-phase high-performance liquid chromatography (RP-HPLC) assay. Pharmacokinetic parameters were calculated using non-compartmental analysis. The co-administration of PE with CBZ resulted in increased plasma maximum concentration (Cmax), area under the curve (AUC0-∞), and half-life (T½), by 14.61%, 48.12%, and 43.72%, respectively. The calculated oral clearance (CL/F) was reduced by 33.54%, while the volume of distribution (Vss) was unaffected. The PE extract also showed a significant potential to reduce CYP3A and CYP2C protein expression by approximately 50%. Therefore, a reduction in the metabolic capacity responsible for CBZ clearance appears to be the mechanism behind this herb-drug interaction. Consequently, the concomitant administration of PE and CBZ should be viewed cautiously. Further studies are needed to determine the clinical relevance of these observations.
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Affiliation(s)
- Mohammad Raish
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Ajaz Ahmad
- Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Khalid M Alkharfy
- Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia.
| | - Basit L Jan
- Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Kazi Mohsin
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abdul Ahad
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Fahad I Al-Jenoobi
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
| | - Abdullah M Al-Mohizea
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, 11451, Saudi Arabia
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Bedada SK, Boga PK. Influence of diosmin on the metabolism and disposition of carbamazepine in healthy subjects. Xenobiotica 2016; 47:879-884. [PMID: 27690733 DOI: 10.1080/00498254.2016.1244368] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
1. Carbamazepine (CBZ) is an antiepileptic drug with narrow therapeutic window and administration in humans receiving long-term therapy with diosmin (DSN) may occur, which leads to CYP3A4-mediated drug interactions. The purpose of the present study was to assess the influence of DSN on the metabolism and pharmacokinetics of CBZ in healthy volunteers. 2. An open-label, sequential, two-period study was conducted in 12 healthy male volunteers. A single dose of DSN 500 mg was administered once daily for 10 days during treatment phase. A single dose of CBZ 200 mg was administered during control and after treatment phases under fasting conditions. The blood samples were collected after CBZ dosing at predetermined time intervals and analyzed by LC-MS/MS. 3. Treatment with DSN significantly enhanced the maximum plasma concentration (Cmax), area under the curve (AUC), half-life (t1/2) and significantly decreased the apparent oral clearance (CL/F) and elimination rate constant (Kel) of CBZ. On the other hand, treatment with DSN significantly decreased the Cmax and AUC of carbamazepine 10, 11-epoxide (CBZE). Furthermore, treatment with DSN significantly decreased the metabolite to parent ratios of Cmax and AUC, indicating the reduced metabolism of CBZ to CBZE. 4. The results suggest that the altered CYP3A4 enzyme activity and pharmacokinetics of CBZ might be attributed to DSN-mediated inhibition of CYP3A4 enzyme, which indicates pharmacokinetic interaction present between DSN and CBZ. Therefore, we conclude that DSN has an inhibiting effect on the metabolism and disposition of CBZ.
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Affiliation(s)
- Satish Kumar Bedada
- a Drug Metabolism and Pharmacokinetics Division, University College of Pharmaceutical Sciences, Kakatiya University , Warangal , Telangana State , India
| | - Praveen Kumar Boga
- a Drug Metabolism and Pharmacokinetics Division, University College of Pharmaceutical Sciences, Kakatiya University , Warangal , Telangana State , India
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Effects of Jia-Wei-Xiao-Yao-San on the Peripheral and Lymphatic Pharmacokinetics of Paclitaxel in Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:5614747. [PMID: 27057200 PMCID: PMC4802034 DOI: 10.1155/2016/5614747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 02/16/2016] [Indexed: 12/26/2022]
Abstract
Paclitaxel is effective against breast cancer. The herbal medicine, Jia-Wei-Xiao-Yao-San (JWXYS), is the most frequent prescription used to relieve the symptoms of breast cancer treatments. The aim of the study was to investigate the herb-drug interaction effects of a herbal medicine on the distribution of paclitaxel to lymph. A validated ultraperformance liquid chromatography with tandem mass spectrometry (UPLC-MS/MS) method was used to determine the paclitaxel levels in rat plasma and lymph after intravenous infusion of paclitaxel alone with or without 7 days of JWXYS pretreatment. The pharmacokinetic results indicate that paclitaxel concentrations in plasma exceeded those in lymph by approximately 3.6-fold. The biodistribution of paclitaxel from plasma to lymph was 39 ± 5%; however, this increased to 45 ± 4% with JWXYS pretreatment. With JWXYS pretreatment, the AUC and Cmax of paclitaxel in plasma were significantly reduced by approximately 1.5-fold, compared to paclitaxel alone. Additionally, JWXYS decreased the AUC and Cmax of paclitaxel in lymph. However, the lymph absorption rate of paclitaxel with or without JWXYS pretreatment was not significantly changed (27 ± 3 and 30 ± 2%, resp.). Our findings demonstrate that when paclitaxel is prescribed concurrently with herbal medicine, monitoring of the blood pharmacokinetics of paclitaxel is recommended.
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Namazi S, Azarpira N, Javidnia K, Emami M, Rahjoo R, Berahmand R, Borhani-Haghighi A. SCN1A and SCN1B gene polymorphisms and their association with plasma concentrations of carbamazepine and carbamazepine 10, 11 epoxide in Iranian epileptic patients. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2015; 18:1215-20. [PMID: 26877851 PMCID: PMC4744361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE S From a genetic point of view, epilepsy is a polygenic multifactorial syndrome. The SCN1A and B genes belong to a family of genes that provide instructions for making sodium channels. Understanding the relevance of SCN1A and SCN1B gene polymorphisms to plasma concentration of carbamazepine (CBZ) and 'its active metabolite carbamazepine 10, 11 epoxide (CBZE), may shed more light on inter-individual variations in response to CBZ. MATERIALS AND METHODS In this cross-sectional study, genotype distribution and allele frequency of six non-synonymous exonic single nucleotide polymorphisms (SNPs) of the SCN1A and B genes were selected and determined using PCR-RFLP in 70 epileptic patients treated with CBZ for at least 6 months. The patients had no hepatic or renal diseases and received no medications known to have a major interaction with CBZ. Serum concentrations of CBZ and CBZE were measured using High-Performance Liquid Chromatography (HPLC). RESULTS The AA, AG and GG alleles of SCN1A were found in 23, 37 and 10 patients, respectively. There were no statistically significant differences in the mean (± standard deviation) of plasma concentrations of CBZ (P=0.8) and CBZE (P=0.1) among these 3 groups. Likewise, there was no statistically significant relationship between SCN1A polymorphisms and CBZ concentration/dose ratio (P=0.7). A significant association was found between CBZ plasma level and CBZ concentration/dose with CBZ daily dose. All patients had the same genotype of SCN1B gene(CC). and no statistical analysis was performed. CONCLUSION No significant association between SCN1A gene polymorphisms and plasma levels of CBZ and CBZE were found[u1].
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Affiliation(s)
- Soha Namazi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Department of Pharmacotherapy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Katayoon Javidnia
- Department of Medicinal Chemistry, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrdad Emami
- Transgenic Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rahimeh Rahjoo
- Department of Pharmacotherapy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Razieh Berahmand
- Department of Pharmacotherapy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Afshin Borhani-Haghighi
- Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Department of Neurology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Corresponding author: Afshin Borhani-Haghighi. Department of Neurology Motahhari Clinic Nemazee Square, Shiraz University of Medical Sciences, Shiraz, Iran.
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Bersani FS, Coviello M, Imperatori C, Francesconi M, Hough CM, Valeriani G, De Stefano G, Bolzan Mariotti Posocco F, Santacroce R, Minichino A, Corazza O. Adverse Psychiatric Effects Associated with Herbal Weight-Loss Products. BIOMED RESEARCH INTERNATIONAL 2015; 2015:120679. [PMID: 26457296 PMCID: PMC4589574 DOI: 10.1155/2015/120679] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 08/02/2015] [Indexed: 12/24/2022]
Abstract
Obesity and overeating are among the most prevalent health concerns worldwide and individuals are increasingly using performance and image-enhancing drugs (PIEDs) as an easy and fast way to control their weight. Among these, herbal weight-loss products (HWLPs) often attract users due to their health claims, assumed safety, easy availability, affordable price, extensive marketing, and the perceived lack of need for professional oversight. Reports suggest that certain HWLPs may lead to onset or exacerbation of psychiatric disturbances. Here we review the available evidence on psychiatric adverse effects of HWLPs due to their intrinsic toxicity and potential for interaction with psychiatric medications.
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Affiliation(s)
- F. Saverio Bersani
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
| | - Marialuce Coviello
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Claudio Imperatori
- Department of Human Sciences, European University of Rome, 00163 Rome, Italy
| | - Marta Francesconi
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Christina M. Hough
- Department of Psychiatry, University of California San Francisco, San Francisco, CA 94143, USA
| | - Giuseppe Valeriani
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
- Department of Psychiatry, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden
| | - Gianfranco De Stefano
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Rita Santacroce
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
- Department of Neuroscience and Imaging, Gabriele D'Annunzio University, 66100 Chieti, Italy
| | - Amedeo Minichino
- Department of Neurology and Psychiatry, Sapienza University of Rome, 00185 Rome, Italy
| | - Ornella Corazza
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK
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Bedada SK, Nearati P. Effect of resveratrol on the pharmacokinetics of carbamazepine in healthy human volunteers. Phytother Res 2015; 29:701-6. [PMID: 25624269 DOI: 10.1002/ptr.5302] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/12/2014] [Accepted: 12/27/2014] [Indexed: 01/06/2023]
Abstract
The purpose of the present study was to assess the effect of resveratrol (RSV) pretreatment on CYP3A4 enzyme activity and pharmacokinetics of carbamazepine (CBZ) in healthy human volunteers. The open-label, two period, sequential study was conducted in 12 healthy human volunteers. A single dose of RSV 500 mg was administered once daily for 10 days during treatment phase. A single dose of CBZ 200 mg was administered during control and after treatment phases under fasting conditions. The blood samples were collected after CBZ dosing at predetermined time intervals and analyzed by LC-MS/MS. In comparison with the control, RSV pretreatment significantly enhanced maximum plasma concentration (Cmax ), area under the curve (AUC), and half life (t1/2 ) and significantly decreased apparent oral clearance (CL/F) and apparent volume of distribution (Vd/F), while there was no significant change observed in time to reach maximum concentration (tmax ) and elimination rate constant (kel ) of CBZ. Furthermore, RSV pretreatment significantly decreased metabolite to parent (CBZE/CBZ) ratios of Cmax and AUC and significantly increased CBZE/CBZ ratios of CL/F and Vd/F, indicating the reduced formation of CBZE to CBZ. The results suggest that the altered CYP3A4 enzyme activity and pharmacokinetics of CBZ might be attributed to RSV-mediated inhibition of CYP3A4 enzyme. Thus, there is a potential pharmacokinetic interaction between RSV and CBZ including other CYP3A4 substrates.
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Affiliation(s)
- Satish Kumar Bedada
- DMPK & Clinical Pharmacology Division, Department of Pharmacology, University College of Pharmaceutical Sciences, Kakatiya University, Warangal, AP, India
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