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Elvir Lazo OL, White PF, Lee C, Cruz Eng H, Matin JM, Lin C, Del Cid F, Yumul R. Use of herbal medication in the perioperative period: Potential adverse drug interactions. J Clin Anesth 2024; 95:111473. [PMID: 38613937 DOI: 10.1016/j.jclinane.2024.111473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/26/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
Use of herbal medications and supplements has experienced immense growth over the last two decades, with retail sales in the USA exceeding $13 billion in 2021. Since the Dietary Supplement Health and Education Act (DSHEA) of 1994 reduced FDA oversight, these products have become less regulated. Data from 2012 shows 18% of U.S. adults used non-vitamin, non-mineral natural products. Prevalence varies regionally, with higher use in Western states. Among preoperative patients, the most commonly used herbal medications included garlic, ginseng, ginkgo, St. John's wort, and echinacea. However, 50-70% of surgical patients fail to disclose their use of herbal medications to their physicians, and most fail to discontinue them preoperatively. Since herbal medications can interact with anesthetic medications administered during surgery, the American Society of Anesthesiologists (ASA) and the American Association of Nurse Anesthetists (AANA) recommend stopping herbal medications 1-2 weeks before elective surgical procedures. Potential adverse drug effects related to preoperative use of herbal medications involve the coagulation system (e.g., increasing the risk of perioperative bleeding), the cardiovascular system (e.g., arrhythmias, hypotension, hypertension), the central nervous system (e.g., sedation, confusion, seizures), pulmonary (e.g., coughing, bronchospasm), renal (e.g., diuresis) and endocrine-metabolic (e.g., hepatic dysfunction, altered metabolism of anesthetic drugs). During the preoperative evaluation, anesthesiologists should inquire about the use of herbal medications to anticipate potential adverse drug interactions during the perioperative period.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; White Mountain Institute, The Sea Ranch, CA 95497, USA.
| | - Carol Lee
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Hillenn Cruz Eng
- Department of Anesthesiology, Adena Health System, Chillicothe, OH, USA.
| | - Jenna M Matin
- Tulane University School of Medicine, New Orleans, LA, USA.
| | - Cory Lin
- Department of Anesthesiology and Perioperative Care, University of California Irvine, CA, USA.
| | - Franklin Del Cid
- Department of Anesthesiology, Hospital Escuela, Tegucigalpa, Honduras.
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine-UCLA, Charles R, Drew University of Medicine and Science, Los Angeles, CA, USA.
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2
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Elvir-Lazo OL, Romero-Navarro AL, White PF. Update on the potential adverse effects of preoperative herbal medication use during the perioperative period. J Clin Anesth 2024; 97:111553. [PMID: 39059275 DOI: 10.1016/j.jclinane.2024.111553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024]
Affiliation(s)
| | | | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, USA; White Mountain Institute, The Sea Ranch, CA 95497, USA.
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Alasvand Zarasvand S, Ogawa S, Nestor B, Bridges W, Haley-Zitlin V. Effects of Herbal Tea (Non-Camellia sinensis) on Glucose Homeostasis and Serum Lipids in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis. Nutr Rev 2024:nuae068. [PMID: 38894639 DOI: 10.1093/nutrit/nuae068] [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: 06/21/2024] Open
Abstract
CONTEXT Hyperglycemia and hyperlipidemia increase the risk for diabetes and its complications, atherosclerosis, heart failure, and stroke. Identification of safe and cost-effective means to reduce risk factors is needed. Herbal teas may be a vehicle to deliver antioxidants and polyphenols for prevention of complications. OBJECTIVE This systematic review and meta-analysis were conducted to evaluate and summarize the impact of herbal tea (non-Camellia sinensis) on glucose homeostasis and serum lipids in individuals with type 2 diabetes (T2D). DATA SOURCES PubMed, FSTA, Web of Science, CINAHL, MEDLINE, and Cochrane Library databases were searched from inception through February 2023 using relevant keyword proxy terms for diabetes, serum lipids, and "non-Camellia sinensis" or "tea." DATA EXTRACTION Data from 14 randomized controlled trials, totaling 551 participants, were included in the meta-analysis of glycemic and serum lipid profile end points. RESULTS Meta-analysis suggested a significant association between drinking herbal tea (prepared with 2-20 g d-1 plant ingredients) and reduction in fasting blood glucose (FBG) (P = .0034) and glycated hemoglobin (HbA1c; P = .045). In subgroup analysis based on studies using water or placebo as the control, significant reductions were found in serum total cholesterol (TC; P = .024), low-density lipoprotein cholesterol (LDL-C; P = .037), and triglyceride (TG; P = .043) levels with a medium effect size. Meta-regression analysis suggested that study characteristics, including the ratio of male participants, trial duration, and region, were significant sources of FBG and HbA1c effect size heterogeneity; type of control intervention was a significant source of TC and LDL-C effect size heterogeneity. CONCLUSIONS Herbal tea consumption significantly affected glycemic profiles in individuals with T2D, lowering FBG levels and HbA1c. Significance was seen in improved lipid profiles (TC, TG, and LDL-C levels) through herbal tea treatments when water or placebo was the control. This suggests water or placebo may be a more suitable control when examining antidiabetic properties of beverages. Additional research is needed to corroborate these findings, given the limited number of studies.
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Affiliation(s)
- Sepideh Alasvand Zarasvand
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634-0316, United States
| | - Shintaro Ogawa
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo 187-8553, Japan
| | - Bailey Nestor
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634-0316, United States
| | - William Bridges
- Department of Mathematical and Statistical Sciences, Clemson University, Clemson, SC 29634, United States
| | - Vivian Haley-Zitlin
- Department of Food, Nutrition, and Packaging Sciences, Clemson University, Clemson, SC 29634-0316, United States
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Zayed AL, Hadieh M, Al Hroot J, Hameedat F, Jaber SA. Development of a rapid HPLC-fluorescence method for monitoring warfarin metabolites formation: In vitro studies for evaluating the effect of piperine on warfarin metabolism and plasma coagulation. Heliyon 2024; 10:e31266. [PMID: 38807873 PMCID: PMC11130653 DOI: 10.1016/j.heliyon.2024.e31266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/30/2024] Open
Abstract
Warfarin, a widely prescribed anticoagulant, is highly effective for various coagulation disorders. However, its efficacy is limited by a narrow therapeutic index and frequent drug interactions, especially those involving metabolism by Cytochrome P450 (CYP450) enzymes. Piperine, found in black and long pepper, possesses blood-thinning properties and has been observed to inhibit CYP3A and CYP2C enzymes linked to warfarin metabolism. This study investigated the effect of piperine on warfarin metabolism in liver microsomes using a rapid and sensitive HPLC-Fluorescence method. The use of PFP (pentafluorophenyl) column with core shell particles provided the selectivity and resolution to resolve warfarin and its 4-, 6-, 7-, and 10-hydroxy metabolites in addition to the internal standard naproxen in less than 3 min. This is the fastest analytical assay for warfarin and its major metabolites reported to date, making it ideal for metabolic studies. The applicability of the method was demonstrated by monitoring the metabolism of S-warfarin in human and rat liver microsomes, and evaluating the inhibitory effect of piperine on metabolite formation. The results showed that piperine inhibited the formation of the major metabolite, 7-hydroxywarfarin, with half-maximal inhibitory concentration (IC50) 14.2 μM and 3.2 μM in human and rat liver microsomes, respectively. Furthermore, coagulation studies in vitro using rat plasma showed that piperine does not affect prothrombin time (PT) and activated partial thromboplastin time (aPTT). This study suggested that piperine may present a potential drug interaction with warfarin at the metabolism level, but has no direct effect on the activation of the extrinsic or intrinsic coagulation cascades. Further clinical investigation is therefore required, as piperine may increase the bioavailability of warfarin, thus increasing risk of serious adverse events in patients.
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Affiliation(s)
- Aref L Zayed
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Mohammad Hadieh
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Jomana Al Hroot
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Fatima Hameedat
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Sana'a A Jaber
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
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Ruplin A, Segal E, McFarlane T. Review of drug-drug interactions in patients with prostate cancer. J Oncol Pharm Pract 2024:10781552241238198. [PMID: 38720547 DOI: 10.1177/10781552241238198] [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: 05/25/2024]
Abstract
OBJECTIVE The objective of this review is to provide an overview of common drug-drug interactions (DDIs) associated with prostate cancer treatments and outline recommendations for managing polypharmacy. DATA SOURCES A literature search of PubMed, Embase, and CINAHL was carried out to identify pharmacokinetic and pharmacodynamic changes caused by DDIs that are relevant for prostate cancer patients, DDIs between prostate cancer therapies and co-administered medications (both prescription and over-the-counter), and measures to prevent DDIs. Medication package inserts were used to identify the impact of DDI on the prostate cancer therapy and suggested interventions. DATA SUMMARY No DDIs are expected for the LHRH agonists leuprolide acetate, histrelin, goserelin, or leuprolide mesylate. However, DDIs have been reported for GnRH antagonists, anti-androgens, PARP inhibitors, and taxanes. Although there are no confirmed DDIs for sipuleucel-T to date, it is not generally recommended to use sipuleucel-T concurrently with immunosuppressive medications. Interventions to prevent DDIs include the use of software that can detect clinically significant DDIs, up-to-date medication reconciliation, the inclusion of dedicated clinical pharmacists in cancer treatment teams, and patient/caregiver education. CONCLUSIONS Prostate cancer patients have a high risk of potential DDIs due to numerous new anti-cancer therapies, the increased use of treatment combinations, and the likelihood of comorbid conditions also requiring drug therapy. Drug-drug interaction screening software, up-to-date medication reconciliation, inclusion of oncology pharmacists on healthcare teams, and patient/caregiver education will aid the development of treatment plans that focus on achieving an optimal risk-benefit profile whilst reducing the risk of DDIs.
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Affiliation(s)
- Andrew Ruplin
- Department of Pharmacy, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Eve Segal
- Department of Pharmacy, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Tom McFarlane
- School of Pharmacy, University of Waterloo, Kitchener, Canada
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Hazra S, Singh PA. Safety Aspects of Herb Interactions: Current Understanding and Future Prospects. Curr Drug Metab 2024; 25:28-53. [PMID: 38482621 DOI: 10.2174/0113892002289753240305062601] [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: 10/27/2023] [Revised: 01/11/2024] [Accepted: 02/09/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND The use of herbal medicines is on the rise throughout the world due to their perceived safety profile. However, incidences of herb-drug, herb-herb and herb-food interactions considering safety aspects have opened new arenas for discussion. OBJECTIVE The current study aims to provide comprehensive insights into the various types of herb interactions, the mechanisms involved, their assessment, and historical developments, keeping herbal safety at the central point of discussion. METHODS The authors undertook a focused/targeted literature review and collected data from various databases, including Science Direct, Wiley Online Library, Springer, PubMed, and Google Scholar. Conventional literature on herbal remedies, such as those by the WHO and other international or national organizations. RESULTS The article considered reviewing the regulations, interaction mechanisms, and detection of herb-herb, herb-drug and herb-food interactions in commonly used yet vital plants, including Glycyrrhiza glabra, Mentha piperita, Aloe barbadensis, Zingiber officinale, Gingko biloba, Withania somnifera, etc. The study found that healthcare professionals worry about patients not informing them about their herbal prescriptions (primarily used with conventional treatment), which can cause herb-drug/herb-food/herb-herb interactions. These interactions were caused by altered pharmacodynamic and pharmacokinetic processes, which might be explained using in-vivo, in-vitro, in-silico, pharmacogenomics, and pharmacogenetics. Nutrivigilance may be the greatest method to monitor herb-food interactions, but its adoption is limited worldwide. CONCLUSION This article can serve as a lead for clinicians, guiding them regarding herb-drug, herb-food, and herb-herb interactions induced by commonly consumed plant species. Patients may also be counseled to avoid conventional drugs, botanicals, and foods with a restricted therapeutic window.
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Affiliation(s)
- Subhajit Hazra
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
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Rasheed H, Ahmed S, Sharma A. Changing Trends Towards Herbal Supplements: An Insight into Safety and Herb-drug Interaction. Curr Pharm Biotechnol 2024; 25:285-300. [PMID: 37464829 DOI: 10.2174/1389201024666230718114606] [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: 07/16/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023]
Abstract
Herbs have been used as sustenance and medicine for a very long time, often in conjunction with other prescribed medications. Even though they are thought to be natural and secure, many of these herbs can interact with other medications and cause potentially dangerous adverse effects or decrease the benefits of the medication. The complex and diverse pharmacological functions carried out by the active ingredients in herbs unavoidably alter the pharmacokinetics of chemical drugs when administered in vivo. Drug transporter expression has a direct impact on how medications are absorbed, distributed, metabolized, and excreted in living organisms. Changes in substrate pharmacokinetics can affect the effectiveness and toxicity of a drug when the active ingredients of a herb inhibit or stimulate the expression of transporters. By reviewing published clinical and preclinical studies, this review aims to raise awareness of herbdrug interactions and discuss their evidence-based mechanisms and clinical consequences. More clinical information on herb-drug interactions is required to make choices regarding patient safety as the incidence and severity of herb-drug interactions are rising due to an increase in the use of herbal preparations globally.This review seeks to increase understanding of herb-drug interactions and explore their evidence-based mechanisms and clinical implications by reviewing published clinical and preclinical studies. The incidence and severity of herb-drug interactions are on the rise due to an increase in the use of herbal preparations worldwide, necessitating the need for more clinical data on these interactions in order to make decisions regarding patient safety. Healthcare workers and patients will become more alert to potential interactions as their knowledge of pharmacokinetic herb-drug interactions grows. The study's objective is to raise readers' awareness of possible interactions between herbal supplements and prescription medications who regularly take them.
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Affiliation(s)
- Haamid Rasheed
- Department of Quality Assurance, Indo Soviet Friendship (ISF), College of Pharmacy, Moga, 142001, Punjab, India
| | - Suhail Ahmed
- Department of Quality Assurance, Indo Soviet Friendship (ISF), College of Pharmacy, Moga, 142001, Punjab, India
| | - Alok Sharma
- Department of Pharmaceutical Technology, MIET, Meerut, 250005, U.P., India
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Hazra S, Singh PA, Bajwa N. Safety Issues of Herb-Warfarin Interactions. Curr Drug Metab 2024; 25:13-27. [PMID: 38465436 DOI: 10.2174/0113892002290846240228061506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/01/2024] [Accepted: 02/14/2024] [Indexed: 03/12/2024]
Abstract
Warfarin is a popular anticoagulant with high global demand. However, studies have underlined serious safety issues when warfarin is consumed concomitantly with herbs or its formulations. This review aimed to highlight the mechanisms behind herb-warfarin interactions while laying special emphasis on its PKPD interactions and evidence on Herb-Warfarin Interaction (HWI) with regards to three different scenarios, such as when warfarin is consumed with herbs, taken as foods or prescribed as medicine, or when used in special situations. A targeted literature methodology involving different scientific databases was adopted for acquiring information on the subject of HWIs. Results of the present study revealed some of the fatal consequences of HWI, including post-operative bleeding, thrombosis, subarachnoid hemorrhage, and subdural hematomas occurring as a result of interactions between warfarin and herbs or commonly associated food products from Hypericum perforatum, Zingiber officinale, Vaccinium oxycoccos, Citrus paradisi, and Punica granatum. In terms of PK-PD parameters, herbs, such as Coptis chinensis Franch. and Phellodendron amurense Rupr., were found to compete with warfarin for binding with plasma proteins, leading to an increase in free warfarin levels in the bloodstream, resulting in its augmented antithrombic effect. Besides, HWIs were also found to decrease International Normalised Ratio (INR) levels following the consumption of Persea americana or avocado. Therefore, there is an urgent need for an up-to-date interaction database to educate patients and healthcare providers on these interactions, besides promoting the adoption of novel technologies, such as natural language processing, by healthcare professionals to guide them in making informed decisions to avoid HWIs.
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Affiliation(s)
- Subhajit Hazra
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
| | - Preet Amol Singh
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
| | - Neha Bajwa
- University Institute of Pharma Sciences (UIPS), Chandigarh University, Mohali-140413, Punjab, India
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Lee HF, Liao PH. The development and impact of an app for a smart drug interaction reminder system. Technol Health Care 2024; 32:1595-1608. [PMID: 37840509 PMCID: PMC11091626 DOI: 10.3233/thc-230650] [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: 05/22/2023] [Accepted: 08/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Improved access to media and medical knowledge has elicited stronger public health awareness. OBJECTIVE This study developed a smart drug interaction reminder system for patients to increase knowledge and reduce nurse workload. METHODS This study used a single-group pre-test/post-test design and applied mining techniques to analyze the weight and probability of interaction among various medicines. Data were collected from 258 participants at a teaching hospital in northern Taiwan using convenience sampling. An app was used to give patients real-time feedback to obtain access to information and remind them of their health issues. In addition to guiding the patients on medications, this app measured the nurses' work satisfaction and patients' knowledge of drug interaction. RESULTS The results indicate that using information technology products to assist the app's real-time feedback system promoted nurses' work satisfaction, improved their health education skills, and helped patients to better understand drug interactions. CONCLUSION Using information technology to provide patients with real-time inquiring functions has a significant effect on nurses' load reduction. Thus, smart drug interaction reminder system apps can be considered suitable nursing health education tools and the SDINRS app can be integrated into quantitative structure-activity relationship intelligence in the future.
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Affiliation(s)
- Hung-Fu Lee
- School of Nursing
- Department of Neurosurgery, Cheng Hsin General Hospital, Taipei City, Taiwan
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10
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Smythe MA, Wu W, Garwood CL. Anticoagulant drug-drug interactions with cannabinoids: A systematic review. Pharmacotherapy 2023; 43:1327-1338. [PMID: 37740600 DOI: 10.1002/phar.2881] [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: 07/13/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 09/24/2023]
Abstract
This systematic review evaluates the extent to which the effect of anticoagulants may be altered in the presence of cannabinoids. The following databases were searched: EMBASE, PubMed, Web of Science, Scopus, PscycINFO, and CINAHL from database inception through May 2023. Search terms included cannabis AND anticoagulant AND drug interactions and related keywords. The major outcome was hemorrhage or thrombosis and if available the relative change in quantitative intensity of anticoagulation after cannabinoid exposure. The search generated 959 citations. After the removal of 440 duplicates, 519 citations were screened. Overall, with the exception of warfarin, evidence supporting an interaction between cannabinoids and anticoagulants is non-existent. Seven case reports evaluating an interaction with warfarin were reported. Cannabis doses involved were either extremely high (e.g., >260 mg/day of delta-9-tetrahydrocannabidiol [THC] or >600 mg/day of cannabidiol [CBD]) or were not known. Hemorrhage was identified in 14.2% (1/7) of reports and thrombosis in 0%. Quantitative anticoagulation levels were increased in patients on warfarin (elevated International Normalized Ratio [INR]) in six of seven cases. A maximum INR change was available in five of seven reports, ranging from +0.4 to +9.61. One report found no change in INR after 4 days of medical cannabis exposure. Another report outlined two separate episodes of INR elevation associated with bleeding requiring hospitalization and reversal after marijuana smoking. Four cases involved reduction in weekly warfarin dose ranging from 22% to 31%. The Drug Information Probability Score was calculated in six cases, with a score of probable for five cases and possible for one. Very low-quality data support a potential drug-drug interaction with warfarin and both THC and CBD. Clinician recognition of this potential interaction is important. Available evidence supports the need to conduct a drug interaction study between cannabinoids and warfarin to clarify the existence of an interaction.
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Affiliation(s)
- Maureen A Smythe
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy Services, Corewell Health William Beaumont University Hospital, Royal Oak, Michigan, USA
| | - Wendy Wu
- University Libraries, Wayne State University, Detroit, Michigan, USA
| | - Candice L Garwood
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, Michigan, USA
- Department of Pharmacy, Harper University Hospital, Detroit Medical Center, Detroit, Michigan, USA
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11
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Reig-Garcia G, Camara-Liebana D, Jiménez-Quiñones R, Vilanó-Vives J, Figa-Vaello J, Garre-Olmo J, Mantas-Jiménez S, Juvinyà-Canal D, Suñer-Soler R. Control of Therapeutic Levels of Anticoagulation and Associated Factors: A Prospective Cohort Study. J Prim Care Community Health 2022; 13:21501319221129935. [PMID: 36300419 PMCID: PMC9623388 DOI: 10.1177/21501319221129935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Maintaining therapeutic levels of anticoagulation is essential to avoid health complications in people who take vitamin K antagonists. This study aimed to analyze the influence of people's characteristics and the presence of changes in their lives in the control of therapeutic levels of anticoagulation. A longitudinal multicenter study with a 1-year follow-up of a cohort of 199 people receiving anticoagulant therapy was performed. The effect of biological, clinical, social, lifestyle, and changes in life on the international normalized ratio (INR) was analyzed. During the follow-up, 46.7% of participants presented good INR control. At baseline, a diagnosis of atrial fibrillation (P = .00), the lack of comorbidities (P = .03), absence of depression (P = .04), and not following a pharmacological treatment with hypoglycemia drugs (P = .01) were associated with good INR control. During the follow-up, the variable of making changes to the usual diet was associated with poor INR control (P = .05). In the binary multiple regression model, factors associated with poor control were taking hypoglycemia drugs (P = .02) and the presence of depression (P = .04), and only the diagnosis of atrial fibrillation was associated with good control (P = .03). People with a diagnosis of atrial fibrillation had good INR control. Having comorbidities, suffering depression, taking hypoglycemia drugs, and making changes to the diet have a negative effect on INR control.
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Affiliation(s)
- Glòria Reig-Garcia
- University of Girona, Girona,
Spain,Health and Health Care Research Group,
Girona, Spain
| | - David Camara-Liebana
- University of Girona, Girona,
Spain,David Camara-Liebana, Department of
Nursing, University of Girona, Emili Grahït,77, Girona, Catalunya 17003, Spain.
| | - Raquel Jiménez-Quiñones
- Primary Health Care, Institut
d’Assistència Sanitària, Institut Català de la Salut, Girona, Spain
| | - Jordi Vilanó-Vives
- Primary Health Care, Institut
d’Assistència Sanitària, Institut Català de la Salut, Girona, Spain
| | - Josep Figa-Vaello
- Primary Health Care, Institut
d’Assistència Sanitària, Institut Català de la Salut, Girona, Spain
| | | | - Susana Mantas-Jiménez
- University of Girona, Girona,
Spain,Health and Health Care Research Group,
Girona, Spain
| | - Dolors Juvinyà-Canal
- University of Girona, Girona,
Spain,Health and Health Care Research Group,
Girona, Spain
| | - Rosa Suñer-Soler
- University of Girona, Girona,
Spain,Health and Health Care Research Group,
Girona, Spain
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12
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Ploylearmsang C, Kanjanasilp J, Tadtiyanant J, Sisala P. Promoting rational herb-drug use through pharmacy-led advice and home visits in NCD patients. Pharm Pract (Granada) 2022; 20:2747. [PMID: 36793912 PMCID: PMC9891797 DOI: 10.18549/pharmpract.2022.4.2747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/17/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction There has been a considerable increase in the concurrent use of prescribed medicines and herbal products, but most users do not have any information about drug-herb interactions. Objective Therefore, this study aimed to investigate the effects of pharmacological advice by community pharmacists on promoting the rational use of prescribed medicines together with herbal products. Methods The study was one group pretest-posttest experimental design, performed on a sample of 32 people who met the following criteria: aged ≥18 years, lived in an urbanized area, have NCDs such as diabetes, hypertension, dyslipidemia, or cardiovascular disease, and have used prescribed medicines and herbal products concurrently. The participants were informed and practically advised on the rational use of herbal products simultaneously with prescribed medicines, the possibility of drug-herb interactions, and self-monitoring of possible adverse effects. Results After implementing pharmacological advice, the participants showed a significant increase in knowledge of rational drug-herb use: from 5.8±1.8 to 8.4±1.6 out of a total of 10 (p<0.001), and their score in terms of appropriate behavior rose from 21.7±2.9 to 24.4±3.1 out of a total of 30 (p<0.001). Additionally, the number of patients with herb-drug interaction risk decreased statistically significantly (37.5% and 25.0%, p=0.031). Conclusion Pharmacy-led advice on rational use of herbal products with prescribed NCD medicines is effective in terms of promoting increases in knowledge and appropriate behavior in these matters. This is a strategy for risk management of herb-drug interactions in NCD patients.
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Affiliation(s)
- Chanuttha Ploylearmsang
- Assistant Professor, International Primary Care Practice Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantarawichai 44150, Thailand.
| | - Juntip Kanjanasilp
- Associate Professor, Clinical trials and Evidence-based Syntheses Research Unit, Faculty of Pharmacy, Mahasarakham University, Kantarawichai 44150, Thailand.
| | - Juthamas Tadtiyanant
- Sixth year PharmD student, Faculty of Pharmacy, Mahasarakham University, Kantarawichai, Mahasarakham, 44150, Thailand.
| | - Piyaporn Sisala
- Sixth year PharmD student, Faculty of Pharmacy, Mahasarakham University, Kantarawichai, Mahasarakham, 44150, Thailand.
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13
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Abudalo R, Abudalo R, Alqudah A, Abuqamar A, Abdelaziz A, Alshawabkeh M, Taha L. Pharmacy practitioners' practice, awareness and knowledge about herbal products and their potential interactions with cardiovascular drugs. F1000Res 2022; 11:912. [PMID: 36212547 PMCID: PMC9520230 DOI: 10.12688/f1000research.121709.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2022] [Indexed: 01/13/2023] Open
Abstract
Background: Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products' adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients' counselling to set up safe and effective drug use. Methods: A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26. Results: Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses. Conclusions: The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.
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Affiliation(s)
- Rawan Abudalo
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan,
| | - Razan Abudalo
- Department of Radiology, Jordanian Royal Medical Services, Amman, Jordan
| | - Abdelrahim Alqudah
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Ayman Abuqamar
- Department of Oncology and Hematology, Jordanian Royal Medical Services, Amman, Jordan
| | - Amr Abdelaziz
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Maram Alshawabkeh
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
| | - Luma Taha
- Department of clinical pharmacy and pharmacy practice, Faculty of Pharmaceutical Sciences, The Hashemite University, Zarqa, Zarqa, 13133, Jordan
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14
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Hatfield J, Saad S, Housewright C. Dietary supplements and bleeding. Proc AMIA Symp 2022; 35:802-807. [DOI: 10.1080/08998280.2022.2121575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Affiliation(s)
- Jess Hatfield
- Texas A&M Health Science Center College of Medicine, Temple, Texas
| | - Saadeddine Saad
- Department of Dermatology, Baylor Scott and White Medical Center – Temple, Temple, Texas
| | - Chad Housewright
- Department of Dermatology, Baylor Scott and White Medical Center – Temple, Temple, Texas
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15
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Lee JH, Sung WS, Bak SB, Kim EJ, Kim YW. Evaluation of Xiaoyao-san for treatment of irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Subramani B, Sathiyarajeswaran P. Current update on herbal sources of antithrombotic activity—a comprehensive review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2022; 34:26. [PMID: 35283622 PMCID: PMC8899788 DOI: 10.1186/s43162-021-00090-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/01/2021] [Indexed: 02/08/2023] Open
Abstract
Background Herbs are commonly used to treat cardiovascular diseases in various traditional medicine. On the other hand, herb-drug interactions are most commonly encountered with conventional antiplatelet and anticoagulant drug prescriptions. This review presents a compilation of plants investigated for antiplatelet and anticoagulation recently and enumerates their possible lead compounds responsible for its action for paving further drug discovery and knowledge update. Main body of the abstract Information about the herbs was withdrawn from the PubMed database of the previous 5 years. We also hand-searched the bibliography of relevant articles for the acquisition of additional information. About 72 herbal sources were identified with the effect of antiplatelet activity, antithrombotic activity, and anticoagulant activity. Bioactive compounds and various secondary metabolites responsible for it, such as alkaloids, saponins, flavonoids, coumarins, polyphenols, furan derivatives, iridoid glycosides, sesquiterpenes, aporphine compounds, were reported. Conclusion Newer pharmacological moieties are needed to prevent or reduce the adverse effects of current anti-thrombotic agents and to improve the safety of patients and cost-effectiveness.
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17
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Lopera V, Rodríguez A, Amariles P. Clinical Relevance of Drug Interactions with Cannabis: A Systematic Review. J Clin Med 2022; 11:jcm11051154. [PMID: 35268245 PMCID: PMC8911401 DOI: 10.3390/jcm11051154] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 12/29/2022] Open
Abstract
Concomitant use of cannabis with other drugs may lead to cannabis–drug interactions, mainly due to the pharmacokinetic mechanism involving the family of CYP450 isoenzymes. This narrative systematic review aimed to systematize the available information regarding clinical relevance of cannabis–drug interactions. We utilized the PubMed/Medline database for this systematic review, using the terms drug interactions and cannabis, between June 2011 and June 2021. Articles with cannabis–drug interactions in humans, in English or Spanish, with full-text access were selected. Two researchers evaluated the article’s inclusion. The level of clinical relevance was determined according to the severity and probability of the interaction. Ninety-five articles were identified and twenty-six were included. Overall, 19 pairs of drug interactions with medicinal or recreational cannabis were identified in humans. According to severity and probability, 1, 2, 12, and 4 pairs of cannabis–drug interactions were classified at levels 1 (very high risk), 2 (high risk), 3 (medium risk), and 5 (without risk), respectively. Cannabis–warfarin was classified at level 1, and cannabis–buprenorphine and tacrolimus at level 2. This review provides evidence for both the low probability of the occurrence of clinically relevant drug interactions and the lack of evidence regarding cannabis–drug interactions.
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18
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Guerrero AZA, Coutinho EL, Ferraz MB, Cirenza C, Santos MCED, Ferraro JR, Paola AAVD. Estratégias Econômicas e Sociais para Anticoagulação de Pacientes com Fibrilação Atrial. Arq Bras Cardiol 2022; 118:88-94. [PMID: 35195214 PMCID: PMC8959044 DOI: 10.36660/abc.20200921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamento: Objetivo: Métodos: Resultados: Conclusões:
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19
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Muyambo S, Ndadza A, Soko ND, Kruger B, Kadzirange G, Chimusa E, Masimirembwa CM, Ntsekhe M, Nhachi CF, Dandara C. Warfarin Pharmacogenomics for Precision Medicine in Real-Life Clinical Practice in Southern Africa: Harnessing 73 Variants in 29 Pharmacogenes. OMICS : A JOURNAL OF INTEGRATIVE BIOLOGY 2022; 26:35-50. [PMID: 34958284 PMCID: PMC8792494 DOI: 10.1089/omi.2021.0199] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Pharmacogenomics is universally relevant for worldwide modern therapeutics and yet needs further development in resource-limited countries. While there is an abundance of genetic association studies in controlled medical settings, there is a paucity of studies with a naturalistic design in real-life clinical practice in patients with comorbidities and under multiple drug treatment regimens. African patients are often burdened with communicable and noncommunicable comorbidities, yet the application of pharmacogenomics in African clinical settings remains limited. Using warfarin as a model, this study aims at minimizing gaps in precision/personalized medicine research in African clinical practice. We present, therefore, pharmacogenomic profiles of a cohort of 503 black Africans (n = 252) and Mixed Ancestry (n = 251) patients from Southern Africa, on warfarin and co-prescribed drugs in a naturalized noncontrolled environment. Seventy-three (n = 73) single nucleotide polymorphisms (SNPs) in 29 pharmacogenes were characterized using a combination of allelic discrimination, Sanger sequencing, restriction fragment length polymorphism, and Sequenom Mass Array. The common comorbidities were hypertension (43-46%), heart failure (39-45%), diabetes mellitus (18%), arrhythmia (25%), and HIV infection (15%). Accordingly, the most common co-prescribed drugs were antihypertensives, antiarrhythmic drugs, antidiabetics, and antiretroviral therapy. We observed marked variation in major pharmacogenes both at interethnic levels and within African subpopulations. The Mixed Ancestry group presented a profile of genetic variants reflecting their European, Asian, and African admixture. Precision medicine requires that African populations begin to capture their own pharmacogenetic SNPs as they cannot always infer with absolute certainty from Asian and European populations. In the current historical moment of the COVID-19 pandemic, we also underscore that the spectrum of drugs interacting with warfarin will likely increase, given the systemic and cardiovascular effects of COVID-19, and the anticipated influx of COVID-19 medicines in the near future. This observational clinical pharmacogenomics study of warfarin, together with past precision medicine research, collectively, lends strong support for incorporation of pharmacogenetic profiling in clinical settings in African patients for effective and safe administration of therapeutics.
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Affiliation(s)
- Sarudzai Muyambo
- Department of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- Department of Biological Sciences, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Zimbabwe
| | - Arinao Ndadza
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine (IIDMM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Nyarai D. Soko
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine (IIDMM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Bianca Kruger
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine (IIDMM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gerard Kadzirange
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Emile Chimusa
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine (IIDMM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collen M. Masimirembwa
- Department of Drug Metabolism and Pharmacokinetics (DMPK), African Institute of Biomedical Sciences and Technology (AiBST), Harare, Zimbabwe
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Charles F.B. Nhachi
- Department of Clinical Pharmacology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Collet Dandara
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology, Institute of Infectious Diseases and Molecular Medicine (IIDMM), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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20
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Lopes M, Coimbra MA, Costa MDC, Ramos F. Food supplement vitamins, minerals, amino-acids, fatty acids, phenolic and alkaloid-based substances: An overview of their interaction with drugs. Crit Rev Food Sci Nutr 2021:1-35. [PMID: 34792411 DOI: 10.1080/10408398.2021.1997909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Food supplements are a widespread group of products ingested as a diet complement, whose consumption has recently skyrocketed due to the consumers' concern with their well-being. Among food supplements, vitamin- and mineral-based ones are the top sellers, and the demand of others, such as those containing polyphenols, is increasing. Owing to their alleged natural characteristics, consumers take the safety of food supplements for granted, and use them even when taking medicines. Thus, their potential interactions with drugs have been sparsely evaluated. This manuscript aims to bring forth an up-to-date overview of the most important knowledge involving the interactions between food supplements and drugs, relevant to be aware by nutritionists and other healthcare professionals. To this end, an extensive bibliographic review was conducted focusing on peer reviewed data from experimental in vivo evidence and clinical studies whenever major clinical interactions have been reported. Elder people and polymedicated or chronic patients are especially vulnerable to the therapeutic ineffectiveness and toxicity caused by these types of interactions. Drugs used to treat cardiovascular, autoimmune, nervous, and oncological diseases are commonly involved in important clinical interactions with food supplements, many with a narrow therapeutic margin.
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Affiliation(s)
- Maria Lopes
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal
| | - Manuel A Coimbra
- LAQV/REQUIMTE, Department of Chemistry, University of Aveiro, Aveiro, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
| | - Maria do Céu Costa
- Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal.,CBIOS-Universidade Lusófona's Research Centre for Biosciences & Health Technologies, Lisboa, Portugal.,NICiTeS, Polytechnic Institute of Lusophony, ERISA-Escola Superior de Saúde Ribeiro Sanches, Lisboa, Portugal
| | - Fernando Ramos
- Faculty of Pharmacy, Azinhaga de Santa Comba, University of Coimbra, Coimbra, Portugal.,REQUIMTE/LAQV, R. D. Manuel II, Apartado 55142, Oporto, Portugal.,Economic and Food Safety Authority (ASAE) Scientific Council, Rua Rodrigo da Fonseca, Lisboa, Portugal
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21
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Zhang Y, Man Ip C, Lai YS, Zuo Z. Overview of Current Herb-Drug Interaction Databases. Drug Metab Dispos 2021; 50:86-94. [PMID: 34697080 DOI: 10.1124/dmd.121.000420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 10/20/2021] [Indexed: 12/25/2022] Open
Abstract
An HERB-Drug Interaction (HDI) database is a structured data collection method for HDI information extracted from scattered literatures for quick retrieval. Our review summarized the ten currently available HDI databases, including those databases comprising HDI on the market. A detailed comparison on the scope of monographs, including the nature of content extracted from the original literature and user interfaces of these databases, was performed, and the number of references of fifty popular herbs in each HDI database was counted and presented in a heatmap to give users an intuitive understanding of the focuses of different HDI databases. Since it is well known that the development and maintenance of databases need continuous investment of capital and manpower, the sustainability of these databases was also reviewed and compared. Recently, artificial intelligence (AI) technologies, especially Natural Language Processing (NLP), have been applied to screen specific topics from massive articles and automatically identify the names of drugs and herbs in the literature. However, its application on the labor-intensive extraction and evaluation of HDI-related experimental conditions and results from literature remains limited due to the scarcity of these HDI data and the lack of well-established annotated datasets for these specific NLP recognition tasks. In view of the difficulties faced by current HDI databases and potential expansion of AI application in HDI database development, we propose a standardized format for data reporting and use of Concept Unique Identifier (CUI) for medical terms in the literature to accelerate the structured data collection. SIGNIFICANCE STATEMENT: The worldwide popularity of botanical and/or traditional medicine products has raised safety concerns due to potential HDI. However, the publicly available HDI databases are mostly outdated or incomplete. Through our review of the currently available HDI databases, a clear understanding of the key issues could be obtained and possible solutions to overcome the labour-intensive extraction as well as professional evaluation of information in HDI database development are proposed.
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Affiliation(s)
- Yufeng Zhang
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Chung Man Ip
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Yuen Sze Lai
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
| | - Zhong Zuo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR
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22
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Leite PM, Martins MAP, Carvalho MDG, Castilho RO. Mechanisms and interactions in concomitant use of herbs and warfarin therapy: An updated review. Biomed Pharmacother 2021; 143:112103. [PMID: 34474338 DOI: 10.1016/j.biopha.2021.112103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
This review is an updated and expanded version published in this journal in 2016. Warfarin pharmacotherapy is extremely complex, since in addition to being a low therapeutic index drug, it does not follow the dose-response pattern and has characteristics that predispose the occurrence of interactions, such as high binding rate to plasma proteins, metabolization by cytochrome P450 enzymes, further to acting in the complex process of blood coagulation, platelet activation, and inflammation. For these reasons, warfarin has great potential for interaction with drugs, foods, and herbal medicines. Herb-warfarin interactions, however, are still not very well studied; thus, the objective of this update is to present new information on the subject aiming to provide a scientific basis to help health professionals in the clinical management of these interactions. A literature review was performed from May to June 2021 in multiple databases and articles published in 2016 to 2021 were included. A total of 59 articles describing 114 herbal medicines were reported to interact with warfarin. Of the plants mentioned, 84% had the potential to increase warfarin effect and the risk of bleeding. Targets possibly involved in these interactions include the processes of blood coagulation, platelet activation, and inflammation, in addition to the pharmacokinetics and pharmacodynamics of warfarin. Despite these alarming numbers, however, the clinical management of interactions is known to be effective. Thus, it is important that the use of these herbal medicines be done with caution in anticoagulated patients and that studies of herb-drug interactions be encouraged in order to generate information to support the clinical management of patients.
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Affiliation(s)
- Paula Mendonça Leite
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Auxiliadora Parreiras Martins
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Carvalho
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil
| | - Rachel Oliveira Castilho
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil; Consórcio Acadêmico Brasileiro de Saúde Integrativa, CABSIN, Brazil.
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23
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The Effect of Wheatgrass Lyophilizate on Blood Clotting Time in Rats. Sci Pharm 2021. [DOI: 10.3390/scipharm89030039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Wheatgrass is widely used in the alternative medicine, however, there is a lack of clinical evidence to support its efficacy. Although based on its chemical composition, data from animal experiments and clinical trials, the use of juice and extracts of Triticum shoots seems to be safe, clinical reports point out its potential interaction with oral anticoagulants. The aim of our study was to assess the interaction of wheatgrass with warfarin in rats and to assess its flavonoid content. Three groups of animals were treated orally with wheatgrass, warfarin, or the combination of wheatgrass and warfarin for five days. Clotting assays were performed using platelet-poor plasma. Prothrombin time was determined by optical and mechanical coagulometers. Flavonoid content of wheatgrass was measured by HPLC. The effect of wheatgrass on prothrombin time was not confirmed. Co-administration of wheatgrass and warfarin did not result in diminished anticoagulant activity. Low amount of flavonoids was detected in wheatgrass juice, the total flavonoid content was 0.467 mg/100 g lyophilized juice powder. The previously reported rutin, quercetin and apigenin was not detected by us. Our results do not confirm the probability of interaction of wheatgrass with oral anticoagulants. However, the low flavonoid content of wheatgrass does not support its use as an antioxidant.
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24
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Sharifi-Rad J, Quispe C, Zam W, Kumar M, Cardoso SM, Pereira OR, Ademiluyi AO, Adeleke O, Moreira AC, Živković J, Noriega F, Ayatollahi SA, Kobarfard F, Faizi M, Martorell M, Cruz-Martins N, Butnariu M, Bagiu IC, Bagiu RV, Alshehri MM, Cho WC. Phenolic Bioactives as Antiplatelet Aggregation Factors: The Pivotal Ingredients in Maintaining Cardiovascular Health. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:2195902. [PMID: 34447485 PMCID: PMC8384526 DOI: 10.1155/2021/2195902] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 07/28/2021] [Indexed: 01/22/2023]
Abstract
Cardiovascular diseases (CVD) are one of the main causes of mortality in the world. The development of these diseases has a specific factor-alteration in blood platelet activation. It has been shown that phenolic compounds have antiplatelet aggregation abilities and a positive impact in the management of CVD, exerting prominent antioxidant, anti-inflammatory, antitumor, cardioprotective, antihyperglycemic, and antimicrobial effects. Thus, this review is intended to address the antiplatelet activity of phenolic compounds with special emphasis in preventing CVD, along with the mechanisms of action through which they are able to prevent and treat CVD. In vitro and in vivo studies have shown beneficial effects of phenolic compound-rich plant extracts and isolated compounds against CVD, despite that the scientific literature available on the antiplatelet aggregation ability of phenolic compounds in vivo is scarce. Thus, despite the current advances, further studies are needed to confirm the cardioprotective potential of phenolic compounds towards their use alone or in combination with conventional drugs for effective therapeutic interventions.
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Affiliation(s)
- Javad Sharifi-Rad
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Cristina Quispe
- Facultad de Ciencias de la Salud, Universidad Arturo Prat, Avda. Arturo Prat 2120, Iquique 1110939, Chile
| | - Wissam Zam
- Department of Analytical and Food Chemistry, Faculty of Pharmacy, Al-Andalus University for Medical Sciences, Tartous, Syria
| | - Manoj Kumar
- Chemical and Biochemical Processing Division, ICAR-Central Institute for Research on Cotton Technology, Mumbai 400019, India
| | - Susana M. Cardoso
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Olivia R. Pereira
- Centro de Investigação de Montanha (CIMO), Instituto Politécnico de Bragança, Campus de Santa Apolónia, 5300-253 Bragança, Portugal
| | - Adedayo O. Ademiluyi
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
| | - Oluwakemi Adeleke
- Functional Foods and Nutraceuticals Unit, Department of Biochemistry, Federal University of Technology, Akure, Nigeria
- Department of Science Laboratory Technology, Ekiti State University, Ado-Ekiti, Nigeria
| | | | - Jelena Živković
- Institute for Medicinal Plants Research “Dr. Josif Pančić”, Tadeuša Košćuška 1, 11000 Belgrade, Serbia
| | - Felipe Noriega
- Department of Plant Production, Faculty of Agronomy, Universidad de Concepción, Chillan 4070386, Chile
| | - Seyed Abdulmajid Ayatollahi
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- Department of Pharmacognosy and Biotechnology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Kobarfard
- Phytochemistry Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Medicinal Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Faizi
- Department of Pharmacology and Toxicology, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Miquel Martorell
- Department of Nutrition and Dietetics, Faculty of Pharmacy, and Centre for Healthy Living, University of Concepción, 4070386 Concepción, Chile
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
- Institute for Research and Innovation in Health (i3S), University of Porto, 4200-135 Porto, Portugal
- Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 1317, 4585-116 Gandra PRD, Portugal
| | - Monica Butnariu
- Banat's University of Agricultural Sciences and Veterinary Medicine “King Michael I of Romania” from Timisoara, Timisoara, Romania
| | - Iulia Cristina Bagiu
- Victor Babes University of Medicine and Pharmacy of Timisoara, Department of Microbiology, Timisoara, Romania
- Multidisciplinary Research Center on Antimicrobial Resistance, Timisoara, Romania
| | - Radu Vasile Bagiu
- Victor Babes University of Medicine and Pharmacy of Timisoara, Department of Microbiology, Timisoara, Romania
- Preventive Medicine Study Center, Timisoara, Romania
| | - Mohammed M. Alshehri
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - William C. Cho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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25
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Leite PM, Freitas A, Amorim J, Figueiredo RCD, Bertolucci S, Faraco A, Martins M, Carvalho MG, Castilho R. In vitro anticoagulant activity of selected medicinal plants: potential interactions with warfarin and development of new anticoagulants. J Basic Clin Physiol Pharmacol 2021; 33:499-510. [PMID: 34273917 DOI: 10.1515/jbcpp-2021-0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/28/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Warfarin is the most widely used anticoagulant in the world, but it has several limitations including its narrow therapeutic range, need for dose adjustment and high potential for interactions. The simultaneous use of other drugs or even medicinal plants and certain foods could interfere with its therapeutic activity. In this context, this study aims to investigate the in vitro anticoagulant potential and phytochemical constitution of 17 plants selected from a previous clinical cross-sectional study (2014), that investigated the habits of plant utilization among patients taking warfarin. METHODS Ethanol extracts and essential oils were evaluated, in vitro, as to their effect in the prothrombin time (PT) and activated partial thromboplastin time (aPTT) tests. Four species that presented aPTT >50 s were selected for phytochemical evaluation. RESULTS Thirteen of the 17 plants selected demonstrated a significant anticoagulant effect in at least one of the evaluated parameters. Citrus sinensis (PT=14.75 and aPTT=53.15), Mentha crispa (aPTT=51.25), Mikania laevigata (PT=14.90 and aPTT=52.10), and Nasturtium officinale (aPTT=50.55) showed greater anticoagulant potential compared to normal plasma pool (PT=12.25 and aPTT=37.73). Chemical profiles of these four species were obtained, and certain compounds were identified: rosmarinic acid from M. crispa and isoorientin from N. officinale. CONCLUSIONS Thus, the results of this study could be a useful indicator for clinical practice towards the possibility of interaction between these plants and anticoagulants, although further clinical research is needed taking into consideration the limitations of in vitro studies. These findings also suggest that further research into the action of these plants could be of real clinical value in identifying potential alternative anticoagulant therapies.
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Affiliation(s)
| | - Aline Freitas
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Juliana Amorim
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - André Faraco
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Martins
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria G Carvalho
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rachel Castilho
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Albabtain MA, Alharthi MM, Dagriri K, Arafat AA, Ayrout E, Alhebaishi Y, AlFagih A. Assessment of the quality of anticoagulation management with warfarin in a tertiary care center. Saudi Med J 2021; 41:1245-1251. [PMID: 33130846 PMCID: PMC7804229 DOI: 10.15537/smj.2020.11.25456] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To evaluate the quality of an anticoagulation clinic in a tertiary hospital and identified factors affecting the time in the therapeutic range (TTR) and its relation to different complications. Methods: This single-center retrospective study conducted between March 2015 and June 2016 included 1914 patients receiving warfarin therapy. They were divided into 4 warfarin indication groups: non-valvular atrial fibrillation (AF) (n=403), valvular AF (n=227), prosthetic valves (n=700), and venous or pulmonary embolism (n=584). RESULTS The median age was 56 (25th, 75th percentiles: [45, 67]) years, and 53.2% were female. The median TTR was 0.52 (0.28, 0.76). Low hemoglobin (0.007) and high alkaline phosphatase (0.020) levels negatively affected the TTR. Venous thromboembolism (VTE) was associated with low TTRs. Minor bleeding occurred in 64 (3.35%), gastrointestinal bleeding in 14 (0.7%), and stroke in 41 (2.2%) patients, with no inter-group differences. The TTR was not associated with minor bleeding (odds ratio [OR]=0.49; p=0.09), gastrointestinal bleeding (OR=0.29; p=0.18), or stroke (OR=1.15; p=0.79). CONCLUSION Reflecting the real-life experience of anticoagulation control, our patients spend less than half the TTR within the INR. The low target TTR mandates the need to improve service quality and control factors affecting the TTR, including hemoglobin levels and regular visits for patients with VTE.
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Affiliation(s)
- Monirah A Albabtain
- Department of Pharmacy, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Sheikhi-Mobarakeh Z, Yarmohammadi H, Mokhatri-Hesari P, Fahimi S, Montazeri A, Heydarirad G. Herbs as old potential treatments for lymphedema management: A systematic review. Complement Ther Med 2020; 55:102615. [PMID: 33221590 DOI: 10.1016/j.ctim.2020.102615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 10/20/2020] [Accepted: 11/04/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Herbs have been reported to be effective in reducing lymphedema burden. This paper aimed to review literature reporting on herbs for lymphedema treatment. METHODS A systematic review was performed using the PRISMA guideline. Clinical studies on herbal intervention and lymphedema were included. Evidence on the effectiveness of herbal interventions for desired outcomes including reduction of edema volume, other symptoms, quality of life and inflammation were collected and assessed in detail. RESULTS In all twenty studies were included in this review. Of these 14 studies were randomized clinical trials and the rest were prospective pilot studies. Herbal treatment was reported for breast cancer-related lymphedema in most studies and coumarin was the most reported herb that used for lymphedema management. Edema volume reduction (17 out of 20) and symptoms improvement (15 out of 20) were the outcomes reported in most studies. CONCLUSION Phytochemicals can be a promising pharmacotherapy for lymphedema management. However, further evidence is needed to establish definite effectiveness for the use of herbal remedies for lymphedema management.
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Affiliation(s)
- Zahra Sheikhi-Mobarakeh
- Traditional Persian Medicine, Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, No. 8 Shams Alley, Vali-e-Asr Street, Tehran, 1516745811, Iran; Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran; Integrative Oncology Research Group, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran
| | - Hossein Yarmohammadi
- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran; Medical Students Research Committee, Shahed University College of Medicine, Mostafa Khomeini Hospital, Italy Street, Keshavarz Blvd, Tehran, Iran
| | - Parisa Mokhatri-Hesari
- Integrative Oncology Research Group, Breast Cancer Research Center, Motamed Cancer Institute, ACECR, No.146, South Gandi Ave, Vanak Sq, Tehran, 1517964311, Iran; Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Shirin Fahimi
- Traditional Medicine and Material Medical Research Center, Department of Traditional Pharmacy, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, No.19, Tavaneer Alley, Vali-e-Asr Ave, Tehran, Iran
| | - Ali Montazeri
- Population Health Research Group, Health Metrics Research Center, Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran
| | - Ghazaleh Heydarirad
- Traditional Persian Medicine, Department of Traditional Medicine, School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, No. 8 Shams Alley, Vali-e-Asr Street, Tehran, 1516745811, Iran.
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Chelluboina B, Vemuganti R. Therapeutic potential of nutraceuticals to protect brain after stroke. Neurochem Int 2020; 142:104908. [PMID: 33220386 DOI: 10.1016/j.neuint.2020.104908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 02/07/2023]
Abstract
Stroke leads to significant neuronal death and long-term neurological disability due to synergistic pathogenic mechanisms. Stroke induces a change in eating habits and in many cases, leads to undernutrition that aggravates the post-stroke pathology. Proper nutritional regimen remains a major strategy to control the modifiable risk factors for cardiovascular and cerebrovascular diseases including stroke. Studies indicate that nutraceuticals (isolated and concentrated form of high-potency natural bioactive substances present in dietary nutritional components) can act as prophylactic as well as adjuvant therapeutic agents to prevent stroke risk, to promote ischemic tolerance and to reduce post-stroke consequences. Nutraceuticals are also thought to regulate blood pressure, delay neurodegeneration and improve overall vascular health. Nutraceuticals potentially mediate these effects by their powerful antioxidant and anti-inflammatory properties. This review discusses the studies that have highlighted the translational potential of nutraceuticals as stroke therapies.
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Affiliation(s)
- Bharath Chelluboina
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA
| | - Raghu Vemuganti
- Department of Neurological Surgery, University of Wisconsin, Madison, WI, USA; William S. Middleton Veterans Administration Hospital, Madison, WI, USA.
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Tan CSS, Lee SWH. Warfarin and food, herbal or dietary supplement interactions: A systematic review. Br J Clin Pharmacol 2020; 87:352-374. [PMID: 32478963 DOI: 10.1111/bcp.14404] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS To present an updated overview on the safety of concurrent use of food, herbal or dietary supplement and warfarin. METHODS A systematic literature review was performed on 5 databases from inception up to 31 December 2019. These interactions were classified depending on the likelihood of interaction and supporting evidences. RESULTS A total of 149 articles describing 78 herbs, food or dietary supplements were reported to interact with warfarin. These reports described potentiation with 45 (57.7%) herbs, food or dietary supplements while 23 (29.5%) reported inhibition and 10 (12.8%) reported limited impact on warfarin pharmacokinetics and pharmacodynamics. Twenty unique herb and dietary supplements also reported to result in minor bleeding events, such as purpura and gum bleeding as well as major events such as intracranial bleeding that led to death. CONCLUSION While most food, herbs and supplements can be safely taken in moderation, healthcare professionals should be aware of the increased risk of bleeding when taking several food and herbs. These include Chinese wolfberry, chamomile tea, cannabis, cranberry, chitosan, green tea, Ginkgo biloba, ginger, spinach, St. John's Wort, sushi and smoking tobacco. Patients should be counselled to continue to seek advice from their healthcare professionals when starting any new herbs, food or supplement.
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Affiliation(s)
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia.,Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Selangor, Malaysia.,School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, Selangor, Malaysia
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30
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Lash DB, Ward S. CYP2C9-mediated warfarin and milk thistle interaction. J Clin Pharm Ther 2020; 45:368-369. [PMID: 31633199 DOI: 10.1111/jcpt.13064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/03/2019] [Accepted: 09/23/2019] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE In vitro studies suggest a CYP2C9-mediated interaction between milk thistle and warfarin, but there has been no in vivo case report on this interaction. CASE DESCRIPTION A White Hispanic man in his 30s was well controlled on warfarin therapy for mitral valve replacement. His INR increased from 2.64 to 4.12, and he denied changes to his medications and diet but noted starting a 'liver cleanse' supplement which contained milk thistle (200 mg). After stopping the supplement his INR normalized, and he remains on the same warfarin dose. WHAT IS NEW AND CONCLUSION This is the first in vivo report of an interaction between milk thistle and warfarin.
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Al-Momany NH, Makahleh ZM, Al-Omari NA, Al-Sarayreh HA, Momani RO. Analysis of Factors That Interrupt With INR Control in the First Anticoagulation Clinic Monitoring Jordanian Patients. Clin Appl Thromb Hemost 2020; 25:1076029619870252. [PMID: 31409123 PMCID: PMC6829640 DOI: 10.1177/1076029619870252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Multiple factors such as vitamin K consumption, drug interactions, herbs interactions,
disease states, and alcohol intake affect international normalized ratio (INR) values and
thus warfarin dosing. These variables have been described in general and for all patients
in the literature. In contrast, the factors that affect INR control in a specific
population are rarely studied. Being aware of these factors contributes a lot in
maintaining an INR control and avoiding the supratherapeutic or subtherapeutic
anticoagulation and the associated risks of hemorrhage or thromboembolism. The aim of this
study is to recognize the specific population factors in Jordanian patients that interrupt
INR control. Such recognition provides clinical pharmacists managing the anti-coagulation
clinic (ACC) with necessary tools and predictors of dose adjustment, nontarget INR
handling, and points to add on to the educational session. A total of 2788 patients were
referred to the first clinical pharmacists managed ACC at Queen Alia Heart Institute—the
only official referral hospital for cardiac patients in Jordan—for education and
monitoring between November 1, 2013, and November 1, 2016. We evaluated specific
population factors that interrupt INR control using a pretested, structured clinical data
collection form. The patients were followed up regularly for achieving target INR (TINR).
For patients who were not achieving TINR, the possible cause was examined thoroughly by
reviewing the patient’s medical file for recent medication intake, comorbidities, and
laboratory results. Then the patients or their caregiver were asked direct questions
regarding their diet, food supplements, cigarette smoking, shisha smoking, alcohol intake,
herbs, and complementary medicine use and compliance, in addition to performing
pharmacogenetic testing (polymorphisms of vitamin K–epoxide reductase complex [VKORC1] and
cytochrome P450 2C9 [CYP2C9] genes) in special cases. For a total of 2788 patients, 89 488
INR values were included in the study. Of all, 20 365 (22.8%) were non-TINR values, 13 145
(14%) were subtherapeutic, and 7220 (8.1%) were supratherapeutic. All patients included in
the study had a non-TINR at least 3 times (n = 65, 2.3%) and as frequent as 50 times (n =
21, 0.8%) during the study period. Non-TINR values ranged from 1 to 11. Serious side
effects reported in 7 patients with uncontrolled INR, 6 were bleeding, which required
hospitalization (2 upper gastrointestinal [GI] bleeding, 3 nasal bleeding, and 1 eye
bleeding), 1 was cerebrovascular accident (CVA thrombolytic). Factors that interrupted INR
control in our population, arranged in descending sequence, were concurrent medication use
46.9% (mainly Salicylates and Amiodarone), smoking cigarettes and shisha 17% (represented
the most frequent single factor that caused non-TINR in the present study), a nonbalanced
dietary vitamin K intake 16.88% caused changes in INR (lower) was related to an increase
in the intake of vitamin K-rich food, were noticed to be much more in the spring season in
Jordan (end of March and April mainly), herbal supplements 15.02%; Hawthorn (Crataegus,
الزعرور) is an herb that lives widely in Jordan, and shockingly we found that it is used
very commonly in our ACC patients and corresponded to an elevated INR <8 in 11
patients, and serious bleeding events that required hospitalization in 2 cases),
noncompliance 1.49%, comorbid diseases 1%, malabsorption 0.53%, alcohol intake 0.39%, and
VKORC1 A/G and CYP2C9 *1*1 genotype 0.15%. The analysis of factors that interrupted with
INR control in our patients were both predicted and distinctive; most of these factors
were reported previously by other researchers. On the other hand, many of the previously
reported factors were not frequently detected in our patients, and the frequency of each
of the realized factors was contributed differently to non-TINR in our population.
Alarming factors causing non-TINR detected in our study include smoking both cigarettes
and shisha, herbal use (Hawthorn and Ginseng), increased intake of vitamin K rich food in
the spring season, and concurrent medication use (Salicylates, Amiodarone, Ciprofloxacin,
nonsteroidal anti-inflammatory drugs [NSAIDS], Azithromycin, Clarithromycin: although the
use of these drugs is mandatory sometimes, it can be replaced by an alternative, eg,
antibiotics or monitored closely together with warfarin).
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Affiliation(s)
- Nairooz H Al-Momany
- 1 Queen Alia Heart Institute, King Hussein Medical Center (KHMC), Royal Medical Services (RMS), Amman, Jordan
| | - Zeid M Makahleh
- 1 Queen Alia Heart Institute, King Hussein Medical Center (KHMC), Royal Medical Services (RMS), Amman, Jordan
| | - Nadia A Al-Omari
- 2 Anti-Coagulation Clinic, Queen Alia Heart Institute, King Hussein Medical Center (KHMC), Royal Medical Services (RMS), Amman, Jordan
| | - Hana A Al-Sarayreh
- 2 Anti-Coagulation Clinic, Queen Alia Heart Institute, King Hussein Medical Center (KHMC), Royal Medical Services (RMS), Amman, Jordan
| | - Rawan O Momani
- 3 Prince Iman Center for Research and Laboratory Sciences, King Hussein Medical Center (KHMC), Royal Medical Services (RMS), Amman, Jordan
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Lin JF, Fan LL, Li BW, Zhao RR, Jiang LG, Zhang BC, Lu YS, Shao JW. A study to evaluate herb-drug interaction underlying mechanisms: An investigation of ginsenosides attenuating the effect of warfarin on cardiovascular diseases. Eur J Pharm Sci 2020; 142:105100. [PMID: 31669385 DOI: 10.1016/j.ejps.2019.105100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 09/06/2019] [Accepted: 10/03/2019] [Indexed: 12/16/2022]
Abstract
Warfarin and ginseng have been widely used in the treatment of cardiovascular diseases. However, the clinical safety and effectiveness of herb-drug combination treatment are still controversial. Therefore, it is very essential to probe the interaction between warfarin and ginseng. In this study, in vitro and in vivo study was carried out to demonstrate that whether there is an interaction between warfarin and ginsenosides (GS), which is the main component of ginseng. In vitro study showed that the adhesion ability between endothelial cells and matrigel/platelets was enhanced due to the up-regulating expression of intercellular adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) proteins by treatment of warfarin+GS combination compared to warfarin/GS treatment alone. Moreover, GS could weaken the anticoagulation effect of warfarin in hyperlipemia rats owning to the increased expression levels of coagulation factors and hepatic cytochrome P450 enzymes in plasma after long-term co-administration of warfarin with GS. The results of both in vitro and in vivo study demonstrated that there is a serious interaction between warfarin and ginseng, which may deteriorate atherosclerosis and thrombosis after combined use of warfarin and GS.
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Affiliation(s)
- Juan-Fang Lin
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China
| | - Lu-Lu Fan
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China
| | - Bo-Wen Li
- Department of Bioengineering, University of Washington, Seattle, WA, United States
| | - Rui-Rui Zhao
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China
| | - Long-Guang Jiang
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China
| | - Bing-Chen Zhang
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China
| | - Yu-Sheng Lu
- Marine Drug R&D Center, Institute of Oceanography, Minjiang University, Fuzhou, 350108, China
| | - Jing-Wei Shao
- Fujian Provincial Key Laboratory of Cancer Metastasis Chemoprevention and Chemotherapy,College of Chemistry, Fuzhou University, Fuzhou, 350116, China; Marine Drug R&D Center, Institute of Oceanography, Minjiang University, Fuzhou, 350108, China.
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Spina E, Barbieri MA, Cicala G, Bruno A, de Leon J. Clinically relevant drug interactions between newer antidepressants and oral anticoagulants. Expert Opin Drug Metab Toxicol 2019; 16:31-44. [PMID: 31795773 DOI: 10.1080/17425255.2020.1700952] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: This is a review of the drug interactions (DIs) between newer antidepressants and oral anticoagulants (OACs): vitamin K antagonists (VKAs) and direct-acting OACs (DOACs).Areas covered: Articles were obtained from PubMed searches performed for each of the newer antidepressants and oral anticoagulants. The basic pharmacokinetic and pharmacodynamic mechanisms for DIs with these drugs were summarized. Some newer antidepressants are inhibitors of a number of cytochrome P450 (CYP) isoforms and many antidepressants appear to have potential to impair serotonin platelet function and increase bleeding risk.Expert opinion: Clinicians should not forget that the DIs between newer antidepressants and VKAs can be potentially lethal. Among SSRIs, fluoxetine and fluvoxamine appear to be associated with the highest DI risk with warfarin, the most commonly prescribed VKA worldwide. Case reports featuring duloxetine, mirtazapine and trazadone suggested potential for interaction with warfarin. As CYP3A4 is an important metabolic pathway for all DOACs except dabigatran, it appears reasonable to recommend avoiding the co-prescription of fluoxetine and fluvoxamine (weak to moderate CYP3A4 inhibitors) and St John's wort (CYP3A4 inducer). Many package inserts for the newer antidepressants include a warning regarding an increased risk of bleeding events with concomitant use of these agents with OACs.
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Affiliation(s)
- Edoardo Spina
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Giuseppe Cicala
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Antonio Bruno
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Jose de Leon
- University of Kentucky Mental Health Research Center at Eastern State Hospital, Lexington, KY, USA.,Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, Spain.,Biomedical Research Centre in Mental Health Net (CIBERSAM), Santiago Apostol Hospital, University of the Basque Country, Vitoria, Spain
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Li Y, Meng Q, Yang M, Liu D, Hou X, Tang L, Wang X, Lyu Y, Chen X, Liu K, Yu AM, Zuo Z, Bi H. Current trends in drug metabolism and pharmacokinetics. Acta Pharm Sin B 2019; 9:1113-1144. [PMID: 31867160 PMCID: PMC6900561 DOI: 10.1016/j.apsb.2019.10.001] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022] Open
Abstract
Pharmacokinetics (PK) is the study of the absorption, distribution, metabolism, and excretion (ADME) processes of a drug. Understanding PK properties is essential for drug development and precision medication. In this review we provided an overview of recent research on PK with focus on the following aspects: (1) an update on drug-metabolizing enzymes and transporters in the determination of PK, as well as advances in xenobiotic receptors and noncoding RNAs (ncRNAs) in the modulation of PK, providing new understanding of the transcriptional and posttranscriptional regulatory mechanisms that result in inter-individual variations in pharmacotherapy; (2) current status and trends in assessing drug-drug interactions, especially interactions between drugs and herbs, between drugs and therapeutic biologics, and microbiota-mediated interactions; (3) advances in understanding the effects of diseases on PK, particularly changes in metabolizing enzymes and transporters with disease progression; (4) trends in mathematical modeling including physiologically-based PK modeling and novel animal models such as CRISPR/Cas9-based animal models for DMPK studies; (5) emerging non-classical xenobiotic metabolic pathways and the involvement of novel metabolic enzymes, especially non-P450s. Existing challenges and perspectives on future directions are discussed, and may stimulate the development of new research models, technologies, and strategies towards the development of better drugs and improved clinical practice.
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Affiliation(s)
- Yuhua Li
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510275, China
- The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qiang Meng
- College of Pharmacy, Dalian Medical University, Dalian 116044, China
| | - Mengbi Yang
- School of Pharmacy, the Chinese University of Hong Kong, Hong Kong, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing 100191, China
| | - Xiangyu Hou
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Lan Tang
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Xin Wang
- School of Life Sciences, East China Normal University, Shanghai 200241, China
| | - Yuanfeng Lyu
- School of Pharmacy, the Chinese University of Hong Kong, Hong Kong, China
| | - Xiaoyan Chen
- Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai 201203, China
| | - Kexin Liu
- College of Pharmacy, Dalian Medical University, Dalian 116044, China
| | - Ai-Ming Yu
- UC Davis School of Medicine, Sacramento, CA 95817, USA
| | - Zhong Zuo
- School of Pharmacy, the Chinese University of Hong Kong, Hong Kong, China
| | - Huichang Bi
- School of Pharmaceutical Sciences, Sun Yat-sen University, Guangzhou 510275, China
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Li S, Li X, Yang R, Wang B, Li J, Cao L, Xiao S, Huang W. Effects of anemoside B4 on pharmacokinetics of florfenicol and mRNA expression of CXR, MDR1, CYP3A37 and UGT1E in broilers. J Vet Med Sci 2019; 81:1804-1809. [PMID: 31611492 PMCID: PMC6943327 DOI: 10.1292/jvms.19-0293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Pulsatillae radix, a traditional Chinese medicine (TCM), is often used
in combination with florfenicol for treatment of intestinal infection in Chinese
veterinary clinics. Anemoside B4 (AB4) is the major effective saponin in
Pulsatillae radix. This study aimed to investigate whether the
pharmacokinetics of florfenicol in broilers was affected by the combination of AB4. In
this study, broilers were given AB4 (50 mg/kg BW), or 0.9% sodium chloride solution by
oral administration for 7 days. They were then fed florfenicol orally (30 mg/kg BW) on the
eighth day. The results showed that the AUC(0-∞), MRT(0-∞),
t1/2z and Cmax of florfenicol were significantly decreased, and
the Vz/F and CLz/F were significantly increased by AB4; the mRNA expression levels of CXR,
CYP3A37 and MDR1 (except CXR and CYP3A37 in the liver) were up-regulated by AB4. In
conclusion, AB4 altered the pharmacokinetics of florfenicol, resulting in lower plasma
concentrations of florfenicol, this was probably related to the mRNA expression of CXR,
CYP3A37 and MDR1 in the jejunum and liver (except CXR and CYP3A37) increased by AB4. The
implications of these findings on the effect of traditional Chinese medicine containing
AB4 on the effectiveness of florfenicol in veterinary practice deserve study.
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Affiliation(s)
- Sicong Li
- Institute of Veterinary Pharmacology, Sichuan Animal Science Academy, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China.,Animal Breeding and Genetics Key Laboratory of Sichuan Province, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China
| | - Xuting Li
- Institute of Veterinary Pharmacology, Sichuan Animal Science Academy, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China.,Animal Breeding and Genetics Key Laboratory of Sichuan Province, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China
| | - Rui Yang
- Institute of Veterinary Pharmacology, Sichuan Animal Science Academy, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China.,Animal Breeding and Genetics Key Laboratory of Sichuan Province, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China
| | - Bin Wang
- Institute of Veterinary Pharmacology, Sichuan Animal Science Academy, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China.,Animal Breeding and Genetics Key Laboratory of Sichuan Province, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China
| | - Jinliang Li
- Institute of Veterinary Pharmacology, Sichuan Animal Science Academy, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China.,Animal Breeding and Genetics Key Laboratory of Sichuan Province, 7 Niusha Road, Jinjiang district, Chengdu 610066, PR China
| | - Liang Cao
- Sichuan Dingjian Animal Pharmaceutical Co., Ltd., 19 7th East Road, Checheng, Longquanyi district, Chengdu 610100, PR China
| | - Songyang Xiao
- Sichuan Dingjian Animal Pharmaceutical Co., Ltd., 19 7th East Road, Checheng, Longquanyi district, Chengdu 610100, PR China
| | - Wei Huang
- Sichuan Dingjian Animal Pharmaceutical Co., Ltd., 19 7th East Road, Checheng, Longquanyi district, Chengdu 610100, PR China
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Costache II, Miron A, Hăncianu M, Aursulesei V, Costache AD, Aprotosoaie AC. Pharmacokinetic Interactions between Cardiovascular Medicines and Plant Products. Cardiovasc Ther 2019; 2019:9402781. [PMID: 32089733 PMCID: PMC7012273 DOI: 10.1155/2019/9402781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022] Open
Abstract
The growing use of plant products among patients with cardiovascular pharmacotherapy raises the concerns about their potential interactions with conventional cardiovascular medicines. Plant products can influence pharmacokinetics or/and pharmacological activity of coadministered drugs and some of these interactions may lead to unexpected clinical outcomes. Numerous studies and case reports showed various pharmacokinetic interactions that are characterized by a high degree of unpredictability. This review highlights the pharmacokinetic clinically relevant interactions between major conventional cardiovascular medicines and plant products with an emphasis on their putative mechanisms, drawbacks of herbal products use, and the perspectives for further well-designed studies.
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Affiliation(s)
- Irina-Iuliana Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Anca Miron
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Monica Hăncianu
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Viviana Aursulesei
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Ana Clara Aprotosoaie
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
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Hijazi MA, Shatila H, El-Lakany A, Aboul Ela M, Kharroubi S, Alameddine M, Naja F. Beliefs, practices and knowledge of community pharmacists regarding complementary and alternative medicine: national cross-sectional study in Lebanon. BMJ Open 2019; 9:e025074. [PMID: 30852542 PMCID: PMC6429928 DOI: 10.1136/bmjopen-2018-025074] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Pharmacists are uniquely positioned to provide patients with evidence-based information in order to ensure effective and safe use of Complementary and alternative medicine (CAM) products. OBJECTIVE Assess beliefs, practices and knowledge related to CAM products among community pharmacists in Lebanon. DESIGN, METHODS AND SETTING Using stratified random sampling, a nationally representative survey was conducted among community pharmacists in Lebanon. Through face-to-face interviews, pharmacists completed a multicomponent questionnaire consisting of four sections: (1) sociodemographic characteristics; (2) beliefs related to regulation of CAM products, role of media in promoting their safe use, availability of resources and continuing education; (3) practices including selling CAM products, providing advice for patients and reporting adverse effects and (4) knowledge about specific CAM products, their uses, side effects and interactions. RESULTS A total of 341 pharmacists agreed to participate (response rate: 86%). Only pharmacists with complete data were included in this study (n=310). Pharmacists agreed that CAM products are effective (63.8%) and that they should be exclusively sold in pharmacies (80.3%), but disagreed that commercially marketed CAM products are well regulated (63.5%) and that media plays a positive role in educating users about these products (55.8%). As for practices, 64.5% of pharmacists were always or often advising patients on safe use; however, 74.2% of participants rarely or never reported adverse effects. Regarding knowledge, although the majority of pharmacists were aware of the uses of CAM products, fewer knew about their side effects and their interactions with drugs. After adjustment for covariates, receiving education/training on CAM products during university was the sole predictor of higher knowledge score (ß=0.68, 95% CI 0.29 to 1.07). CONCLUSIONS This study revealed positive beliefs of pharmacists in Lebanon towards CAM products and indicated important gaps in their practice and knowledge. Deliberate efforts to enhance the education of pharmacists are warranted to ensure the safe integration and use of CAM products in Lebanon.
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Affiliation(s)
- Mohamad Ali Hijazi
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Hibeh Shatila
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Maha Aboul Ela
- Department of Pharmaceutical Sciences, Beirut Arab University, Beirut, Lebanon
| | - Samer Kharroubi
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamad Alameddine
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Strategy & Institutional Excellence, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, Dubai, United Arab Emirates
| | - Farah Naja
- Department of Nutrition and Food Sciences, American University of Beirut, Beirut, Lebanon
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Borse SP, Singh DP, Nivsarkar M. Understanding the relevance of herb-drug interaction studies with special focus on interplays: a prerequisite for integrative medicine. Porto Biomed J 2019; 4:e15. [PMID: 31595257 PMCID: PMC6726296 DOI: 10.1016/j.pbj.0000000000000015] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022] Open
Abstract
Integrative medicine refers to the blending of conventional and evidence-based complementary medicines and therapies with the aim of using the most appropriate of either or both modalities for ultimate patient benefits. One of the major hurdles for the same is the chances of potential herb–drug interactions (HDIs). These HDIs could be beneficial or harmful, or even fatal; therefore, a thorough understanding of the eventualities of HDIs is essential so that a successful integration of the modern and complementary alternative systems of medicine could be achieved. Here, we summarize all the important points related to HDIs, including types, tools/methods for study, and prediction of the HDIs, along with a special focus on interplays between drug metabolizing enzymes and transporters. In addition, this article covers future perspective, with a focus on background endogenous players of interplays and approaches to predict the drug–disease–herb interactions so as to fetch the desired effects of these interactions.
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Affiliation(s)
- Swapnil P Borse
- Department of Pharmacology and Toxicology, B.V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Thaltej.,NIRMA University, Sarkhej-Gandhinagar Highway, Ahmadabad, Gujarat, India
| | - Devendra P Singh
- Department of Pharmacology and Toxicology, B.V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Thaltej.,NIRMA University, Sarkhej-Gandhinagar Highway, Ahmadabad, Gujarat, India
| | - Manish Nivsarkar
- Department of Pharmacology and Toxicology, B.V. Patel Pharmaceutical Education and Research Development (PERD) Centre, Thaltej
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Abebe W. Review of herbal medications with the potential to cause bleeding: dental implications, and risk prediction and prevention avenues. EPMA J 2019; 10:51-64. [PMID: 30984314 DOI: 10.1007/s13167-018-0158-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 12/20/2018] [Indexed: 12/27/2022]
Abstract
Medicinal plant products have been used in health care since time immemorial. During the past three decades, the use of herbal supplements has been on the rise in the USA. A number of these products have been shown to possess the potential to interfere with blood clotting. This paper is a review of blood-thinning herbal supplements commonly used in the USA, accompanied by discussion of the dental implications of their use along with suggestions for prediction and prevention of the risk of bleeding. Twenty herbal supplements belonging to four pharmacological groups are identified and reviewed. While the majority (45%) of the supplements reviewed possesses antiplatelet properties, the remaining are dispersed among anticoagulant (15%), a combination of antiplatelet and anticoagulant (15%), and other diverse groups (25%). The literature reveals that most of the available information on blood-thinning herbs is based on in vitro experiments, animal studies, and individual clinical case reports. Some herbal effects are also speculated based on theoretical grounds. These observations, together with the deficiency of the law regulating herbal supplements, indicate limitations of the literature and the regulatory mechanisms related to these products, further implying the need for additional research and improved regulation. While emphasizing the dental implications of the findings reported in the literature, suggestions were made for prediction and prevention of the risk of bleeding caused by herbal medications, based on the concepts of predictive, preventive, and personalized medicine.
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Affiliation(s)
- Worku Abebe
- Department of Oral Biology and Diagnostic Sciences, Dental College of Georgia, Augusta University, CL-2130, Augusta, GA 30912-1128 USA
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Saksena D, Mishra YK, Muralidharan S, Kanhere V, Srivastava P, Srivastava CP. Follow-up and management of valvular heart disease patients with prosthetic valve: a clinical practice guideline for Indian scenario. Indian J Thorac Cardiovasc Surg 2019; 35:3-44. [PMID: 33061064 PMCID: PMC7525528 DOI: 10.1007/s12055-019-00789-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Valvular heart disease (VHD) patients after prosthetic valve implantation are at risk of thromboembolic events. Follow-up care of patients with prosthetic valve has a paramount role in reducing the morbidity and mortality. Currently, in India, there is quintessential need to stream line the follow-up care of prosthetic valve patients. This mandates the development of a consensus guideline for the antithrombotic therapy in VHD patients post prosthetic valve implantation. METHODS A national level panel was constituted comprising 13 leading cardio care experts in India who thoroughly reviewed the up to date literature, formulated the recommendations, and developed the consensus document. Later on, extensive discussions were held on this draft and the recommendations in 8 regional meetings involving 79 additional experts from the cardio care in India, to arrive at a consensus. The final consensus document is developed relying on the available evidence and/or majority consensus from all the meetings. RESULTS The panel recommended vitamin K antagonist (VKA) therapy with individualized target international normalized ratio (INR) in VHD patients after prosthetic valve implantation. The panel opined that management of prosthetic valve complications should be personalized on the basis of type of complications. In addition, the panel recommends to distinguish individuals with various co-morbidities and attend them appropriately. CONCLUSIONS Anticoagulant therapy with VKA seems to be an effective option post prosthetic valve implantation in VHD patients. However, the role for non-VKA oral therapy in prosthetic valve patients and the safety and efficacy of novel oral anticoagulants in patients with bioprosthetic valve need to be studied extensively.
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Kamuren Z, Kigen G, Keter A, Maritim A. Characteristics of patients with thromboembolic disorders on warfarin therapy in resource limited settings. BMC Health Serv Res 2018; 18:723. [PMID: 30231891 PMCID: PMC6145184 DOI: 10.1186/s12913-018-3537-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022] Open
Abstract
Background Warfarin is a drug with narrow therapeutic index used in the management of thromboembolic disorders. Several factors affect its plasma concentrations with a resultant risk of toxicity. We examined the database of patients on warfarin therapy in order to establish the factors that affect the stability of INR and correlated them to clinical outcomes in resource limited settings. Methods We analysed retrospective data of patients admitted to adult medical wards at Moi Teaching and Referral Hospital (MTRH) in 2015. Inclusion criteria were patients with thromboembolic and related disorders and on warfarin treatment. Derived data included demographics, indications for warfarin use, co-prescribed drugs, co-morbidities, INR measurements, duration of hospital stay and clinical outcomes. Descriptive statistics were used to summarize the data. Pearson’s correlation coefficient was used to assess relationships between duration of hospitalization and number of INR tests. Regression splines were used to capture INR trends during the follow up period. Data was analysed using R v. 3.3.1. Results A total of 310 patients had thromboembolic disorders, out of which 63 met the study criteria. The median age was 48 years, while the mean number of INR measurements was once every four days. Majority of patients did not achieve stable INR values, with only two having consecutive INR values within therapeutic goal. Patients who died had high INR levels. The median duration of hospital stay was 9 days (IQR: 7.0, 16.5). There was a significant correlation between length of stay in hospital and the number of times that INR were measured (Corr = 0.667, p < 0.001). The two most common indications for warfarin were DVT (64.4%) and atrial fibrillation (24.7%). All the patients had one or more comorbid conditions except for 11 with DVT alone, with cardiovascular diseases and infections being the most frequent, and on concomitant medications, majority of which are known to interact with warfarin. Conclusions It was difficult to achieve stable INR under the prevailing conditions despite the frequent tests. The potential factors that may have contributed to the fluctuations include drug-drug interactions, frequency of INR tests, comorbidities and the short duration of hospital stay.
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Affiliation(s)
- Zipporah Kamuren
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, Eldoret, 30100, Kenya.
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Alfred Keter
- Academic Model Providing Access to Healthcare, P.O. Box 4606, Eldoret, 30100, Kenya
| | - Alice Maritim
- Department of Pharmacology and Toxicology, Moi University School of Medicine, P.O. Box 4606, Eldoret, 30100, Kenya
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Abstract
Medicinal plants have been used for treatment of human ailments since ancient times. Objective of this study is to document the effect of herbal drugs on anticoagulant therapy. The material for this review was taken mostly from PubMed and the Cochrane database of systematic reviews. Some other relevant references were collected from personal database of papers on anti-coagulant properties of plants. Literature review shows that many plants such as Thymus vulgaris, Cyamopsis tetragonoloba taub, Pulmonaria officinalis and Cinnamomum cassia etc have anti-coagulant activity. This review shows that medicinal plants should be prescribed with care to patients on anticoagulant therapy.
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Lloyd SL, Striley CW. Marijuana Use Among Adults 50 Years or Older in the 21st Century. Gerontol Geriatr Med 2018; 4:2333721418781668. [PMID: 29977980 PMCID: PMC6024284 DOI: 10.1177/2333721418781668] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 04/25/2018] [Accepted: 05/15/2018] [Indexed: 02/04/2023] Open
Abstract
Background: Marijuana is the most commonly used illicit drug among older adults. As an older population grows in the United States that has a tolerant attitude toward marijuana use, the dynamics of marijuana use and the effects of marijuana on personal, social, and health outcomes among older adults require attention. Objectives: This review summarizes epidemiological literature on marijuana use among older adults. Method: A literature search was conducted using PubMed, AgeLine, and an online search engine from January 2000 to December 2017, resulting in 18 articles. Results: The greatest increase in marijuana use was observed among those in the older adult population 50 years or older, and those 65 years or older had the greatest increase in marijuana use in the older adult population. Common correlates of marijuana use among those in the older population included being male, being unmarried, having multiple chronic diseases, having psychological stress, and using other substances such as alcohol, tobacco, other illicit drugs, and prescription drugs. Conclusion: The increased use of marijuana in older populations requires surveillance and additional research to understand the use and effects of marijuana in older populations to avoid negative health outcomes.
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Xu Y, Patel DN, Ng SLP, Tan SH, Toh D, Poh J, Lim AT, Chan CL, Low MY, Koh HL. Retrospective Study of Reported Adverse Events Due to Complementary Health Products in Singapore From 2010 to 2016. Front Med (Lausanne) 2018; 5:167. [PMID: 29946545 PMCID: PMC6006675 DOI: 10.3389/fmed.2018.00167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/14/2018] [Indexed: 01/16/2023] Open
Abstract
The objective of this study is to collate and analyse adverse event reports associated with the use of complementary health products (CHP) submitted to the Health Sciences Authority (HSA) of Singapore for the period 2010–2016 to identify various trends and signals for pharmacovigilance purposes. A total of 147,215 adverse event reports suspected to be associated with pharmaceutical products and CHP were received by HSA between 2010 and 2016. Of these, 143,191 (97.3%) were associated with chemical drugs, 1,807 (1.2%) with vaccines, 1,324 (0.9%) with biological drugs (biologics), and 893 (0.6%) with CHP. The number of adverse event reports associated with Chinese Proprietary Medicine, other complementary medicine and health supplements are presented. Eight hundred and ninety three adverse event reports associated with CHP in the 7-year period have been successfully collated and analyzed. In agreement with other studies, adverse events related to the “skin and appendages disorders” were the most commonly reported. Most of the cases involved dermal allergies (e.g., rashes) associated with the use of glucosamine products and most of the adulterated products were associated with the illegal addition of undeclared drugs for pain relief. Dexamethasone, chlorpheniramine, and piroxicam were the most common adulterants detected. Reporting suspected adverse events is strongly encouraged even if the causality is not confirmed because any signs of clustering will allow rapid regulatory actions to be taken. The findings from this study help to create greater awareness on the health risks, albeit low, when consuming CHP and dispelling the common misconception that “natural” means “safe.” In particular, healthcare professionals and the general public should be aware of potential adulteration of CHP. The analysis of spontaneously reported adverse events is an important surveillance system in monitoring the safety of CHP and helps in the understanding of the risk associated with the use of such products. Greater collaboration and communication between healthcare professionals, regulators, patients, manufacturers, researchers, and the general public are important to ensure the quality and safety of CHP.
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Affiliation(s)
- Yimin Xu
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.,Applied Sciences Group, Pharmaceutical Division, Health Sciences Authority, Singapore, Singapore
| | - Dhavalkumar N Patel
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Suet-Leng P Ng
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Siew-Har Tan
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Dorothy Toh
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Jalene Poh
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Adena Theen Lim
- Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Cheng-Leng Chan
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.,Vigilance, Compliance and Enforcement Cluster, Health Products Regulation Group, Health Sciences Authority, Singapore, Singapore
| | - Min-Yong Low
- Applied Sciences Group, Pharmaceutical Division, Health Sciences Authority, Singapore, Singapore
| | - Hwee-Ling Koh
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
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Son J, Cho YH, Jeong DS, Sung K, Kim WS, Lee YT, Park PW. Mechanical versus Tissue Aortic Prosthesis in Sexagenarians: Comparison of Hemodynamic and Clinical Outcomes. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:100-108. [PMID: 29662807 PMCID: PMC5894573 DOI: 10.5090/kjtcs.2018.51.2.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 11/02/2017] [Accepted: 11/13/2017] [Indexed: 01/20/2023]
Abstract
Background The question of which type of prosthetic aortic valve leads to the best outcomes in patients in their 60s remains controversial. We examined the hemodynamic and clinical outcomes of aortic valve replacement in sexagenarians according to the type of prosthesis. Methods We retrospectively reviewed 270 patients in their 60s who underwent first-time aortic valve replacement from 1995 to 2011. Early and late mortality, major adverse valve-related events, anticoagulation-related events, and hemodynamic outcomes were assessed. The mean follow-up duration was 58.7±44.0 months. Results Of the 270 patients, 93 had a mechanical prosthesis (mechanical group), and 177 had a bioprosthesis (tissue group). The tissue group had a higher mean age and prevalence of preoperative stroke than the mechanical group. The groups had no differences in the aortic valve mean pressure gradient (AVMPG) or the left ventricular mass index (LVMI) at 5 years after surgery. In a sub-analysis limited to prostheses in the supra-annular position, the AVMPG was higher in the tissue group, but the LVMI was still not significantly different. There was no early mortality. The 10-year survival rate was 83% in the mechanical group and 90% in the tissue group. The type of aortic prosthesis did not influence overall mortality, cardiac mortality, or major adverse valve-related events. Anticoagulation-related events were more common in the mechanical group than in the tissue group (p=0.034; hazard ratio, 4.100; 95% confidence interval, 1.111–15.132). Conclusion The type of aortic prosthesis was not associated with hemodynamic or clinical outcomes, except for anticoagulation-related events.
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Affiliation(s)
- Jongbae Son
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Kiick Sung
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Wook Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Tak Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Pyo Won Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Yeung KS, Hernandez M, Mao JJ, Haviland I, Gubili J. Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytother Res 2018; 32:865-891. [PMID: 29464801 DOI: 10.1002/ptr.6033] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/08/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
Anxiety and depression are prevalent among cancer patients, with significant negative impact. Many patients prefer herbs for symptom relief to conventional medications which have limited efficacy/side effects. We identified single-herb medicines that may warrant further study in cancer patients. Our search included PubMed, Allied and Complementary Medicine, Embase, and Cochrane databases, selecting only single-herb randomized controlled trials between 1996 and 2016 in any population for data extraction, excluding herbs with known potential for interactions with cancer treatments. One hundred articles involving 38 botanicals met our criteria. Among herbs most studied (≥6 randomized controlled trials each), lavender, passionflower, and saffron produced benefits comparable to standard anxiolytics and antidepressants. Black cohosh, chamomile, and chasteberry are also promising. Anxiety or depressive symptoms were measured in all studies, but not always as primary endpoints. Overall, 45% of studies reported positive findings with fewer adverse effects compared with conventional medications. Based on available data, black cohosh, chamomile, chasteberry, lavender, passionflower, and saffron appear useful in mitigating anxiety or depression with favorable risk-benefit profiles compared to standard treatments. These may benefit cancer patients by minimizing medication load and accompanying side effects. However, well-designed larger clinical trials are needed before these herbs can be recommended and to further assess their psycho-oncologic relevance.
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Affiliation(s)
- K Simon Yeung
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Marisol Hernandez
- Information Systems/Medical Library, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Jun J Mao
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Ingrid Haviland
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Jyothirmai Gubili
- Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
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Choi S, Oh DS, Jerng UM. A systematic review of the pharmacokinetic and pharmacodynamic interactions of herbal medicine with warfarin. PLoS One 2017; 12:e0182794. [PMID: 28797065 PMCID: PMC5552262 DOI: 10.1371/journal.pone.0182794] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 07/25/2017] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study was to systematically review data regarding pharmacokinetic (PK)-pharmacodynamic (PD) parameters from randomized controlled trials relating to interactions between herbal medicines and warfarin. Methods Three electronic databases were searched to identify relevant trials. Two reviewers independently performed the study selection and data extraction. The risk of bias and reporting quality were also assessed independently by two reviewers using the Cochrane risk of bias tool and the consolidated standards of reporting trials (CONSORT). Outcomes were measured for all reported PK-PD parameters and adverse events. Results Nine randomized controlled trials met our inclusion criteria. Most of the included studies were unclear regarding the risk of bias and had a low quality of methodology. Using CONSORT, the reporting percentages for the articles ranged from 36.5% to 61.5% and the mean percentage for all articles was 45.6%. St John’s wort and echinacea affected the PK parameters of warfarin. Ginseng, ginger, garlic, and cranberry had no significant effect on the PK parameters. American ginseng altered the PD parameters of warfarin. St John’s wort, ginseng, Korea red ginseng, ginkgo, ginger, garlic, aged garlic, and echincea did not significantly alter the PD parameters. Studies of ginkgo and cranberry showed conflicting results on the PK parameters and PD parameters, respectively. The incidence of adverse events in all trials was low and no major adverse events were reported. Conclusions It was difficult to determine whether ten herbal medicines had significant effects on the PK-PD parameters of warfarin. Low quality of evidence, different compounds within and different compositions of the herbs, and methodological limitations of the crossover study, which is a clinical study in which subjects receive a sequence of different interventions, made it difficult to form conclusions. Additional studies that remedy these vulnerabilities are necessary to verify these results.
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Affiliation(s)
- Songie Choi
- The K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Dal-Seok Oh
- The K-herb Research Center, Korea Institute of Oriental Medicine, Daejeon, South Korea
| | - Ui Min Jerng
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, South Korea
- * E-mail:
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49
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Gupta RC, Chang D, Nammi S, Bensoussan A, Bilinski K, Roufogalis BD. Interactions between antidiabetic drugs and herbs: an overview of mechanisms of action and clinical implications. Diabetol Metab Syndr 2017; 9:59. [PMID: 28770011 PMCID: PMC5527439 DOI: 10.1186/s13098-017-0254-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/12/2017] [Indexed: 12/26/2022] Open
Abstract
Diabetes is a complex condition with a variety of causes and pathophysiologies. The current single target approach has not provided ideal clinical outcomes for the treatment of the disease and its complications. Herbal medicine has been used for the management of various diseases such as diabetes over centuries. Many diabetic patients are known to use herbal medicines with antidiabetic properties in addition to their mainstream treatments, which may present both a benefit as well as potential risk to effective management of their disease. In this review we evaluate the clinical and experimental literature on herb-drug interactions in the treatment of diabetes. Pharmacokinetic and pharmacodynamic interactions between drugs and herbs are discussed, and some commonly used herbs which can interact with antidiabetic drugs summarised. Herb-drug interactions can be a double-edged sword presenting both risks (adverse drug events) and benefits (through enhancement). There is a general lack of data on herb-drug interactions. As such, more rigorous scientific research is urgently needed to guide clinical practice as well as to safeguard the wellbeing of diabetes patients.
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Affiliation(s)
- Ramesh C. Gupta
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- Department of Agricultural Chemistry and Soil Science, School of Agricultural Sciences and Rural Development, Nagaland University, Medziphema, 797 106 India
| | - Dennis Chang
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Srinivas Nammi
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- School of Science and Health, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Alan Bensoussan
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Kellie Bilinski
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
| | - Basil D. Roufogalis
- NICM, Western Sydney University, Locked Bag 1797, Penrith, NSW 1797 Australia
- Discipline of Pharmacology, School of Medical Sciences, Sydney Medical School, The University of Sydney, Sydney, NSW 2006 Australia
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Kampouraki E, Kamali F. Dietary implications for patients receiving long-term oral anticoagulation therapy for treatment and prevention of thromboembolic disease. Expert Rev Clin Pharmacol 2017. [PMID: 28635328 DOI: 10.1080/17512433.2017.1345622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The effectiveness of oral anticoagulation therapy with warfarin (a vitamin K antagonist) in the treatment of thromboembolic disease, including stroke prophylaxis in patients with atrial fibrillation is well recognised. However, warfarin has a narrow therapeutic window and an unpredictable anticoagulation response, which make it difficult to achieve and maintain optimal anticoagulation. Various dietary factors, including sudden changes in eating patterns, can significantly alter anticoagulation control, thereby potentially exposing patients to the risk of bleeding or thromboembolic complications. Dietary vitamin K intake is a particularly important factor, given the mechanism of action of warfarin. Areas covered: In this article, we cover the sources of vitamin K and their potential effect of dietary vitamin K on anticoagulation response to warfarin. We also discuss the results of studies on the effect of vitamin K supplementation on anticoagulation stability. Expert commentary: A stable dietary vitamin K, promoted by daily oral vitamin K supplementation, can improve anticoagulation stability in patients on warfarin therapy. There is experimental evidence in animals that dietary vitamin K affects anticoagulation response to the direct thrombin inhibitor, ximelagatran. Whether dietary vitamin K affects anticoagulation response to the currently licensed direct oral anticoagulants (DOACs) in man remains to be investigated.
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Affiliation(s)
| | - Farhad Kamali
- a Institute of Cellular Medicine , Newcastle University , Newcastle upon Tyne , UK
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