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D’Angelo A, Vitiello L, Lixi F, Abbinante G, Coppola A, Gagliardi V, Pellegrino A, Giannaccare G. Optic Nerve Neuroprotection in Glaucoma: A Narrative Review. J Clin Med 2024; 13:2214. [PMID: 38673487 PMCID: PMC11050811 DOI: 10.3390/jcm13082214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 03/30/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
In recent years, researchers have been interested in neuroprotective therapies as a cutting-edge therapeutic strategy to treat neurodegenerative disorders by shielding the brain system from harmful events. Millions of individuals worldwide suffer from glaucoma, an ocular neurodegenerative disease characterized by gradual excavation of the optic nerve head, retinal axonal damage, and consequent visual loss. The pathology's molecular cause is still mostly unknown, and the current treatments are not able to alter the disease's natural progression. Thus, the modern approach to treating glaucoma consists of prescribing medications with neuroprotective properties, in line with the treatment strategy suggested for other neurodegenerative diseases. For this reason, several naturally derived compounds, including nicotinamide and citicoline, have been studied throughout time to try to improve glaucoma management by exploiting their neuroprotective properties. The purpose of this review is to examine the naturally derived compounds that are currently utilized in clinical practice for neuroprotection in glaucomatous patients based on scientific data, emphasizing these compounds' pivotal mechanism of action as well as their proven therapeutic and neuroprotective benefits.
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Affiliation(s)
- Angela D’Angelo
- Department of Medicine and Surgery, University of Naples “Federico II”, 80138 Naples, NA, Italy;
| | - Livio Vitiello
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.A.); (A.C.); (V.G.); (A.P.)
| | - Filippo Lixi
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, CA, Italy; (F.L.); (G.G.)
| | - Giulia Abbinante
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.A.); (A.C.); (V.G.); (A.P.)
| | - Alessia Coppola
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.A.); (A.C.); (V.G.); (A.P.)
| | - Vincenzo Gagliardi
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.A.); (A.C.); (V.G.); (A.P.)
| | - Alfonso Pellegrino
- Eye Unit, “Luigi Curto” Hospital, Azienda Sanitaria Locale Salerno, 84035 Polla, SA, Italy; (G.A.); (A.C.); (V.G.); (A.P.)
| | - Giuseppe Giannaccare
- Eye Clinic, Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, CA, Italy; (F.L.); (G.G.)
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Liu Y, Sun J, Yang C, Qin M, Xu S, Zhao Y, Liu G. Safflower yellow for injection enhances anti-coagulation of warfarin in rats: implications in pharmacodynamics and pharmacokinetics. Xenobiotica 2024; 54:75-82. [PMID: 38445636 DOI: 10.1080/00498254.2024.2326987] [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: 12/04/2023] [Accepted: 03/02/2024] [Indexed: 03/07/2024]
Abstract
This study investigated whether Safflower Yellow for injection (SYI) would affect the anticoagulation of warfarin in rats.Wistar male rats were divided into six groups randomly and administered with SYI (9 mg/kg, intraperitoneal injection) in single-dose and steady-dose warfarin (0.2 mg/kg, oral gavage), respectively. The pharmacodynamic parameters of PT and APTT were measured by a coagulation analyser. R/S-warfarin concentration was measured by UHPLC-MS/MS, and pharmacokinetic parameters calculated using DAS 2.0 software.The single-dose study demonstrated that SYI, alone or co-administered with warfarin, could significantly increase PT, INR, and APTT values (p < 0.01). R-warfarin Cmax, AUC, and t1/2 values increased by 9.25% (p > 0.05), 25.96% (p < 0.01), and 26.17% (p < 0.01), respectively, whereas the CL/F value reduced by 22.22% (p < 0.01) in the presence of SYI. Meanwhile, S-warfarin Cmax, AUC, and t1/2 values increased by 37.41%, 32.11%, and 31.73% (all p < 0.01), respectively, whereas the CL/F value reduced by 33.33% (p < 0.01). The steady-dose study showed that PT, INR, APTT, and the concentrations of R/S-warfarin increased significantly when SYI was co-administered with warfarin (p < 0.01).SYI can enhance warfarin's anticoagulation intensity and decelerate its metabolism in rats.
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Affiliation(s)
- Yan Liu
- Department of Pharmacy, The Second Affiliated Hospital, Harbin Medical University, The Heilongjiang Key Laboratory of Drug Research, Harbin, China
| | - Jiahui Sun
- College of Pharmacy, Harbin Medical University, Harbin, China
| | - Chunjuan Yang
- College of Pharmacy, Harbin Medical University, Harbin, China
| | - Mengnan Qin
- Department of Pharmacy, The Second Affiliated Hospital, Harbin Medical University, The Heilongjiang Key Laboratory of Drug Research, Harbin, China
| | - Shiwei Xu
- Department of Pharmacy, The Second Affiliated Hospital, Harbin Medical University, The Heilongjiang Key Laboratory of Drug Research, Harbin, China
| | - Yue Zhao
- Department of Pharmacy, The Second Affiliated Hospital, Harbin Medical University, The Heilongjiang Key Laboratory of Drug Research, Harbin, China
| | - Gaofeng Liu
- Department of Pharmacy, The Second Affiliated Hospital, Harbin Medical University, The Heilongjiang Key Laboratory of Drug Research, Harbin, China
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Luo W, Luo X, Chen S, Li J, Huang X, Rao Y, Xu W. Chinese stroke patients with atrial fibrillation used Robert's age-adjusted warfarin loading protocol obtained good INR results within therapeutic range. Sci Rep 2023; 13:18230. [PMID: 37880296 PMCID: PMC10600158 DOI: 10.1038/s41598-023-45379-7] [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: 07/26/2023] [Accepted: 10/18/2023] [Indexed: 10/27/2023] Open
Abstract
To assess whether Roberts' age-adjusted warfarin loading protocol is effective in Chinese patients and whether the SAMeTT2R2 score can predict international normalized ratio (INR) control. Roberts' protocol for warfarin titration was applied to patients with non-valvular atrial fibrillation (NVAF) complicated with ischemic stroke at the Department of Neurology between 2014 and 2019. Clinical and sociodemographic variables were recorded. A minimum of 1-year follow-up was used to calculate the time in therapeutic range (TTR) of the INR. A total of 94 acute ischemic stroke patients with NVAF were included in the study. Seventy-seven (81.9%) of the patients had attained stable INR (2.0-3.0) at the fifth dose, and 90.0% of the patients had achieved stable INR on the ninth day. Seventeen (18.1%) of the patients had an INR > 4 during dose-adjustment period. Patients with INR > 4 had significantly lower body weight (53.8 vs. 63.1 kg, P = 0.014), lower rate of achievement of stable INR (35.3% vs. 92.2%, P = 0.000), and lower rate of TTR ≥ 65% (23.5% vs. 70.1%, P = 0.001), but with no significant increase in bleeding risk. A total of 89 patients underwent long-term INR follow-up, of which 58 (65.2%) patients achieved TTR ≥ 65%. Patients with poor TTR had significantly lower body weight (56.3 vs. 63.7 kg, P = 0.020) and lower rate of stable INR achievement (64.5% vs. 89.7%, P = 0.002). All 94 patients had SAMeTT2R2 score ≥ 2. There was no linear association between SAMeTT2R2 score and the rate of TTR ≥ 65% (Ptrend = 0.095). Chinese ischemic stroke patients with NVAF on warfarin can safely and quickly achieve therapeutic INR using Roberts' age-adjusted protocol and can obtain a good TTR. Lower body weight may be a predictor of poor TTR and INR > 4. Patients who have not attained stable INR after adjusting the dose five times are at high risk for poor TTR. SAMeTT2R2 score may not predict TTR in Chinese ischemic stroke patients with NVAF.
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Affiliation(s)
- Weiliang Luo
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
| | - Xuanwen Luo
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
| | - Suqin Chen
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
| | - Jiming Li
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China.
| | - Xiaodong Huang
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
| | - Yu Rao
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
| | - Wengsheng Xu
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, 516001, Guangdong, China
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Xie Y, Wang C. Herb-drug interactions between Panax notoginseng or its biologically active compounds and therapeutic drugs: A comprehensive pharmacodynamic and pharmacokinetic review. JOURNAL OF ETHNOPHARMACOLOGY 2023; 307:116156. [PMID: 36754189 DOI: 10.1016/j.jep.2023.116156] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/24/2022] [Accepted: 01/06/2023] [Indexed: 06/18/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Herbs, along with the use of herb-drug interactions (HDIs) to combat diseases, are increasing in popularity worldwide. HDIs have two effects: favorable interactions that tend to improve therapeutic outcomes and/or minimize the toxic effects of drugs, and unfavorable interactions aggravating the condition of patients. Panax notoginseng (Burk.) F.H. Chen is a medicinal plant that has long been commonly used in traditional Chinese medicine to reduce swelling, relieve pain, clear blood stasis, and stop bleeding. Numerous studies have demonstrated the existence of intricate pharmacodynamic (PD) and pharmacokinetic (PK) interactions between P. notoginseng and conventional drugs. However, these HDIs have not been systematically summarized. AIM OF THE REVIEW To collect the available literature on the combined applications of P. notoginseng and drugs published from 2005 to 2022 and summarize the molecular mechanisms of interactions to circumvent the potential risks of combination therapy. MATERIALS AND METHODS This work was conducted by searching PubMed, Scopus, Web of Science, and CNKI databases. The search terms included "notoginseng", "Sanqi", "drug interaction," "synergy/synergistic", "combination/combine", "enzyme", "CYP", and "transporter". RESULTS P. notoginseng and its bioactive ingredients interact synergistically with numerous drugs, including anticancer, antiplatelet, and antimicrobial agents, to surmount drug resistance and side effects. This review elaborates on the molecular mechanisms of the PD processed involved. P. notoginseng shapes the PK processes of the absorption, distribution, metabolism, and excretion of other drugs by regulating metabolic enzymes and transporters, mainly cytochrome P450 enzymes and P-glycoprotein. This effect is a red flag for drugs with a narrow therapeutic window. Notably, amphipathic saponins in P. notoginseng act as auxiliary materials in drug delivery systems to enhance drug solubility and absorption and represent a new entry point for studying interactions. CONCLUSION This article provides a comprehensive overview of HDIs by analyzing the results of the in vivo and in vitro studies on P. notoginseng and its bioactive components. The knowledge presented here offers a scientific guideline for investigating the clinical importance of combination therapies. Physicians and patients need information on possible interactions between P. notoginseng and other drugs, and this review can help them make scientific predictions regarding the consequences of combination treatments.
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Affiliation(s)
- Yujuan Xie
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, The MOE Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Centre for Standardization of Chinese Medicines, 1200 Cailun Road, Shanghai, 201203, China
| | - Changhong Wang
- Institute of Chinese Materia Medica, Shanghai University of Traditional Chinese Medicine, The MOE Key Laboratory for Standardization of Chinese Medicines, Shanghai R&D Centre for Standardization of Chinese Medicines, 1200 Cailun Road, Shanghai, 201203, China.
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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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Hsu SM, Lin HJ, Kao YW, Li TM, Shia BC, Huang ST. Concurrent use of Chinese herbal medicine and anticoagulants may reduce major bleeding events. PLoS One 2022; 17:e0271965. [PMID: 35998204 PMCID: PMC9398017 DOI: 10.1371/journal.pone.0271965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background This retrospective cohort study investigated the risk of major bleeding events during the concurrent use of Chinese herbal medicine (CHM) and anticoagulants in clinical practice. Methods A total of 4,470 patients receiving anticoagulant drugs were selected from Taiwan’s National Health Insurance Research Database (NHIRD). Half (n = 2,235) were also using CHMs (CHM cohort); the other half were not (non-CHM cohort). Each cohort was matched 1:1 using the propensity score. Chi-square testing and the Student’s t-test were used to examine differences between two cohorts. Cox proportional hazard regression analysis assessed the risks for major bleeding events in each cohort, as well as bleeding risks associated with specific CHM formulas and herbs. Cumulative incidence curves for major bleeding events were calculated using Kaplan-Meier analysis. Results Compared with the non-CHM cohort, the CHM cohort had a lower risk of overall bleeding events (p < 0.001) including hemorrhagic stroke (p = 0.008), gastrointestinal (GI) bleeding (p < 0.001), urogenital bleeding (p ≤ 0.001) and nasal/ear/eye bleeding (p = 0.004). Single herbs, such as Glycyrrhiza uralensis et Rhizoma, Panax notoginseng, Panax ginseng, Platycodon grandiflorum, Eucommia ulmoides Oliver and formulas, such as Shu Jing Huo Xue Tang, Shao Yao Gan Cao Tang and Ji Sheng Shen Qi Wan were associated with a lower risk of major bleeding events. Conclusion Using CHMs with anticoagulants appeared to decrease the risk of major bleeding, especially CHMs products containing Glycyrrhiza uralensis et Rhizoma, Panax notoginseng, Panax ginseng, Platycodon grandiflorum and Eucommia ulmoides Oliver. Further investigations are needed to determine whether CHM can maintain the therapeutic efficacy of anticoagulants while simultaneously reducing potential side effects.
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Affiliation(s)
- Shuo-Min Hsu
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Hung-Jen Lin
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Wei Kao
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
| | - Te-Mao Li
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Ben-Chang Shia
- Graduate Institute of Business Administration, Fu Jen Catholic University, Taipei, Taiwan
- * E-mail: , (STH); (BCS)
| | - Sheng-Teng Huang
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, China Medical University Hospital, Taichung, Taiwan
- Research Cancer Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- An-Nan Hospital, China Medical University, Tainan, Taiwan
- * E-mail: , (STH); (BCS)
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Wang LS, Yen PT, Weng SF, Hsu JH, Yeh JL. Clinical Patterns of Traditional Chinese Medicine for Ischemic Heart Disease Treatment: A Population-Based Cohort Study. Medicina (B Aires) 2022; 58:medicina58070879. [PMID: 35888597 PMCID: PMC9320598 DOI: 10.3390/medicina58070879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background and objectives: Traditional Chinese medicines (TCMs) are widely prescribed to relieve ischemic heart disease (IHD); however, no cohort studies have been conducted on the use of TCMs for patients with IHD. The aim of the study was to analyze TCM prescription patterns for patients with IHD. Materials and Methods: The retrospective population-based study employed a randomly sampled cohort of 4317 subjects who visited TCM clinics. Data were obtained from the National Health Insurance Research Database (NHIRD) of Taiwan for the period covering 2000 to 2017. Data analysis focused on the top ten most commonly prescribed formulae and single TCMs. We also examined the most common two- and three-drug combinations of TCM in single prescriptions. Demographic characteristics included age and sex distributions. Analysis was performed on 22,441 prescriptions. Results: The majority of TCM patients were male (53.6%) and over 50 years of age (65.1%). Zhi-Gan-Cao-Tang (24.76%) was the most frequently prescribed formulae, and Danshen (28.89%) was the most frequently prescribed single TCM for the treatment of IHD. The most common two- and three-drug TCM combinations were Xue-Fu-Zhu-Yu-Tang and Danshen” (7.51%) and “Zhi-Gan-Cao-Tang, Yang-Xin-Tang, and Gua-Lou-Xie-Bai-Ban-Xia-Tang” (2.79%). Conclusions: Our results suggest that most of the frequently prescribed TCMs for IHD were Qi toning agents that deal with cardiovascular disease through the promotion of blood circulation. The widespread use of these drugs warrants large-scale, randomized clinical trials to investigate their effectiveness and safety.
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Affiliation(s)
- Lung-Shuo Wang
- Department of Chinese Medicine, Sin-Lau Hospital, Tainan 70142, Taiwan; (L.-S.W.); (P.-T.Y.)
- The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung 82445, Taiwan
| | - Pei-Tzu Yen
- Department of Chinese Medicine, Sin-Lau Hospital, Tainan 70142, Taiwan; (L.-S.W.); (P.-T.Y.)
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Jong-Hau Hsu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Correspondence: (J.-H.H.); (J.-L.Y.)
| | - Jwu-Lai Yeh
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Pharmacology, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
- Correspondence: (J.-H.H.); (J.-L.Y.)
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Başaran N, Paslı D, Başaran AA. Unpredictable adverse effects of herbal products. Food Chem Toxicol 2021; 159:112762. [PMID: 34896186 DOI: 10.1016/j.fct.2021.112762] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 12/17/2022]
Abstract
Herbal products are being increasingly used all over the world for preventive and therapeutic purposes because of the belief of their safety. They have become an important part of health care system in many countries since they can easily be purchased in the health food stores or online. However, the lack of sufficient study on their efficacy and toxicity, inadequate controls of their availability, reduce their safety. Unlike conventional drugs, herbal products are not regulated for purity and potency. Herbal products contain substances which can induce or inhibit enzymes that take part in drug metabolism. Therefore the concurrent use of drugs with some medicinal plants can cause serious adverse effects and can also decrease the efficacy of the therapy. Particularly, drugs with narrow therapeutic index and plants which can affect drug metabolizing enzymes when used together, may lead to unpredictable adverse reactions. Impurities, contaminants and adulterants found in the herbal products, are the most common malpractises in herbal raw-material trade. In this review the unpredictable adverse effects of herbal products due to their possible interactions with drugs and also due to the adulteration and contamination with prohibited chemicals will be discussed in detail.
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Affiliation(s)
- Nurşen Başaran
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey.
| | - Duygu Paslı
- Hacettepe University, Faculty of Pharmacy, Department of Pharmaceutical Toxicology, Ankara, Turkey
| | - A Ahmet Başaran
- Başkent University, Faculty of Pharmacy, Department of Pharmacognosy, Ankara, Turkey
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Zhang C, Li Y, Yin C, Zheng J, Liu G. In vitro study on the effect of peucedanol on the activity of cytochrome P450 enzymes. PHARMACEUTICAL BIOLOGY 2021; 59:935-940. [PMID: 35294326 PMCID: PMC8274509 DOI: 10.1080/13880209.2021.1944223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/13/2021] [Accepted: 06/13/2021] [Indexed: 06/14/2023]
Abstract
CONTEXT Peucedanol is a major extract of Peucedanum japonicum Thunb. (Apiaceae) roots, which is a commonly used herb in paediatrics. Its interaction with cytochrome P450 enzymes (CYP450s) would lead to adverse effects or even failure of therapy. OBJECTIVE The interaction between peucedanol and CYP450s was investigated. MATERIALS AND METHODS Peucedanol (0, 2.5, 5, 10, 25, 50, and 100 μM) was incubated with eight human liver CYP isoforms (CYP1A2, 2A6, 3A4, 2C8, 2C9, 2C19, 2D6, and 2E1), in pooled human liver microsomes (HLMs) for 30 min with specific inhibitors as positive controls and untreated HLMs as negative controls. The enzyme kinetics and time-dependent study (0, 5, 10, 15, and 30 min) were performed to obtain corresponding parameters in vitro. RESULTS Peucedanol significantly inhibited the activity of CYP1A2, 2D6, and 3A4 in a dose-dependent manner with IC50 values of 6.03, 13.57, and 7.58 μM, respectively. Peucedanol served as a non-competitive inhibitor of CYP3A4 with a Ki value of 4.07 μM and a competitive inhibitor of CYP1A2 and 2D6 with a Ki values of 3.39 and 6.77 μM, respectively. Moreover, the inhibition of CYP3A4 was time-dependent with the Ki/Kinact value of 5.44/0.046 min/μM. DISCUSSION AND CONCLUSIONS In vitro inhibitory effect of peucedanol on the activity of CYP1A2, 2A6, and 3A4 was reported in this study. As these CYPs are involved in the metabolism of various drugs, these results implied potential drug-drug interactions between peucedanol and drugs metabolized by CYP1A2, 2D6, and 3A4, which needs further in vivo validation.
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Affiliation(s)
- Cun Zhang
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
| | - Yongwei Li
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
| | - Changlong Yin
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
| | - Jie Zheng
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
| | - Guozhi Liu
- Department of Neonatology, Yidu Central Hospital of Weifang, Weifang, China
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Moussa M, Hansz K, Rasmussen M, Gillman C, Pollard C, Kwak E, Izsak E. Cardiovascular Effects of Energy Drinks in the Pediatric Population. Pediatr Emerg Care 2021; 37:578-582. [PMID: 32569249 DOI: 10.1097/pec.0000000000002165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Consumption of energy drinks in the pediatric population is correlated with more emergency department visits and causes adverse reactions, such as neurological, psychiatric, gastrointestinal, renal, and cardiovascular effects. These cardiovascular complications include increased cardiometabolic risk with high intake of sugar, short-term blood pressure increases and a decrease in cerebral blood flow due to the caffeine content, increased or decreased blood pressure from taurine, unmasked cardiac conditions, such as channelopathies, and atrial and ventral fibrillations. Cardiovascular complications can also arise when energy drinks are mixed with pharmaceutical drugs, such as amiodarone, potent CYP1A2 inhibitors, warfarin, digoxin, or corticosteroids. Combining energy drinks with alcohol also precipitates adverse cardiovascular events, posing a risk to the health of children and adolescents. This review further explores the ingredients in energy drinks and their mechanism of action in causing these cardiovascular complications.
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Affiliation(s)
- Mohamad Moussa
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Keith Hansz
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Michaela Rasmussen
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Cassidy Gillman
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Casey Pollard
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Eunice Kwak
- From the Department of Emergency Medicine, University of Toledo College of Medicine and Life Sciences
| | - Eugene Izsak
- Department of Pediatric Emergency Medicine, Promedica Toledo Hospital, Toledo, OH
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Suroowan S, Abdallah HH, Mahomoodally MF. Herb-drug interactions and toxicity: Underscoring potential mechanisms and forecasting clinically relevant interactions induced by common phytoconstituents via data mining and computational approaches. Food Chem Toxicol 2021; 156:112432. [PMID: 34293424 DOI: 10.1016/j.fct.2021.112432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/28/2021] [Accepted: 07/17/2021] [Indexed: 01/05/2023]
Abstract
Herbals in the form of medicine are employed extensively around the world. Herbal and conventional medicine combination is a potentially dangerous practice mainly in comorbid, hepato insufficient and frail patients leading to perilous herb-drug interactions (HDI) and toxicity. This study features potential HDI of 15 globally famous plant species through data mining and computational methods. Several plant species were found to mimic warfarin. Phytochemicals from M. charantia induced hypoglycemica. M. chamomila and G. biloba possessed anticoagulant activities. S. hispanica reduces postprandial glycemia. R. officinalis has been reported to inhibit the efflux of anticancer substrates while A. sativum can boost the clearance of anticancer agents. P. ginseng can alter blood coagulation. A cross link of the biological and in silico data revealed that a plethora of herbal metabolites such as ursolic and rosmarinic acid among others are possible/probable inhibitors of specific CYP450 enzymes. Consequently, plant species/metabolites with a given pharmacological property/metabolizing enzyme should not be mixed with drugs having the same pharmacological property/metabolizing enzyme. Even if combined with drugs, herbal medicines must be used at low doses for a short period of time and under the supervision of a healthcare professional to avoid potential adverse and toxic effects.
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Affiliation(s)
- Shanoo Suroowan
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius
| | - Hassan Hadi Abdallah
- Department of Chemistry, College of Education, Salahaddin University-Erbil, Erbīl, Iraq
| | - Mohamad Fawzi Mahomoodally
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Réduit, Mauritius.
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12
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Yao W, Feng Y, Liu T, Li W, Zhang M, Yao Y, Wu S. Rivaroxaban versus low-molecular weight heparin plus warfarin prevents portal vein system thrombosis after splenectomy and pericardial devascularization: A randomized clinical trial. EXCLI JOURNAL 2021; 20:537-549. [PMID: 33883982 PMCID: PMC8056059 DOI: 10.17179/excli2020-3120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/22/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to evaluate the safety and efficacy of rivaroxaban in preventing portal vein system thrombosis (PVST) in patients with liver cirrhosis after splenectomy and pericardial devascularization. 70 cirrhotic patients undergoing splenectomy and pericardial devascularization were randomly assigned to rivaroxaban treatment (n=35) or low-molecular weight heparin (LMWH) plus warfarin treatment (n=35) for 30 days in this randomized controlled trial. The primary endpoint is the PVST formation. Ultrasound doctors and radiologists were blinded to the randomization results. Both groups received routine outpatient inspection every month and were followed for one year. 17 patients (48.6 %) in rivaroxaban group developed PVST, compared with 27 patients (77.1 %) in LMWH plus warfarin group (P=0.025). The incidence of PVST during the first year postoperation was significantly lower in rivaroxaban group than in LMWH plus warfarin group (F=7.901, P=0.006). The intra-group comparisons versus baseline showed the liver function improved from POD 21 to POM 1, and coagulation function improved from POM 2, in rivaroxaban group. In contrast, the liver function improved from POM 1 to POM 2, and coagulation function improved from POM 4, in LMWH plus warfarin group. The prophylactic use of rivaroxaban significantly decreases the incidence of PVST after splenectomy and pericardial devascularization in cirrhotic patients compared to LMWH plus warfarin treatment. Besides, rivaroxaban treatment was safe and effective and associated with better liver and coagulation functions improvement than LMWH plus warfarin treatment.
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Affiliation(s)
- Wei Yao
- Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China
| | - Yongan Feng
- Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China
| | - Ting Liu
- Department of Hepatobiliary Surgery, the Affiliated Baoji Hospital of Xi'an Medical University, 4 Qingjiang Road, Baoji, Shaanxi 721006, P.R. China
| | - Wujun Li
- Department of General Surgery, the First Affiliated Hospital of Xi'an Medical University, 48 Fenghao West Road, Xi'an, Shaanxi, 710077, PR China
| | - Mei Zhang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi 710061, P.R. China
| | - Yingmin Yao
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi 710061, P.R. China
| | - Shengli Wu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, Shaanxi 710061, P.R. China
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13
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Systematic Review: Guideline-Based Approach for the Management of Asthma and Subtypes via Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4319657. [PMID: 33505494 PMCID: PMC7810530 DOI: 10.1155/2021/4319657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Background Asthma is a chronic condition that results in the inflammation and narrowing of airways, often clinically presenting as wheeze and shortness of breath. Little is known of the mechanisms of action (MOA) of herbs used to treat asthma. The aim of this study is to review existing data regarding known MOA of traditional Chinese medicine which will aid in the understanding of possible interactions between Western drugs and Chinese herbs as well as the standardization of management via a proposed guideline to improve patient safety and possible synergism in the long term. Methods We searched through 5 databases for commonly prescribed herbs and formulas for asthma and narrowed down the search to identify the underlying MOA of individual herbs that could specifically target asthma symptoms. We included studies that stated the MOA of individual herbs when used for treating symptoms of asthma, excluding them if they are described as part of a formula. Results A total of 26 herbs commonly prescribed for asthma with known mechanism of action were identified. Herbs used for asthma were found to have similar MOA as that for drugs. Based on existing GINA guidelines, a guideline is proposed which includes a total of 5 steps depending on the severity of asthma and the herbs' MOA. 16 formulas were subsequently identified for the management of asthma, which consist of 12 “stand-alone” and 4 “add-on” formulas. “Stand-alone” formulas used independently for asthma generally follow the GINA guidelines but do not proceed beyond step 3. These formulas consist mainly of beta-agonist and steroid-like effects. “Add-on” formulas added as adjunct to “stand-alone” formulas, however, mainly act on T helper cells or have steroid-like effects. Conclusion Through the understanding of MOA of herbs and their respective formulas, it will ensue greater patient safety and outcomes.
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Wang T, Hou J, Xiao W, Zhang Y, Zhou L, Yuan L, Yin X, Chen X, Hu Y. Chinese medicinal plants for the potential management of high-altitude pulmonary oedema and pulmonary hypertension. PHARMACEUTICAL BIOLOGY 2020; 58:815-827. [PMID: 32883127 PMCID: PMC8641673 DOI: 10.1080/13880209.2020.1804407] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 07/28/2020] [Accepted: 07/28/2020] [Indexed: 05/29/2023]
Abstract
CONTEXT Despite the abundance of knowledge regarding high-altitude pulmonary edoema (HAPE) and high-altitude pulmonary hypertension (HAPH), their prevalence continues to be on the rise. Thus, there is an urgent need for newer safe, effective, and relatively economic drug candidates. China is particularly known for the use of medicinal plants. OBJECTIVE This review summarizes the medicinal plants used for HAPE and HAPH in the past 30 years, as well as some potential plants. METHODS Publications on HAPE and HAPH from 1990 to 2020 were identified using Web of Science, PubMed, SCOPUS, Springer Link, Google Scholar databases, Chinese Clinical Trial Registry and CNKI with the following keywords: 'medicinal plants,' 'hypoxia,' 'high altitude pulmonary edema,' 'high altitude pulmonary hypertension,' 'pathophysiology,' 'mechanisms,' 'prevention,' 'treatment,' 'human,' 'clinical,' 'safety,' and 'pharmacokinetics.' RESULTS We found 26 species (from 20 families) out of 5000 plants which are used for HAPE and HAPH prevention or treatment. Rhodiola rosea Linn. (Crassulaceae) is the most widely utilized. The most involved family is Lamiaceae, which contains 5 species. DISCUSSION AND CONCLUSIONS We mainly reviewed the medicinal plants and mechanisms for the treatment of HAPE and HAPH, and we also assessed related toxicology experiments, pharmacokinetics and bioavailability. Potential medicinal plants were also identified. Further research is needed to determine the pharmacological effects and active ingredients of these potential medicinal plants.
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Affiliation(s)
- Tingting Wang
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Jun Hou
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Wenjing Xiao
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Yaolei Zhang
- Faculty of Medical, Southwest Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Longfu Zhou
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Li Yuan
- Faculty of Medical, Southwest Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Xiaoqiang Yin
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
| | - Xin Chen
- Department of Laboratory Medicine, The Third People’s Hospital of Chengdu/Affiliated Hospital of Southwest, Jiaotong University, Chengdu, Sichuan, P. R. China
| | - Yonghe Hu
- Department of Central Laboratory, The General Hospital of Western Theater Command, Chengdu, Sichuan, P. R. China
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Guo J, Low KS, Mei L, Li JH, Qu W, Guan G. Use of traditional medicine for dental care by different ethnic groups in New Zealand. BMC Oral Health 2020; 20:280. [PMID: 33046025 PMCID: PMC7552356 DOI: 10.1186/s12903-020-01272-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing public interest in the use of TM internationally, yet there is a paucity of research on the use of TM by the public in the dental setting. This study aimed to explore the views, use of and access to TM in dentistry among different ethnic groups residing in New Zealand. METHODS Qualitative study and in-depth interviews were used. An individual semi-structured questionnaire was used to collect data. Interviews were recorded, transcribed, and analysed using an inductive approach to identify the main themes. RESULTS Three main themes were extracted from interviews with 14 participants from diverse cultural backgrounds: [1] the perspectives of TM varied among different ethnic groups and included the involvement of spirituality, the environment, knowledge and usage of TM. [2] The TM that was used by different ethnic groups included plants, herbs, massage, and other forms of healing. Reasons for choosing traditional or western medicines generally included family tradition, access to TM, and finding a competent traditional healer. [3] The barriers in accessing TM included the paucity of traditional healers, difficulty accessing plants and cost, therefore most would look for a substitution or alternative treatment. CONCLUSION Even though the access to these TM in New Zealand was a challenge for the majority of the participants, they are still considered the first-line treatment for the majority. This study provided dental practitioners an insight into the different sort of TM used by the population. By understanding and acknowledging the use of TM, dental practitioners could create a supportive environment for patients to disclose their use of TM and allow them to educate patients on the use of TM.
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Affiliation(s)
- Jun Guo
- Department of Stomatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, 32# West Section 2, 1st Ring Road, Chengdu, 610072, China
| | - Kah Seng Low
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand
| | - Li Mei
- Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Dunedin, New Zealand.
| | - Jia Hui Li
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Wenwen Qu
- Department of Gynaecology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Guangzhao Guan
- Department of Oral Diagnostic and Surgical Sciences, Faculty of Dentistry, University of Otago, 310 Great King Street, Dunedin, 9016, New Zealand.
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Huang J, Zhang Z, Huang C, Li X, Zhang X, Lu H. [Pharmacist-led anticoagulation monitoring can significantly improve the effectiveness and safety of warfarin for patients during hospitalization]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2020; 40:544-549. [PMID: 32895134 DOI: 10.12122/j.issn.1673-4254.2020.04.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the role of pharmacist-led anticoagulation monitoring service for warfarin anticoagulation therapy in patients during hospitalization. METHODS We retrospectively analyzed the data of 421 patients receiving warfarin anticoagulation therapy during hospitalization between April, 2016 and December, 2017. Of these patients, 316 received daily pharmacist-led anticoagulation monitoring service including checking the patients' International Normalized Ratio (INR) and other pertinent laboratory test results and reviewing medication changes and the patients' clinical status (monitoring group); the other 105 patients receiving warfarin anticoagulation therapy without pharmaceutical care served as the control group. The data including compliance rate of anticoagulant indicators, incidence and rate of prompt management of INR alert, thrombosis and bleeding events during hospitalization were analyzed among these patients. RESULTS Compared with the control patients, the patients in the monitoring group showed a significantly higher percentage time within target INR range [(73.20±9.46)% vs (46.32±17.11)%, P < 0.001] and a higher qualified rate of INR before discharge (98.42% vs 60.95%, P < 0.001) as well as a higher proper INR-monitoring frequency (97.15% vs 66.67%, P < 0.001). The patients in the monitoring group showed a significantly lower incidence of INR alert than the control patients (8.23% vs 20.00%, P < 0.001) with also a much higher rate of prompt management (96.15% vs 33.33%). The two groups had similar incidences of clinical events except that the control group reported a higher incidence of minor bleeding episodes (9.52% vs 2.53%, P=0.005). CONCLUSIONS Pharmacist-led anticoagulation monitoring service can significantly improve the effectiveness and safety of warfarin anticoagulation therapy for patients during hospitalization.
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Affiliation(s)
- Jiawen Huang
- Department of Pharmacy, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Zhidong Zhang
- Department of Pharmacy, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Chengfeng Huang
- Department of Cardiovascular Surgery, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xiaohui Li
- Department of Cardiovascular Surgery, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Xiaoshen Zhang
- Department of Cardiovascular Surgery, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
| | - Hua Lu
- Department of Cardiovascular Surgery, First Affiliated Hospital, Jinan University, Guangzhou 510630, China
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Shaito A, Thuan DTB, Phu HT, Nguyen THD, Hasan H, Halabi S, Abdelhady S, Nasrallah GK, Eid AH, Pintus G. Herbal Medicine for Cardiovascular Diseases: Efficacy, Mechanisms, and Safety. Front Pharmacol 2020; 11:422. [PMID: 32317975 PMCID: PMC7155419 DOI: 10.3389/fphar.2020.00422] [Citation(s) in RCA: 148] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 03/19/2020] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular diseases (CVDs) are a significant health burden with an ever-increasing prevalence. They remain the leading causes of morbidity and mortality worldwide. The use of medicinal herbs continues to be an alternative treatment approach for several diseases including CVDs. Currently, there is an unprecedented drive for the use of herbal preparations in modern medicinal systems. This drive is powered by several aspects, prime among which are their cost-effective therapeutic promise compared to standard modern therapies and the general belief that they are safe. Nonetheless, the claimed safety of herbal preparations yet remains to be properly tested. Consequently, public awareness should be raised regarding medicinal herbs safety, toxicity, potentially life-threatening adverse effects, and possible herb–drug interactions. Over the years, laboratory data have shown that medicinal herbs may have therapeutic value in CVDs as they can interfere with several CVD risk factors. Accordingly, there have been many attempts to move studies on medicinal herbs from the bench to the bedside, in order to effectively employ herbs in CVD treatments. In this review, we introduce CVDs and their risk factors. Then we overview the use of herbs for disease treatment in general and CVDs in particular. Further, data on the ethnopharmacological therapeutic potentials and medicinal properties against CVDs of four widely used plants, namely Ginseng, Ginkgo biloba, Ganoderma lucidum, and Gynostemma pentaphyllum, are gathered and reviewed. In particular, the employment of these four plants in the context of CVDs, such as myocardial infarction, hypertension, peripheral vascular diseases, coronary heart disease, cardiomyopathies, and dyslipidemias has been reviewed, analyzed, and critically discussed. We also endeavor to document the recent studies aimed to dissect the cellular and molecular cardio-protective mechanisms of the four plants, using recently reported in vitro and in vivo studies. Finally, we reviewed and reported the results of the recent clinical trials that have been conducted using these four medicinal herbs with special emphasis on their efficacy, safety, and toxicity.
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Affiliation(s)
- Abdullah Shaito
- Department of Biological and Chemical Sciences, Lebanese International University, Beirut, Lebanon
| | - Duong Thi Bich Thuan
- Department of Biochemistry, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Hoa Thi Phu
- Department of Biochemistry, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Thi Hieu Dung Nguyen
- Department of Physiology, University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Hiba Hasan
- Institute of Anatomy and Cell Biology, Justus Liebig University Giessen, Giessen, Germany
| | - Sarah Halabi
- Biology Department, Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Samar Abdelhady
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Gheyath K Nasrallah
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar
| | - Ali H Eid
- Department of Biomedical Sciences, College of Health Sciences, Qatar University, Doha, Qatar.,Department of Pharmacology and Toxicology, American University of Beirut, Beirut, Lebanon
| | - Gianfranco Pintus
- Department of Medical Laboratory Sciences, University of Sharjah, Sharjah, United Arab Emirates.,Department of Biomedical Sciences, Faculty of Medicine, University of Sassari, Sassari, Italy
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Shiroto T, Sakata Y, Nochioka K, Abe R, Kasahara S, Sato M, Aoyanagi H, Fujihashi T, Yamanaka S, Hayashi H, Miura M, Takahashi J, Miyata S, Shimokawa H. Clinical benefits and risks of antithrombotic therapy in patients with atrial fibrillation with comorbidities - A report from the CHART-2 Study. Int J Cardiol 2020; 299:160-168. [PMID: 31611087 DOI: 10.1016/j.ijcard.2019.09.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/29/2019] [Accepted: 09/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The benefits of antithrombotic therapy (ATT) for atrial fibrillation (AF) are occasionally offset by major bleeding complications. However, the clinical benefits and risks of ATT in AF patients, with special references to comorbidities, such as heart failure (HF), coronary artery disease (CAD), and the patterns of AF, remain to be fully elucidated. METHODS A total of 3221 consecutive AF patients from our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study (N = 10,219) were divided into 4 groups based on ATT at enrollment; no-ATT, anticoagulant alone, antiplatelet alone, and both of them (AC&AP). Then, efficacy and safety outcomes including thromboembolic events, major bleeding, and mortality were evaluated among the 4 groups. RESULTS Anticoagulant monotherapy was associated with reduced risk of ischemic stroke in patients with but not in those without HF, CAD, or non-paroxysmal AF. Although there was no significant difference in major bleeding among the 4 groups, a composite of thromboembolism and major bleeding occurred more frequently in the AC&AP group, even in combination with anticoagulants and single antiplatelet therapy, indicating that the combination therapy is more harmful than anticoagulant monotherapy for AF patients, especially for those with HF or CAD. Lastly, no-ATT group was associated with worse prognosis compared with other 3 groups. CONCLUSIONS These results indicate that ATT is beneficial for AF patients particularly for those with HF, CAD, or non-paroxysmal AF and that among ATT, anticoagulant monotherapy may be most profitable for both clinical benefits and risks for AF patients.
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Affiliation(s)
- Takashi Shiroto
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; The Big Data Medicine Center, Tohoku University, Sendai, Japan.
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ruri Abe
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shintaro Kasahara
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masayuki Sato
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hajime Aoyanagi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takahide Fujihashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shinsuke Yamanaka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideka Hayashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanobu Miura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Satoshi Miyata
- Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; The Big Data Medicine Center, Tohoku University, Sendai, Japan; Department of Evidence-based Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Lee WQ, Teoh J, Lee PZK, Low ZXG, Sim X, Chong FFM, Wagner NL. Factors influencing communication of traditional Chinese medicine use between patients and doctors: A multisite cross-sectional study. JOURNAL OF INTEGRATIVE MEDICINE 2019; 17:396-403. [PMID: 31548146 DOI: 10.1016/j.joim.2019.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/17/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE In Singapore, the use of traditional Chinese medicine (TCM) alongside Western medicine (WM) is common. There are risks of adverse herb-drug interactions when taken concurrently. Current literature suggests that TCM use is not regularly reported to WM doctors in Singapore, but the underlying reasons are not understood. METHODS A cross-sectional study was conducted across Singapore by administering questionnaires to TCM-using patients and WM-practising general practitioners (GPs). The questionnaire examined the following themes: (1) demographics and TCM use pattern; (2) respondents' (patients and GPs) knowledge and beliefs about TCM and the factors influencing the discussion of TCM during the WM consultation; and (3) respondents' qualitative suggestions to increase disclosure rate. RESULTS A total of 484 patients and 334 GPs were surveyed. Factors associated with patients' initiation of TCM discussion include length of consultation (odds ratio [OR]: 2.1; P < 0.001), comfort level in discussing TCM (OR: 1.6; P < 0.001) and belief in importance of discussion (OR: 1.4; P = 0.017). Doctor's initiation of discussion (74%) was the top patient-ranked factor influencing their discussion of TCM. For doctors, knowledge of TCM indications (OR: 2.2; P < 0.001), belief in importance of discussion (OR: 2.1; P < 0.001) and comfort level in discussing TCM (OR: 1.9; P = 0.001) were associated with their initiation of TCM use discussion. Possible WM-TCM interactions (58%) was the top doctor-ranked factor influencing their discussion of TCM. CONCLUSION The discussion of TCM in a WM setting is multifactorial. Interventions include doctors' active screening for TCM use in patients and equipping doctors with TCM knowledge. Improving communication between patients and doctors is key to avoiding harmful herb-drug interactions.
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Affiliation(s)
- Wen Qiang Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore.
| | - Jeremy Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Pei Zheng Kenneth Lee
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Zhi Xiong Gerard Low
- Yong Loo Lin School of Medicine, National University of Singapore, 117597, Singapore
| | - Xueling Sim
- Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore
| | - Foong Fong Mary Chong
- Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore
| | - Norbert Ludwig Wagner
- Saw Swee Hock School of Public Health, National University of Singapore, 117549, Singapore
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20
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Cai P, Qiu H, Qi F, Zhang X. The toxicity and safety of traditional Chinese medicines: Please treat with rationality. Biosci Trends 2019; 13:367-373. [PMID: 31564696 DOI: 10.5582/bst.2019.01244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Pingping Cai
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong Universityy, Ji'nan, China
| | - Hua Qiu
- Department of gynecology, Jinan Municipal Hospital of Traditional Chinese Medicine, Ji'nan, China
| | - Fanghua Qi
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong Universityy, Ji'nan, China
| | - Xiaoyi Zhang
- Department of Traditional Chinese Medicine, Shandong Provincial Hospital affiliated to Shandong Universityy, Ji'nan, China
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21
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Shamsuddin N, Karuppannan M, Hafiz Wan Md Adnan WA, Farooqui M, Gnanasan S. Pattern of complementary and alternative medicine (CAM) use among patients with chronic kidney disease. Complement Ther Clin Pract 2019; 37:86-92. [PMID: 31539806 DOI: 10.1016/j.ctcp.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Noorasyikin Shamsuddin
- Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Malaya, Kuala Lumpur, Malaysia.
| | - Mahmathi Karuppannan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam, Malaysia
| | | | - Maryam Farooqui
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah, Qassim, Saudi Arabia
| | - Shubashini Gnanasan
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Puncak Alam, Malaysia
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22
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Szczuka D, Nowak A, Zakłos-Szyda M, Kochan E, Szymańska G, Motyl I, Blasiak J. American Ginseng ( Panax quinquefolium L.) as a Source of Bioactive Phytochemicals with Pro-Health Properties. Nutrients 2019; 11:E1041. [PMID: 31075951 PMCID: PMC6567205 DOI: 10.3390/nu11051041] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022] Open
Abstract
Panax quinquefolium L. (American Ginseng, AG) is an herb characteristic for regions of North America and Asia. Due to its beneficial properties it has been extensively investigated for decades. Nowadays, it is one of the most commonly applied medical herbs worldwide. Active compounds of AG are ginsenosides, saponins of the glycosides group that are abundant in roots, leaves, stem, and fruits of the plant. Ginsenosides are suggested to be primarily responsible for health-beneficial effects of AG. AG acts on the nervous system; it was reported to improve the cognitive function in a mouse model of Alzheimer's disease, display anxiolytic activity, and neuroprotective effects against neuronal damage resulting from ischemic stroke in animals, demonstrate anxiolytic activity, and induce neuroprotective effects against neuronal damage in ischemic stroke in animals. Administration of AG leads to inhibition of hypertrophy in heart failure by regulation of reactive oxygen species (ROS) in mice as well as depletion of cardiac contractile function in rats. It also has an anti-diabetic and anti-obesity potential as it increases insulin sensitivity and inhibits formation of adipose tissue. AG displays anti-cancer effect by induction of apoptosis of cancer cells and reducing local inflammation. It exerts antimicrobial effects against several pathogenic strains of bacteria. Therefore, AG presents a high potential to induce beneficial health effects in humans and should be further explored to formulate precise nutritional recommendations, as well as to assess its value in prevention and therapy of some disorders, including cancer.
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Affiliation(s)
- Daria Szczuka
- Institute of Fermentation Technology and Microbiology, Lodz University of Technology, Wolczanska 171/173, 90-924 Lodz, Poland.
| | - Adriana Nowak
- Institute of Fermentation Technology and Microbiology, Lodz University of Technology, Wolczanska 171/173, 90-924 Lodz, Poland.
| | - Małgorzata Zakłos-Szyda
- Institute of Technical Biochemistry, Lodz University of Technology, Stefanowskiego 4/10, 90-924 Lodz, Poland.
| | - Ewa Kochan
- Pharmaceutical Biotechnology Department, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland.
| | - Grażyna Szymańska
- Pharmaceutical Biotechnology Department, Medical University of Lodz, Muszynskiego 1, 90-151 Lodz, Poland.
| | - Ilona Motyl
- Institute of Fermentation Technology and Microbiology, Lodz University of Technology, Wolczanska 171/173, 90-924 Lodz, Poland.
| | - Janusz Blasiak
- Department of Molecular Genetics, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland.
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Peach Kernel Oil Downregulates Expression of Tissue Factor and Reduces Atherosclerosis in ApoE knockout Mice. Int J Mol Sci 2019; 20:ijms20020405. [PMID: 30669336 PMCID: PMC6359210 DOI: 10.3390/ijms20020405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 01/05/2023] Open
Abstract
Atherosclerosis is the pathological process in arteries due to the plaque formation that is responsible for several diseases like heart disease, stroke and peripheral arterial disease. In this study, we performed in vitro and in vivo assays to evaluate the potential anti-atherosclerosis activity of peach kernel oil. For the in vitro assay, we incubated human umbilical vein endothelial cells (HUVEC) with tumor necrosis factor-α (TNF-α) to induce tissue factors (TF, an essential mediator of hemostasis and trigger of thrombosis) elevation. We found that TNF-α-induced TF elevation was suppressed by peach kernel oil in a dose-dependent manner at both mRNA and protein levels. Peach kernel oil can significantly improve HUVEC viability, protect the endothelial cells, which achieved the goal of prevention of thrombotic diseases. For the in vivo assay, we investigated the effect and mechanism of peach kernel oil on preventing atherosclerotic lesion formation in ApoE knockout mice. Results show that peach kernel oil could reduce total cholesterol, triglyceride, low-density lipoprotein cholesterol levels, elevate the high-density lipoprotein cholesterol level in serum, and reduce the area of the aortic atherosclerotic lesions in high-fat diet fed ApoE knockout mice. Moreover, peach kernel oil treatment can significantly down regulate the expression of TF protein to inhibit the formation of atherosclerotic plaque. In conclusion, peach kernel oil may be a potential health food to prevent atherosclerosis in cardiovascular diseases.
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Zhang X, Zhang X, Wang X, Zhao M. Influence of andrographolide on the pharmacokinetics of warfarin in rats. PHARMACEUTICAL BIOLOGY 2018; 56:351-356. [PMID: 29983086 PMCID: PMC6130436 DOI: 10.1080/13880209.2018.1478431] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 03/26/2018] [Accepted: 05/15/2018] [Indexed: 05/27/2023]
Abstract
CONTEXT Andrographolide and warfarin are often used together in clinics in China. However, the herb-drug interaction between andrographolide and warfarin is still unknown. OBJECTIVE This study investigates the herb-drug interaction between andrographolide and warfarin in vivo and in vitro. MATERIALS AND METHODS A sensitive and reliable LC-MS/MS method was developed for the determination of warfarin in male Sprague-Dawley rats plasma, and then the pharmacokinetics of orally administered warfarin (0.5 mg/kg) with or without andrographolide (30 mg/kg/day for 7 days) pretreatment was investigated. In addition, Sprague-Dawley rat liver microsomes incubation systems were used to support the in vivo pharmacokinetic data and investigate its potential mechanism. RESULTS The method validation results showed that a sensitive and reliable LC-MS/MS method was developed for the determination of warfarin in rat plasma samples. The pharmacokinetic results indicated that co-administration of andrographolide could increase the systemic exposure of warfarin significantly, including area under the curve (118.92 ± 18.08 vs. 60.58 ± 9.46 μg × h/mL), maximum plasma concentration (3.32 ± 0.41 vs. 2.35 ± 0.25 μg/mL) and t1/2 (22.73 ± 3.28 vs. 14.27 ± 2.67 h). Additionally, the metabolic stability of warfarin increased from 23.5 ± 4.7 to 38.7 ± 6.1 min with the pretreatment of andrographolide, and the difference was significant (p < 0.05). DISCUSSION AND CONCLUSION In conclusion, andrographolide could increase the systemic exposure of warfarin in rats when andrographolide and warfarin were co-administered, and possibly by slowing down the metabolism of warfarin in rat liver by inhibiting the activity of CYP3A4 or CYP2C9.
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Affiliation(s)
- Xiaoli Zhang
- Department of Nephrology, Yidu Central Hospital of Weifang, Shandong, China
- Department of Nursing, Yidu Central Hospital of Weifang, Shandong, China
| | - Xiaosu Zhang
- Department of Nephrology, Yidu Central Hospital of Weifang, Shandong, China
| | - Xiaocui Wang
- Department of Nephrology, Yidu Central Hospital of Weifang, Shandong, China
| | - Meijun Zhao
- Department of Nursing, Yidu Central Hospital of Weifang, Shandong, China
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Memariani Z, Moeini R, Hamedi SS, Gorji N, Mozaffarpur SA. Medicinal plants with antithrombotic property in Persian medicine: a mechanistic review. J Thromb Thrombolysis 2018; 45:158-179. [PMID: 29124622 DOI: 10.1007/s11239-017-1580-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Thrombosis is one of the major causes of morbidity and mortality in a wide range of vessels diseases. Due to the high prevalence of thromboembolic disorders investigations are being carried out on new antithrombotic agents with limited adverse side effects in which herbal medicines are considered as alternative remedies. Persian medicine (PM) as a traditional medicine has a good potential for pharmacotherapy based on its own principles and development of drugs via investigating PM literature. In PM manuscripts there are some concepts that express the management of blood clots and antithrombotic properties. This study reviewed the pharmacological effects of medicinal plants mentioned in PM literature for blood clot management in light of current knowledge. Plants mentioned in PM for management of blood clot belong to 12 families in which Apiaceae, Lamiaceae and Compositae were the most repeated ones. Among the proposed plants Allium sativum, Rosmarinus officinalis, Boswellia serrata, Sesamum indicum, Matricaria chamomilla and Carthamus tinctorius have been the most researched plants in modern antithrombotic studies while for some plants such as Helichrysum stoechas, Dracocephalum kotschi, Carum carvi, Bunium persicum and Lagoecia cuminoides no evidence could be found. One of the interesting notes in clot management in PM texts was introducing the target organ for some of the recommended herbs like Carum carvi and Bunium persicum for dissolving blood clot in stomach and Commiphora mukul for thrombosed hemorrhoid. It seems review of PM recommendations can help to design future researches for antithrombotic drugs discovering with more effectiveness and safety.
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Affiliation(s)
- Zahra Memariani
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,School of Traditional Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Reihaneh Moeini
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,School of Traditional Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
| | - Shokooh Sadat Hamedi
- School of Traditional Medicine, Mashhad University of Medical Sciences, Mashhad, Islamic Republic of Iran
| | - Narjes Gorji
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran. .,School of Traditional Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.
| | - Seyyed Ali Mozaffarpur
- Traditional Medicine and History of Medical Sciences Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Islamic Republic of Iran.,School of Traditional Medicine, Babol University of Medical Sciences, Babol, Islamic Republic of Iran
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Liu Y, Liu S, Shi Y, Qin M, Sun Z, Liu G. Effects of safflower injection on the pharmacodynamics and pharmacokinetics of warfarin in rats. Xenobiotica 2017; 48:818-823. [PMID: 28783419 DOI: 10.1080/00498254.2017.1361051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
1. Safflower injection (SI) is extracted from Chinese herbal medicine safflower that comprises many active components. Warfarin is a common anticoagulant and has exhibited drug interactions with several herbal products. This study aimed to investigate the effects of SI on pharmacodynamics and pharmacokinetics of warfarin in rats. 2. Wistar rats were randomly divided into blank control group, SI group, warfarin control group and SI + warfarin group, respectively. In SI and SI + warfarin groups, rats were injected with SI (1.6 mL/kg/d, i.p.) for 14 days. Warfarin (0.2 mg/kg) was given orally on the eighth day. Saline was given as control. The blood samples were collected at various time points. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were measured. UPLC-MS/MS was used to determine the plasma concentrations of S(R)-warfarin, and the pharmacokinetic parameters were calculated. 3. PT, APTT in SI and SI + warfarin rats increased significantly compared with corresponding control rats. The pharmacokinetic parameters including Cmax, t1/2, AUC0-t and AUC0-∞ of S-warfarin and R-warfarin in SI + warfarin rats were higher than those in warfarin control rats. 4. These findings suggest that SI significantly increases the anticoagulant effect of warfarin by affecting its pharmacodynamic and pharmacokinetic parameters.
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Affiliation(s)
- Yan Liu
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
| | - Shuang Liu
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
| | - Yuan Shi
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
| | - Mengnan Qin
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
| | - Zhidan Sun
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
| | - Gaofeng Liu
- a Department of Pharmacy , the Second Affiliated Hospital, Harbin Medical University, (Institute of Clinical Pharmacy, the Heilongjiang Key Laboratory of Drug Research, Harbin Medical University) , Harbin , P.R. China
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Wang Z, Tang Z, Zhu W, Ge L, Ge J. Efficacy and safety of traditional Chinese medicine on thromboembolic events in patients with atrial fibrillation: A systematic review and meta-analysis. Complement Ther Med 2017; 32:1-10. [DOI: 10.1016/j.ctim.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 01/06/2023] Open
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28
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R- and S-Warfarin Were Transported by Breast Cancer Resistance Protein: From In Vitro to Pharmacokinetic-Pharmacodynamic Studies. J Pharm Sci 2017; 106:1419-1425. [DOI: 10.1016/j.xphs.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 12/23/2016] [Accepted: 01/05/2017] [Indexed: 11/24/2022]
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Sorbera M, Joseph T, DiGregorio RV. Elevated International Normalized Ratio in a Patient Taking Warfarin and Mauby: A Case Report. J Pharm Pract 2016; 30:567-570. [PMID: 27543375 DOI: 10.1177/0897190016663435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a 70-year-old Haitian man who had been taking warfarin for 5 years for atrial fibrillation and pulmonary hypertension. This patient had his international normalized ratio (INR) checked in the pharmacist-run anticoagulation clinic and was followed monthly. Prior to the interaction, his INR was therapeutic for 5 months while taking warfarin 10.5 mg/d. The patient presented with an INR > 8.0. Patient held 4 days of warfarin and restarted on warfarin 8.5 mg/d. Two weeks later, his INR was 2.5. After continuing dose, patient presented 2 weeks later and INR was 4.8. Upon further questioning, the patient stated he recently began ingesting mauby. Mauby is a bitter dark liquid extracted from the bark of the mauby tree that is commonly used in the Caribbean population as a folk remedy with many health benefits. This case report illustrates that mauby may have a probable drug-herb interaction (Naranjo Algorithm Score of 6) when given with warfarin. There is a lack of published literature and unclear information on the Internet describing the interaction of mauby and warfarin. Health professionals should be cautious regarding interactions between warfarin and mauby until the interaction is fully elucidated.
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Affiliation(s)
- Maria Sorbera
- 1 Department of Pharmacy Practice, Touro College of Pharmacy, New York, NY, USA
| | - Tina Joseph
- 2 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Fort Lauderdale, FL, USA
| | - Robert V DiGregorio
- 3 Pharmacotherapy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
- 4 Department of Pharmacy Practice, Arnold and Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, Brooklyn, NY, USA
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30
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Hung YC, Cheng YC, Muo CH, Chiu HE, Liu CT, Hu WL. Adjuvant Chinese Herbal Products for Preventing Ischemic Stroke in Patients with Atrial Fibrillation. PLoS One 2016; 11:e0159333. [PMID: 27428543 PMCID: PMC4948896 DOI: 10.1371/journal.pone.0159333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 06/30/2016] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Chinese herbal products (CHPs) are widely used for atrial fibrillation (AF) in Taiwan. We investigated the effect of adjuvant CHPs in preventing ischemic stroke in patients with AF. METHODS Taiwanese patients in the Health Insurance Database newly diagnosed with AF during 2000-2011 were enrolled. Medication treatment with/without CHPs was administered within 7 days after the AF diagnosis. The clinical endpoint was an ischemic stroke. The Chi-square test, Fisher's exact test, and Student t test were used to examine differences between the traditional Chinese medicine (TCM) and non-TCM cohorts. Cox proportional hazard regression was used to assess the risk for ischemic stroke between two cohorts. RESULTS Three hundred and eleven patients underwent TCM treatment and 1715 patients did not. Compared to non-TCM users, TCM users had a lower incidence of stroke (12.59% vs. 1.93%, respectively) and lower risk of stroke [CHA2DS2-VASc score = 0-2 (hazard ratio = 0.20; 95% confidence interval = 0.06-0.65)]. Compared to non-TCM users, the stroke risk was significantly lower in TCM users with AF who were female or younger than 65 years, but not in males, people more than 65 years old, or people with comorbidities. Compared to TCM users, non-TCM users who received conventional treatment had a higher ischemic stroke risk. The risk for AF-related hospitalization was significantly lower in TCM users (0.64%) than in non-TCM users (38.1%). CONCLUSIONS Users of TCM with AF have a lower risk of new-onset ischemic stroke. Therefore, adjuvant CHP therapy may have a protective effect and may be used in AF patients to prevent ischemic stroke.
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Affiliation(s)
- Yu-Chiang Hung
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
- * E-mail: (YCH); (WLH)
| | - Yu-Chen Cheng
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Hsienhsueh Elley Chiu
- School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Kaohsiung Medical University College of Medicine, Kaohsiung, Taiwan
- Fooyin University College of Nursing, Kaohsiung, Taiwan
- * E-mail: (YCH); (WLH)
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