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Zare P, Poustchi H, Mohammadi Z, Mesgarpour B, Akbari M, Kamalipour A, Abdipour-Mehrian SR, Hashemi ES, Ghamar-Shooshtari A, Hosseini SA, Malekzadeh R, Bazrafshan Drissi H, Malekzadeh F, Molavi Vardanjani H. Polypharmacy and medication usage patterns in hypertensive patients: Findings from the Pars Cohort Study. Res Social Adm Pharm 2024:S1551-7411(24)00231-6. [PMID: 39098543 DOI: 10.1016/j.sapharm.2024.07.006] [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: 09/11/2023] [Revised: 05/19/2024] [Accepted: 07/31/2024] [Indexed: 08/06/2024]
Abstract
Polypharmacy, defined here as the concomitant use of five or more medications, is a significant health issue, particularly affecting individuals with chronic diseases like hypertension (HTN). To compare individuals with and without HTN in term of polypharmacy, and to investigate correlates of polypharmacy and medication use patterns in individuals with HTN in southwest Iran. This cross-sectional study used the baseline data of 9270 participants of the Pars Cohort Study (PCS) with a mean age of 52.6 ± 9.7 years. Poisson multivariable modeling was applied to identify correlates of polypharmacy, and Lexicomp® was used to assess drug-drug interactions. Anatomical Therapeutic Chemical classification was used to describe the pattern of medication use. The prevalence of polypharmacy in individuals without hypertension was 4.7 % (4.2%-5.2 %) vs. 23.7 % (22.1%-25.3 %) in individuals with hypertension (P < 0.001). Individuals with hypertension from middle-high socioeconomic status (SES) had a 1.51-fold higher prevalence of polypharmacy than vs. low SES. Those with more than three comorbidities had a 5.18 times higher prevalence of polypharmacy than those with isolated hypertension. Calcium channel blockers were the most common antihypertensives (20.9 %). In terms of drug-drug interactions, type C interactions were most prevalent among participants with hypertension and polypharmacy (76.0 %). Our findings imply a fairly high prevalence of polypharmacy and drug-drug interactions among individuals with hypertension; to tackle this issue, we recommend a national pharmacovigilance system, training programs for primary care physicians, public education and awareness campaigns, drug-checking campaigns, targeted screenings to alter modifiable risk factors, and the use of safe combination pills.
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Affiliation(s)
- Pooria Zare
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hossein Poustchi
- Liver and Pancreatobiliary Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Mohammadi
- Liver and Pancreatobiliary Disease Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bita Mesgarpour
- Research and Technology, National Institute for Medical Research and Development (NIMAD), Tehran, Iran
| | - Mohammadreza Akbari
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Kamalipour
- Department of Ophthalmology, Hamilton Glaucoma Center, Shiley Eye Institute, University of California, San Diego, CA, USA
| | | | - Elham-Sadat Hashemi
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Arash Ghamar-Shooshtari
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; Ophtalmology Resident of Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Hosseini
- Postdoctoral Researcher, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Malekzadeh
- Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Bazrafshan Drissi
- Department of Cardiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Malekzadeh
- Digestive Diseases Research Center, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Molavi Vardanjani
- MPH Department, School of Medicine, Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Sarkar A, Fanous KI, Marei I, Ding H, Ladjimi M, MacDonald R, Hollenberg MD, Anderson TJ, Hill MA, Triggle CR. Repurposing Metformin for the Treatment of Atrial Fibrillation: Current Insights. Vasc Health Risk Manag 2024; 20:255-288. [PMID: 38919471 PMCID: PMC11198029 DOI: 10.2147/vhrm.s391808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 06/05/2024] [Indexed: 06/27/2024] Open
Abstract
Metformin is an orally effective anti-hyperglycemic drug that despite being introduced over 60 years ago is still utilized by an estimated 120 to 150 million people worldwide for the treatment of type 2 diabetes (T2D). Metformin is used off-label for the treatment of polycystic ovary syndrome (PCOS) and for pre-diabetes and weight loss. Metformin is a safe, inexpensive drug with side effects mostly limited to gastrointestinal issues. Prospective clinical data from the United Kingdom Prospective Diabetes Study (UKPDS), completed in 1998, demonstrated that metformin not only has excellent therapeutic efficacy as an anti-diabetes drug but also that good glycemic control reduced the risk of micro- and macro-vascular complications, especially in obese patients and thereby reduced the risk of diabetes-associated cardiovascular disease (CVD). Based on a long history of clinical use and an excellent safety record metformin has been investigated to be repurposed for numerous other diseases including as an anti-aging agent, Alzheimer's disease and other dementias, cancer, COVID-19 and also atrial fibrillation (AF). AF is the most frequently diagnosed cardiac arrythmia and its prevalence is increasing globally as the population ages. The argument for repurposing metformin for AF is based on a combination of retrospective clinical data and in vivo and in vitro pre-clinical laboratory studies. In this review, we critically evaluate the evidence that metformin has cardioprotective actions and assess whether the clinical and pre-clinical evidence support the use of metformin to reduce the risk and treat AF.
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Affiliation(s)
- Aparajita Sarkar
- Department of Medical Education, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Kareem Imad Fanous
- Department of Medical Education, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Isra Marei
- Department of Pharmacology & Medical Education, Weill Cornell Medicine- Qatar, Doha, Qatar
| | - Hong Ding
- Department of Pharmacology & Medical Education, Weill Cornell Medicine- Qatar, Doha, Qatar
| | - Moncef Ladjimi
- Department of Biochemistry & Medical Education, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Ross MacDonald
- Health Sciences Library, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Morley D Hollenberg
- Department of Physiology & Pharmacology, and Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd J Anderson
- Department of Cardiac Sciences and Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michael A Hill
- Dalton Cardiovascular Research Center & Department of Medical Pharmacology & Physiology, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - Chris R Triggle
- Department of Pharmacology & Medical Education, Weill Cornell Medicine- Qatar, Doha, Qatar
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Stojadinovic M, Lausevic M, Milosevic IA, Zaric RZ, Jemcov TK, Komadina L, Petrovic DS, Djuric P, Bulatovic A, Jakovljevic S, Jankovic S. Risk Factors for Potential Drug-Drug Interactions in Patients on Chronic Peritoneal Dialysis. Pharmacology 2024; 109:147-155. [PMID: 38432197 DOI: 10.1159/000537968] [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: 12/19/2023] [Accepted: 02/19/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION The prevalence of potential drug-drug interactions (pDDIs) is becoming a major safety concern, as it has been previously linked to a significant number of adverse drug events and could have serious consequences for patients, including death. This is especially relevant for patients with chronic renal failure, as they are particularly vulnerable to drug-drug interactions. The aim of this study was to evaluate the prevalence and associated factors of pDDIs in patients receiving chronic peritoneal dialysis. METHODS An observational, cross-sectional study was conducted on consecutive peritoneal dialysis patients attending four tertiary care hospitals for regular monthly examination. The primary outcome was the number of pDDIs identified using Lexicomp. Potential predictors were determined using multiple linear regression. RESULTS Total number of patients included in the study was 140. The results showed that pDDIs were highly prevalent, especially in patients who use antiarrhythmics (p = 0.001), have diabetes mellitus (p = 0.001), recently started peritoneal dialysis (p = 0.003), or have higher number of prescribed drugs (p < 0.001). Number of prescribed drugs (p < 0.001) remained a significant predictor of high-risk pDDIs in addition to the female gender (p = 0.043). CONCLUSION Clinicians should be particularly cautious when prescribing multiple medications to high-risk patients, such as peritoneal dialysis patients, to mitigate the risk of drug-drug interactions and associated adverse health outcomes.
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Affiliation(s)
- Milorad Stojadinovic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Mirjana Lausevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
- Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Iman Assi Milosevic
- Department of Nephrology, University Clinical Center of Serbia, Belgrade, Serbia
| | | | - Tamara Kosta Jemcov
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Ljiljana Komadina
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zemun, Belgrade, Serbia
| | - Dejan Slavko Petrovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Nephrology, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Petar Djuric
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Ana Bulatovic
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Hospital Centre Zvezdara, Belgrade, Serbia
| | - Stefan Jakovljevic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Surgery, University Clinical Center of Kragujevac, Kragujevac, Serbia
| | - Slobodan Jankovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
- Department of Clinical Pharmacology, University Clinical Center of Kragujevac, Kragujevac, Serbia
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Sivadas A, Sahana S, Jolly B, Bhoyar RC, Jain A, Sharma D, Imran M, Senthivel V, Divakar MK, Mishra A, Mukhopadhyay A, Gibson G, Narayan KV, Sivasubbu S, Scaria V, Kurpad AV. Landscape of pharmacogenetic variants associated with non-insulin antidiabetic drugs in the Indian population. BMJ Open Diabetes Res Care 2024; 12:e003769. [PMID: 38471670 PMCID: PMC10936492 DOI: 10.1136/bmjdrc-2023-003769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Genetic variants contribute to differential responses to non-insulin antidiabetic drugs (NIADs), and consequently to variable plasma glucose control. Optimal control of plasma glucose is paramount to minimizing type 2 diabetes-related long-term complications. India's distinct genetic architecture and its exploding burden of type 2 diabetes warrants a population-specific survey of NIAD-associated pharmacogenetic (PGx) variants. The recent availability of large-scale whole genomes from the Indian population provides a unique opportunity to generate a population-specific map of NIAD-associated PGx variants. RESEARCH DESIGN AND METHODS We mined 1029 Indian whole genomes for PGx variants, drug-drug interaction (DDI) and drug-drug-gene interactions (DDGI) associated with 44 NIADs. Population-wise allele frequencies were estimated and compared using Fisher's exact test. RESULTS Overall, we found 76 known and 52 predicted deleterious common PGx variants associated with response to type 2 diabetes therapy among Indians. We report remarkable interethnic differences in the relative cumulative counts of decreased and increased response-associated alleles across NIAD classes. Indians and South Asians showed a significant excess of decreased metformin response-associated alleles compared with other global populations. Network analysis of shared PGx genes predicts high DDI risk during coadministration of NIADs with other metabolic disease drugs. We also predict an increased CYP2C19-mediated DDGI risk for CYP3A4/3A5-metabolized NIADs, saxagliptin, linagliptin and glyburide when coadministered with proton-pump inhibitors (PPIs). CONCLUSIONS Indians and South Asians have a distinct PGx profile for antidiabetes drugs, marked by an excess of poor treatment response-associated alleles for various NIAD classes. This suggests the possibility of a population-specific reduced drug response in atleast some NIADs. In addition, our findings provide an actionable resource for accelerating future diabetes PGx studies in Indians and South Asians and reconsidering NIAD dosing guidelines to ensure maximum efficacy and safety in the population.
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Affiliation(s)
- Ambily Sivadas
- St John's Research Institute, Bangalore, Karnataka, India
| | - S Sahana
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Bani Jolly
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhinav Jain
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Disha Sharma
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Mohamed Imran
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vigneshwar Senthivel
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Anushree Mishra
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | | | - Greg Gibson
- Georgia Institute of Technology, Atlanta, Georgia, USA
| | | | - Sridhar Sivasubbu
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
| | - Vinod Scaria
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, India
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Subbiah U, Ajith A, Venkata Subbiah H. Molecular docking and dynamics simulation of Orthosiphon stamineus against SGLT1 and SGLT2. J Biomol Struct Dyn 2023; 41:13663-13678. [PMID: 36995112 DOI: 10.1080/07391102.2023.2193984] [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: 08/13/2022] [Accepted: 02/06/2023] [Indexed: 03/31/2023]
Abstract
Orthosiphon stamineus Benth a traditional medicine used in the treatment of diabetes and kidney diseases. Sodium-glucose co-transporter (SGLT1 and SGLT2) inhibitors are the novel group of drugs used to treat patients with type 2 diabetes mellitus. In this study 20 phytochemical compounds from Orthosiphon stamineus Benth were obtained from 3 databases viz Dr.Duke's phytochemical, Ethno botanical database and IMPPAT. They were subjected to physiochemical, drug likeliness, and ADMET and toxicity predictions. Homology modeling and molecular docking against SGLT1 and SGLT2 were performed and the stability of the selected drug molecule was validated by molecular dynamic (MD) simulation for 200 ns. Among the 20 compounds, 14-Dexo-14-O-acetylorthosiphol Y alone showed higher binding affinity with SGLT1 and SGLT2 protein with the binding energy of -9.6 and -11.4 Kcal/mol respectively and had highest affinity towards SGLT2 inhibitor. This compound also satisfied Lipinski rule of 5 and had a good ADMET profile. The compound is non-toxic to marine organisms and to normal cell lines and non-mutagenic. The RMSD value attained equilibrium at 150 ns with the stability around 4.8 Å and no significant deviation was reported from 160 to 200 ns for SGLT2. Our study suggests that 14-Dexo-14-O-acetylorthosiphol Y showed promising results against the SGLT2 and could be considered as a potent anti-diabetic drug.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Usha Subbiah
- Human Genetics Research Centre, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Athira Ajith
- Human Genetics Research Centre, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Harini Venkata Subbiah
- Human Genetics Research Centre, Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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CLInical Profile and Side Effects of chronic use of oral Amiodarone in cardiology outpatients department (CLIPSE-A Study)- A prospective observational study. Ann Med Surg (Lond) 2022; 80:104167. [PMID: 36045807 PMCID: PMC9422214 DOI: 10.1016/j.amsu.2022.104167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/08/2022] [Accepted: 07/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Amiodarone belongs to Class-III anti-arrhythmic drugs. It is one of the most effective anti-arrhythmic drugs used to treat or prevent several types of arrhythmias including atrial fibrillation, atrial flutter, ventricular tachycardia, and wide complex tachycardia, but unfortunately carries a high toxicity profile. Also, side effects of amiodarone involving various organs can be life-threatening. Materials & methods This was an observational study carried out for six months i.e from April to September. The study included patients who are on amiodarone for greater than or equal to six months. The required data was collected in-person from the case sheets, treatment charts, and by interviewing the patients. The data for 67 patients was documented in suitable data collection form for analysis. Results From our study data, it was noted that amiodarone was used for 3 different indications-atrial fibrillation, atrial flutter, and ventricular tachycardia. Among 67 patients enrolled, 38 had no side-effects. Side-effects data in the rest grouped basing on the organ system affected: 9 patients had renal effects, 6 patients had ophthalmic effects, 4 patients had endocrine effects, and 5 patients had hepatic effects. Conclusion From our study, it is concluded that amiodarone is a safe and effective anti-arrhythmic drug at lower doses i.e. 200-1100 mg/week. When treated in lower doses of 1400–2800 mg/week, many side effects have been incident. Although these effects are mild and develop only after prolonged usage of the drug, it should be used judiciously. Amiodarone has an unusual spectrum of side effects with a prevalence of 15% in the first year, increasing up to 50% during long-term use. Our study demonstrated amiodarone does not produce significant side-effects when used in doses of 200–1100 mg/week. Few side-effects are observed when amiodarone is used in higher doses of 1200–2800 mg/week. When a side-effect is observed, mere reducing the dose or withdrawal of drug might help. In most of the cases of atrial fibrillation, amiodarone is discontinued or altered in first year of treatment basing on risk/benefit ratio.
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Patnaik N, Mishra KG, Pradhan NR. Evaluation of Serum Testosterone Levels Following Three Months of SA3X (Spilanthes acmella) Supplementation. Cureus 2022; 14:e26236. [PMID: 35898380 PMCID: PMC9308386 DOI: 10.7759/cureus.26236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction: Low testosterone is usually associated with erectile dysfunction (ED). SA3X (Spilanthes acmella) has proven to be effective in alleviating symptoms of ED, which could be due to an alteration in serum testosterone levels. This study was carried out to evaluate the change in testosterone levels in participants with ED supplemented with SA3X for three months. Materials and Methods: A group of 326 sexually active men aged 25-60 years was investigated from November 2021 to May 2022 in Hyderabad. The participants were subjected to supplementation with SA3X capsules for three months, and a follow-up was done at the end of six months with serum testosterone assessment in each visit. The change in testosterone level was assessed using a mixed model repeated measures analysis. Results: A significant increase was observed in the mean serum testosterone levels by the end of the second month (323.91 ± 13.76 ng/dL vs. 309.84 ± 14.11 ng/dL; p=0.03) and third month (332.27 ± 12.85 ng/dL vs. 309.84 ± 14.11 ng/dL; p<0.01) of SA3X therapy. The adjusted mean change in testosterone levels was found to be 22.43 ng/dL at the end of the three-month therapy. It was also observed that the change in testosterone levels was significantly lower in participants having diabetes mellitus, hypercholesterolemia, and a history of substance abuse. However, participants on phosphodiesterase-5 inhibitors had an increased change in testosterone levels. Conclusion: Supplementation with SA3X capsules for three months increases the serum testosterone levels. However, causality cannot be ascertained owing to the longitudinal nature of the study, and further controlled trials are required for the same.
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Chiosi F, Rinaldi M, Campagna G, Manzi G, De Angelis V, Calabrò F, D’Andrea L, Tranfa F, Costagliola C. Effect of a Fixed Combination of Curcumin, Artemisia, Bromelain, and Black Pepper Oral Administration on Optical Coherence Tomography Angiography Indices in Patients with Diabetic Macular Edema. Nutrients 2022; 14:nu14071520. [PMID: 35406133 PMCID: PMC9002511 DOI: 10.3390/nu14071520] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 02/01/2023] Open
Abstract
Background: To investigate the effects of a fixed combination of Curcumin (200 mg), Artemisia (80 mg), Bromelain (80 mg), and Black pepper (2 mg) on vascular parameters in mild to moderate diabetic macular edema (DME). Design: Prospective, case-control study. Methods: Fifty-six patients affected by diabetes mellitus type II were enrolled in the study. Twenty-eight patients with DME received 2 tablets/day, before meals of a dietary complementary supplement containing in fixed combination Curcumin (200 mg), Artemisia (80 mg), Bromelain (80 mg), and Black pepper (2 mg) (Intravit®, OFFHEALTH Spa, Firenze, Italy) for 6 months. Twenty-eight age-matched subjects affected by diabetes mellitus type II were given placebo and served as control group. Patients underwent best correct visual acuity (BCVA), swept optical coherence tomography (OCT), and OCT-Angiography (OCTA). OCTA images of the superficial capillary plexus (SCP) and deep capillary plexus (DCP) were obtained for each eye. By the end of the follow-up patients were defined responder to the therapy when a decrease of more than 30 μm was registered in central retinal thickness (CRT) measurement, while a poor responder was determined by the absence of reduction or an increase in central retinal thickness at 6 months. We assessed the foveal avascular zone (FAZ) area, vessel density and quantified the number of microaneurysms in each layer. Results: A significant improvement of BCVA and CRT reduction was recorded at 6 months follow-up in the dietary complementary supplementation group compared to control (respectively p = 0.028 and p = 0.0003). VD of the total capillary plexus, microaneurysms count, glycaemia and HbA1c did not vary over the follow-up period between groups. Within the Intravit® group, poor responders tended to show a larger FAZ area, more microaneurysms, and a lower VD in the DCP compared to the good responders group (p < 0.0001). Conclusions: A fixed combination of Curcumin, Artemisia, Bromelain, and Black pepper oral administration may have a positive impact on central retinal thickness, visual acuity, and VD of the DCP in compensated type 2 diabetic patients with mild DME.
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Affiliation(s)
- Flavia Chiosi
- Department of Ophthalmology, Monaldi Hospital, Azienda Ospedaliera dei Colli Via Leonardo Bianchi, 8013 Napoli, Italy;
- Correspondence: ; Tel.: +39-339-5333929; Fax: +39-0817064209
| | - Michele Rinaldi
- Department of Ophthalmology, University of Campania “Luigi Vanvitelli”, 80100 Napoli, Italy;
| | - Giuseppe Campagna
- Department of Medical-Surgical Sciences and Translational Medicine, University of Rome “La Sapienza”, 00161 Roma, Italy;
| | - Gianluigi Manzi
- Department of Ophthalmology, Monaldi Hospital, Azienda Ospedaliera dei Colli Via Leonardo Bianchi, 8013 Napoli, Italy;
| | - Vincenzo De Angelis
- Eye Clinic, Azienda Ospedaliera A. Cardarelli, 80131 Naples, Italy; (V.D.A.); (F.C.)
| | - Francesco Calabrò
- Eye Clinic, Azienda Ospedaliera A. Cardarelli, 80131 Naples, Italy; (V.D.A.); (F.C.)
| | - Luca D’Andrea
- Eye Clinic, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Napoli “Federico II”, 80138 Napoli, Italy; (L.D.); (F.T.); (C.C.)
| | - Fausto Tranfa
- Eye Clinic, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Napoli “Federico II”, 80138 Napoli, Italy; (L.D.); (F.T.); (C.C.)
| | - Ciro Costagliola
- Eye Clinic, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Napoli “Federico II”, 80138 Napoli, Italy; (L.D.); (F.T.); (C.C.)
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Rujanapun N, Jaidee W, Duangyod T, Phuneerub P, Paojumroom N, Maneerat T, Pringpuangkeo C, Ramli S, Charoensup R. Special Thai Oolong Tea: Chemical Profile and In Vitro Antidiabetic Activities. Front Pharmacol 2022; 13:797032. [PMID: 35321328 PMCID: PMC8936575 DOI: 10.3389/fphar.2022.797032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/04/2022] [Indexed: 12/03/2022] Open
Abstract
Special Thai oolong tea is oolong tea (Camellia sinensis (L.) Kuntze) steamed with selected Thai botanical drugs. Oolong tea steamed with ginger (Zingiber officinale), lemongrass (Cymbopogon citratus), and celery (Anathallis graveolens L.) is called eternity tea (EN), whereas peaceful rest (PR) tea is made of oolong tea leaves steamed with Indian gooseberry (Phyllanthus emblica), Turkey berry (Solanum torvum), and wild betel leaf bush leaves (Piper sarmentosum). Oolong tea is known for its numerous biological activities including antidiabetic properties. However, the effect of the additional botanical drugs on the biological activities of special oolong teas has not yet been explored. From the results, the PR extract exhibited the best activity in the in vitro assays relevant to antidiabetic properties such as chemical antioxidant, anti-inflammation, anti-adipogenesis, enzyme inhibition, and glucose uptake and consumption. The UHPLC-QTOF-MS/MS profiles of PR and EN extracts indicated chemical profiles different from oolong tea. For instance, gingerdiol and gingerol were detected in EN, whereas piperettine I was detected in PR. Therefore, it was inferred that among the three tea extracts, the additional compounds in PR contributed to good activities compared to oolong and EN. It is also important to highlight that the PR extract inhibited glucose uptake and consumption by adipocytes and skeletal muscles at concentrations of 500 and 100 μg/ml, respectively, as well as metformin activity (p < 0.05). Findings from this study support the antidiabetic potential of PR tea.
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Affiliation(s)
- Narawadee Rujanapun
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
| | - Wuttichai Jaidee
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
| | - Thidarat Duangyod
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
- School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Pravaree Phuneerub
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
- School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
| | - Napassawan Paojumroom
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
| | - Tharakorn Maneerat
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
- Center of Chemical Innovation for Sustainability, School of Science, Mae Fah Luang University, Chiang Rai, Thailand
| | | | - Salfarina Ramli
- Faculty of Pharmacy, Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
- Interactive Pharmacogenomics Institute (iPROMISE), Universiti Teknologi MARA Cawangan Selangor, Selangor, Malaysia
| | - Rawiwan Charoensup
- Medicinal Plant Innovation Center of Mae Fah Luang University, Mae Fah Luang University, Chiang Rai, Thailand
- School of Integrative Medicine, Mae Fah Luang University, Chiang Rai, Thailand
- *Correspondence: Rawiwan Charoensup,
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10
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Wang Y, Karmakar T, Ghosh N, Basak S, Gopal Sahoo N. Targeting mangiferin loaded N-succinyl chitosan-alginate grafted nanoparticles against atherosclerosis - A case study against diabetes mediated hyperlipidemia in rat. Food Chem 2022; 370:131376. [PMID: 34662793 DOI: 10.1016/j.foodchem.2021.131376] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 01/01/2023]
Abstract
Mangiferin (MGF), from Mangifera indica is well reported for its hypoglycemic activity and hypolipidemic activity. However, MGF suffers therapeutic limitation due to poor solubility causing disparaging bioavailability. Herein to address this problem, we have incorporated MGF in alginate grafted N-succinylated chitosan (NSC) nanomatrix. Characterization by molecular docking, FT-IR and 2D-NMR (COSY) has revealed that MGF could reinforce interaction with NSC. The OH and CH2OH groups of MGF may set interactions with pyranosic OH, CH2OH, NH2 (or NH-succinyl and COOH-succinyl) of NSC. The NSC-MGF nanoconjugate revealed a spherical particle geometry of 100 ∼ 200 nm size. The encapsulated MGF showed 100% release in vitro. In vivo, NSC-MGF nanoconjugate revealed blood glucose lowering from 300 mg/dL to ∼ 90 mg/dL as well as ∼ 37% lowering of total plasma cholesterol. This is well comparative to the earlier reports which acknowledged only 1 ∼ 36% lowering of plasma cholesterol with MGF. Furthermore, NSC-MGF lowered serum trigyceride to ∼ 61%, while in earlier studies, only 10 ∼ 40% serum triglycerides reduction was found with solitary MGF.
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Affiliation(s)
- Ying Wang
- Ophthalmology and Otorhinolaryngology, Xi 'an No. 3 Hospital, Xi'an, Shaanxi 710018, China
| | - Tanushree Karmakar
- Dr. B.C. Roy College of Pharmacy & Allied Health Sciences, Durgapur, WB, India
| | - Nilanjan Ghosh
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata, West Bengal, India
| | - Souvik Basak
- Dr. B.C. Roy College of Pharmacy & Allied Health Sciences, Durgapur, WB, India.
| | - Nanda Gopal Sahoo
- Department of Chemistry, Kumaun University, D.S.B. Campus, Nainital, Uttrakhand, India.
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11
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Cottura N, Kinvig H, Grañana-Castillo S, Wood A, Siccardi M. Drug-Drug Interactions in People Living with HIV at Risk of Hepatic and Renal Impairment: Current Status and Future Perspectives. J Clin Pharmacol 2022; 62:835-846. [PMID: 34990024 PMCID: PMC9304147 DOI: 10.1002/jcph.2025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/03/2022] [Indexed: 11/10/2022]
Abstract
Despite the advancement of antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV), drug–drug interactions (DDIs) remain a relevant clinical issue for people living with HIV receiving ART. Antiretroviral (ARV) drugs can be victims and perpetrators of DDIs, and a detailed investigation during drug discovery and development is required to determine whether dose adjustments are necessary or coadministrations are contraindicated. Maintaining therapeutic ARV plasma concentrations is essential for successful ART, and changes resulting from potential DDIs could lead to toxicity, treatment failure, or the emergence of ARV‐resistant HIV. The challenges surrounding DDI management are complex in special populations of people living with HIV, and often lack evidence‐based guidance as a result of their underrepresentation in clinical investigations. Specifically, the prevalence of hepatic and renal impairment in people living with HIV are between five and 10 times greater than in people who are HIV‐negative, with each condition constituting approximately 15% of non‐AIDS‐related mortality. Therapeutic strategies tend to revolve around the treatment of risk factors that lead to hepatic and renal impairment, such as hepatitis C, hepatitis B, hypertension, hyperlipidemia, and diabetes. These strategies result in a diverse range of potential DDIs with ART. The purpose of this review was 2‐fold. First, to summarize current pharmacokinetic DDIs and their mechanisms between ARVs and co‐medications used for the prevention and treatment of hepatic and renal impairment in people living with HIV. Second, to identify existing knowledge gaps surrounding DDIs related to these special populations and suggest areas and techniques to focus upon in future research efforts.
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Affiliation(s)
- Nicolas Cottura
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Hannah Kinvig
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | | | - Adam Wood
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Marco Siccardi
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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12
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Dardano A, Aragona M, Daniele G, Miccoli R, Del Prato S. Efficacy of Dulaglutide in a Patient With Type 2 Diabetes, High Cardiovascular Risk, and HIV: A Case Report. Front Endocrinol (Lausanne) 2022; 13:847778. [PMID: 35295985 PMCID: PMC8918572 DOI: 10.3389/fendo.2022.847778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a common comorbidity in people living with HIV (PLWH). Anti-hyperglycemic treatment in PLWH is still a challenge, and no randomized controlled studies using new glucose-lowering agents are currently available. CASE DESCRIPTION A 55-year-old-women was admitted to our Diabetes Unit because of hyperosmolar hyperglycemic state (HHS) and sepsis. The medical history included HIV infection and insulin-treated diabetes. On clinical examination, the lady appeared dehydrated with dry buccal mucosa, tachycardia, altered mental status, genital infection, and fever. On admission, plasma glucose was 54.5 mmol/L, HbA1c 155 mmol/mol, osmolarity 389.4 mOsm/kg, bicarbonate 24.6 mmol/L with no detectable serum ketones. The patient was treated with i.v. fluid and insulin, and antibiotic therapy commenced. Upon HHS and sepsis resolution, a basal-bolus insulin therapy was implemented that was followed by significant improvement of daily glucose profiles and progressive reduction of insulin requirement until complete discontinuation. A low dose of metformin plus linagliptin was started. Since a severe atherosclerotic disease was diagnosed, a GLP-1 receptor agonist, dulaglutide, was added to metformin upon linagliptin withdrawal with maintenance of good glycemic control, treatment adherence and amelioration of quality of life and no side effects. CONCLUSION This case suggests that GLP-1 receptor agonist therapy may be effective and safe for treatment of T2D with high cardiovascular risk in PLWH, supporting the need of clinical trials directly assessing the safety and the efficacy of GLP-1 receptor agonist in these individuals.
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Affiliation(s)
- Angela Dardano
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Angela Dardano,
| | - Michele Aragona
- Section of Metabolic Diseases & Diabetes, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Giuseppe Daniele
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Miccoli
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Department of Clinical & Experimental Medicine, University of Pisa, Pisa, Italy
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Chandarana CV, Roy S. Comprehensive Review on Neuro-degenerative Type 3 DM. Curr Diabetes Rev 2022; 18:e131221198790. [PMID: 34961464 DOI: 10.2174/1573399818666211213103624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/28/2021] [Accepted: 10/11/2021] [Indexed: 11/22/2022]
Abstract
According to research, Alzheimer's disease (AD) is considered a metabolic illness caused by defective insulin signaling, insulin resistance, and low insulin levels in the brain. Type 3 diabetes has been postulated for AD because reduced insulin signaling has molecular and physiological consequences that are comparable to type I and type 2 diabetes mellitus, respectively. The similarities between type 2 diabetes and Alzheimer's disease suggest that these clinical trials might yield therapeutic benefits. However, it is important to note that lowering your risk of Alzheimer's dementia, whether you have diabetes or not, is still a multidimensional process involving factors like exercise, smoking, alcohol, food, and mental challenges. The current aim is to show that the relationship between T3D and AD is based on both the processing of amyloid-β (Aβ) precursor protein toxicity and the clearance of Aβ, which are the results of impaired insulin signaling. The brain's metabolism, with its high lipid content and energy needs, places excess demands on mitochondria and appears more susceptible to oxidative damage than the rest of the body. Current data suggests that increased oxidative stress relates to amyloid-β (Aβ) pathology and the onset of AD.
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Affiliation(s)
- Chandani V Chandarana
- Department of Pharmaceutical Quality Assurance, SSR College of Pharmacy, Sayli, Silvassa-396230, India
| | - Salona Roy
- SSR College of Pharmacy, Silvassa, India
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14
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Pilla SJ, Pitts SI, Maruthur NM. High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. J Patient Saf 2022; 18:e217-e224. [PMID: 32569099 DOI: 10.1097/pts.0000000000000739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Sulfonylureas, the second most common oral diabetes treatment, have interactions with antimicrobials that substantially increase the risk of hypoglycemia. The objectives of this study are to quantify the concurrent use of sulfonylureas and interacting antimicrobial in U.S. ambulatory care and to examine whether interacting antimicrobials are used for an appropriate indication. METHODS We analyzed the 2006-2016 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual probability samples of visits to U.S. office-based physicians. We determined nationally representative estimates of visits for adults with concurrent use of sulfonylureas and 7 antimicrobials with established interactions. We examined whether visit diagnoses included appropriate indications for antibiotics according to national guidelines. RESULTS There were 2.5 million visits per year (95% confidence interval [CI] 2.2-2.9) in which sulfonylureas were used with systemic antimicrobials, of which 1 million (95% CI, 0.8-1.2) or 38.0% (95% CI, 32.3%-44.0%) were interacting antimicrobials. Sulfonylurea users had similar odds of interacting antimicrobial use as patients using diabetes medications without antimicrobial interactions (adjusted odds ratio, 1.07; 95% CI, 0.82-1.40). The most common interacting antimicrobials used with sulfonylureas were fluoroquinolones, accounting for 59.9% (95% CI, 50.7%-68.2%) of antimicrobials, and sulfamethoxazole-trimethoprim, accounting for 21.1% (95% CI, 14.8%-29.2%). There was no appropriate antibiotic indication in 69.7% (95% CI, 55.2%-81.1) of visits with interacting antibiotic use. CONCLUSIONS Sulfonylureas and antimicrobials with potentially hazardous interactions are frequently used together. To reduce resultant hypoglycemic events, there is a need for interventions to increase physician awareness and promote antibiotic stewardship.
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Risk Factors for the Occurrence of Potential Drug-Drug Interactions in Surgical Patients. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background: Drug-drug interactions are defined as modifications of the drug action that result from the simultaneous administration of another individual drug or several drugs. Nowadays, potential drug-drug interactions (DDIs) are most frequently detected and analyzed using personal digital assistant software programs (online interaction checker tools).
Objective: To determine the risk factors for the emergence of all drug-drug interactions in surgical patients with particular emphasis on clinically significant interactions.
Patients and methods: This was a retrospective cohort analysis of patients treated at the Surgical Clinic of the Clinical Center Kragujevac. Three interaction checkers were used to reveal drug-drug interactions: Medscape, Epocrates and Micromedex.
Results: The study included total of 200 patients, aged 58.54±17.08 years. Average number of drug-drug interactions per patient was between 10.50±9.10 (Micromedex) and 18.75±17.14 (Epocrates). Number of prescribed drugs, antidepressive therapy, antiarrhythmic therapy, number of pharmacological/therapeutic subgroups (2nd level of ATC classification) prescribed, delirium or dementia, diabetes, heart failure, and number of physicians who prescribed drugs to single patient were identified as risk factors for drug-drug interactions while length of hospitalization in days and age of patient in years emerged as protective factors.
Conclusion: Drug-drug interactions are relatively common in surgical patients and predisposed by factors such as number of prescribed drugs or drug group per patient, number of physicians who prescribed drugs, antidepressive therapy, antiarrhythmic therapy, presence of delirium or dementia, diabetes and heart failure. On the other hand, prolonged hospitalization and higher age are factors that reduce the risk of interactions in surgical patients.
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16
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In Vitro Investigation of Binding Interactions between Albumin–Gliclazide Model and Typical Hypotensive Drugs. Int J Mol Sci 2021; 23:ijms23010286. [PMID: 35008711 PMCID: PMC8745505 DOI: 10.3390/ijms23010286] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/20/2021] [Accepted: 12/26/2021] [Indexed: 11/26/2022] Open
Abstract
Type 2 diabetes management usually requires polytherapy, which increases the risk of drug-to-drug interactions. Among the multiple diabetes comorbidities, hypertension is the most prevalent. This study aimed to investigate the binding interactions between the model protein, bovine albumin, and the hypoglycemic agent gliclazide (GLICL) in the presence of typical hypotensive drugs: quinapril hydrochloride (QUI), valsartan (VAL), furosemide (FUR), amlodipine besylate (AML), and atenolol (ATN). Spectroscopic techniques (fluorescence quenching, circular dichroism) and thermodynamic experiments were employed. The binding of the gliclazide to the albumin molecule was affected by the presence of an additional drug ligand, which was reflected by the reduced binding constant of the BSA–DRUG–GLICL system. This may indicate a possible GLICL displacement and its enhanced pharmacological effect, as manifested in clinical practice. The analysis of the thermodynamic parameters indicated the spontaneity of the reaction and emphasized the role of hydrogen bonding and van der Waals forces in these interactions. The secondary structure of the BSA remained almost unaffected.
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17
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Bitew M, Desalegn T, Demissie TB, Belayneh A, Endale M, Eswaramoorthy R. Pharmacokinetics and drug-likeness of antidiabetic flavonoids: Molecular docking and DFT study. PLoS One 2021; 16:e0260853. [PMID: 34890431 PMCID: PMC8664201 DOI: 10.1371/journal.pone.0260853] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Computer aided toxicity and pharmacokinetic prediction studies attracted the attention of pharmaceutical industries as an alternative means to predict potential drug candidates. In the present study, in-silico pharmacokinetic properties (ADME), drug-likeness, toxicity profiles of sixteen antidiabetic flavonoids that have ideal bidentate chelating sites for metal ion coordination were examined using SwissADME, Pro Tox II, vNN and ADMETlab web tools. Density functional theory (DFT) calculations were also employed to calculate quantum chemical descriptors of the compounds. Molecular docking studies against human alpha amylase were also conducted. The results were compared with the control drugs, metformin and acarbose. The drug-likeness prediction results showed that all flavonoids, except myricetin, were found to obey Lipinski's rule of five for their drug like molecular nature. Pharmacokinetically, chrysin, wogonin, genistein, baicalein, and apigenin showed best absorption profile with human intestinal absorption (HIA) value of ≥ 30%, compared to the other flavonoids. Baicalein, butein, ellagic acid, eriodyctiol, Fisetin and quercetin were predicted to show carcinogenicity. The flavonoid derivatives considered in this study are predicted to be suitable molecules for CYP3A probes, except eriodyctiol which interacts with P-glycoprotein (p-gp). The toxicological endpoints prediction analysis showed that the median lethal dose (LD50) values range from 159-3919 mg/Kg, of which baicalein and quercetin are found to be mutagenic whereas butein is found to be the only immunotoxin. Molecular docking studies showed that the significant interaction (-7.5 to -8.3 kcal/mol) of the studied molecules in the binding pocket of the α-amylase protein relative to the control metformin with the crucial amino acids Asp 197, Glu 233, Asp 197, Glu 233, Trp 59, Tyr 62, His 101, Leu 162, Arg 195, His 299 and Leu 165. Chrysin was predicted to be a ligand with high absorption and lipophilicity with 84.6% absorption compared to metformin (78.3%). Moreover, quantum chemical, ADMET, drug-likeness and molecular docking profiles predicted that chrysin is a good bidentate ligand.
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Affiliation(s)
- Mamaru Bitew
- Department of Applied Chemistry, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
| | - Tegene Desalegn
- Department of Applied Chemistry, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
| | - Taye B. Demissie
- Department of Chemistry, University of Botswana, Gaborone, Botswana
| | - Anteneh Belayneh
- Department of Pharmacy, College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Milkyas Endale
- Department of Applied Chemistry, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
| | - Rajalakshmanan Eswaramoorthy
- Department of Applied Chemistry, School of Applied Natural Science, Adama Science and Technology University, Adama, Ethiopia
- Department of Biomaterials, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
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18
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Polypharmacy in the Management of Arterial Hypertension-Friend or Foe? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121288. [PMID: 34946233 PMCID: PMC8705955 DOI: 10.3390/medicina57121288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
Background and Objectives: Polypharmacy is associated with drug-drug or food-drug interactions that may pose treatment difficulties. The objective of the study was to investigate the use of polypharmacy in hypertensive patients hospitalized in the Internal Medicine Clinic of a European referral hospital. Materials and Methods: We conducted a retrospective chart review study on patients identified by a database search of discharge diagnoses to assess the use of polypharmacy and identify potential drug-drug and food-drug interactions. Results: In total, 166 hypertensive patients (68.46 ± 12.70 years, range 42-94 years) were compared to 83 normotensive subjects (67.82 ± 14.47 years, range 22-94 years) who were hospitalized in the clinic during the same period. Polypharmacy was more common in hypertensive versus normotensive subjects (p = 0.007). There were no differences in terms of age, as well as major (0.44 ± 0.77 versus 0.37 ± 0.73 interactions/patient, p = 0.52) and minor (1.25 ± 1.50 versus 1.08 ± 1.84 interactions/patient, p = 0.46) drug-drug interactions between patients with and without hypertension. The mean number of drug-drug interactions (6.55 ± 5.82 versus 4.93 ± 5.59 interactions/patient, p = 0.03), moderate drug-drug interactions (4.94 ± 4.75 versus 3.54 ± 4.17, p = 0.02) and food-drug interactions (2.64 ± 1.29 versus 2.02 ± 1.73, p = 0.00) was higher in patients with hypertension versus their counterparts. Conclusions: The present study reinforces that polypharmacy is a serious concern in hypertensive patients, as reflected by the high number of potentially harmful drug-drug or food-drug interactions. We recorded higher numbers of comorbidities, prescribed drugs, and moderate drug-drug/food-drug interactions in hypertensive versus normotensive patients. A strategy to evaluate the number of discharge medications and reduce drug-drug interactions is essential for the safety of hypertensive patients.
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El-Beltagy AEFBM, Saleh AMB, Attaallah A, Gahnem RA. Therapeutic role of Azadirachta indica leaves ethanolic extract against diabetic nephropathy in rats neonatally induced by streptozotocin. Ultrastruct Pathol 2021; 45:391-406. [PMID: 34720017 DOI: 10.1080/01913123.2021.1988015] [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: 10/19/2022]
Abstract
Diabetic nephropathy (DN) is manifested by chronic loss of renal function due to damage of glomeruli and renal tubules. Therefore, this study is mainly designed to evaluate the therapeutic role of Azadiracta indica (neem) leaves extract as a novel approach for treatment of DN in rats neonatally induced by streptozotocin (STZ). For this study, 40 offspring were selected after parturition and categorized into four groups (n = 10). Group1: control group, group 2: neem leaves extract supplemented group, group 3: diabetic group that injected with a single dose of STZ and group 4: diabetic group treated with neem extract. The results revealed deleterious histological and ultrstructural changes in the renal tissues of diabetic rats. Such changes included atrophied glomeruli, dilated renal cortical tubules and scattered hemorrhage spots, thickening of glomerular basement membrane, expansion of mesangial matrix and pyknotic podocyte. Additionally, the proximal convoluted tubule and distal tubule showed cytoplasmic vacuolation, vacuolated mitochondria, scattered lipid droplets, lost microvilli and disrupted basal lamina and basal infoldings. Moreover, significant decreased levels of serum antioxidants (SOD&CAT) and significant increased levels of serum MDA, urea and creatinine were noticed in diabetic rats. Neem leaves extract successfully alleviated the histological and ultrastructural as well as biochemical changes induced by diabetes.
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Affiliation(s)
| | - Amira M B Saleh
- Zoology Department, Faculty of Science, Damanhur University, Damanhur, Egypt
| | - Amany Attaallah
- Zoology Department, Faculty of Science, Damanhur University, Damanhur, Egypt
| | - Reham A Gahnem
- Oral Biology Department, Faculty of Oral and Dental Medicine, Delta University for Science and Technology, Gamasa, Egypt
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20
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Kittel-Schneider S, Arteaga-Henriquez G, Vasquez AA, Asherson P, Banaschewski T, Brikell I, Buitelaar J, Cormand B, Faraone SV, Freitag CM, Ginsberg Y, Haavik J, Hartman CA, Kuntsi J, Larsson H, Matura S, McNeill RV, Ramos-Quiroga JA, Ribases M, Romanos M, Vainieri I, Franke B, Reif A. Non-mental diseases associated with ADHD across the lifespan: Fidgety Philipp and Pippi Longstocking at risk of multimorbidity? Neurosci Biobehav Rev 2021; 132:1157-1180. [PMID: 34757108 DOI: 10.1016/j.neubiorev.2021.10.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
Several non-mental diseases seem to be associated with an increased risk of ADHD and ADHD seems to be associated with increased risk for non-mental diseases. The underlying trajectories leading to such brain-body co-occurrences are often unclear - are there direct causal relationships from one disorder to the other, or does the sharing of genetic and/or environmental risk factors lead to their occurring together more frequently or both? Our goal with this narrative review was to provide a conceptual synthesis of the associations between ADHD and non-mental disease across the lifespan. We discuss potential shared pathologic mechanisms, genetic background and treatments in co-occurring diseases. For those co-occurrences for which published studies with sufficient sample sizes exist, meta-analyses have been published by others and we discuss those in detail. We conclude that non-mental diseases are common in ADHD and vice versa and add to the disease burden of the patient across the lifespan. Insufficient attention to such co-occurring conditions may result in missed diagnoses and suboptimal treatment in the affected individuals.
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Affiliation(s)
- Sarah Kittel-Schneider
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany; Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany.
| | - Gara Arteaga-Henriquez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Alejandro Arias Vasquez
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Phil Asherson
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Heidelberg University, Medical Faculty Mannheim, Mannheim, Germany
| | - Isabell Brikell
- National Centre for Register-based Research, Department of Economics and Business Economics Aarhus BSS, Aarhus University, Fuglesangs Allé 26, DK-8210 Aarhus V, Aarhus, Denmark; iPSYCH - The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Copenhagen and Aarhus, Denmark; Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Karakter Child and Adolescent Psychiatry University Center, Nijmegen, the Netherlands
| | - Bru Cormand
- Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain; Institut de Biomedicina de la Universitat de Barcelona (IBUB), Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Spain; Institut de Recerca Sant Joan de Déu (IR-SJD), Esplugues de Llobregat, Catalonia, Spain
| | - Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, D-60528 Frankfurt am Main, Germany
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, SE-113 64 Stockholm, Sweden
| | - Jan Haavik
- Bergen Center of Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Postboks 1400, 5021 Bergen, Norway; Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Catharina A Hartman
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), PO Box 30.001, 9700 RB, Groningen, the Netherlands
| | - Jonna Kuntsi
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Box 281, 171 77, Stockholm, Sweden; Örebro University, School of Medical Sciences, Campus USÖ, S-701 82 Örebro, Sweden
| | - Silke Matura
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
| | - Rhiannon V McNeill
- Center of Mental Health, Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain
| | - Marta Ribases
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Universitat Autonoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Departament de Genètica, Microbiologia i Estadística, Facultat de Biologia, Universitat de Barcelona, Catalonia, Spain
| | - Marcel Romanos
- Center of Mental Health, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic Medicine, University Hospital of Würzburg, Margarete-Höppel-Platz 1, D-97080 Würzburg, Germany
| | - Isabella Vainieri
- Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, SE5 8AF, London, UK
| | - Barbara Franke
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Departments of Psychiatry and Human Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Heinrich-Hoffmann-Str. 10, D-60528 Frankfurt am Main, Germany
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21
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Bleasby K, Houle R, Hafey M, Lin M, Guo J, Lu B, Sanchez RI, Fillgrove KL. Islatravir Is Not Expected to Be a Victim or Perpetrator of Drug-Drug Interactions via Major Drug-Metabolizing Enzymes or Transporters. Viruses 2021; 13:1566. [PMID: 34452431 PMCID: PMC8402619 DOI: 10.3390/v13081566] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/16/2021] [Accepted: 07/23/2021] [Indexed: 12/11/2022] Open
Abstract
Islatravir (MK-8591) is a nucleoside reverse transcriptase translocation inhibitor in development for the treatment and prevention of HIV-1. The potential for islatravir to interact with commonly co-prescribed medications was studied in vitro. Elimination of islatravir is expected to be balanced between adenosine deaminase-mediated metabolism and renal excretion. Islatravir did not inhibit uridine diphosphate glucuronosyltransferase 1A1 or cytochrome p450 (CYP) enzymes CYP1A2, 2B6, 2C8, 2C9, 2C19, 2D6, or 3A4, nor did it induce CYP1A2, 2B6, or 3A4. Islatravir did not inhibit hepatic transporters organic anion transporting polypeptide (OATP) 1B1, OATP1B3, organic cation transporter (OCT) 1, bile salt export pump (BSEP), multidrug resistance-associated protein (MRP) 2, MRP3, or MRP4. Islatravir was neither a substrate nor a significant inhibitor of renal transporters organic anion transporter (OAT) 1, OAT3, OCT2, multidrug and toxin extrusion protein (MATE) 1, or MATE2K. Islatravir did not significantly inhibit P-glycoprotein and breast cancer resistance protein (BCRP); however, it was a substrate of BCRP, which is not expected to be of clinical significance. These findings suggest islatravir is unlikely to be the victim or perpetrator of drug-drug interactions with commonly co-prescribed medications, including statins, diuretics, anti-diabetic drugs, proton pump inhibitors, anticoagulants, benzodiazepines, and selective serotonin reuptake inhibitors.
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Affiliation(s)
| | | | | | | | | | | | | | - Kerry L. Fillgrove
- Merck & Co., Inc., Kenilworth, NJ 07033, USA; (K.B.); (R.H.); (M.H.); (M.L.); (J.G.); (B.L.); (R.I.S.)
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22
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Campesi I, Seghieri G, Franconi F. Type 2 diabetic women are not small type 2 diabetic men: Sex-and-gender differences in antidiabetic drugs. Curr Opin Pharmacol 2021; 60:40-45. [PMID: 34325380 DOI: 10.1016/j.coph.2021.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022]
Abstract
Many pieces of evidence have accumulated over time suggesting sex-and-gender differences in type 2 diabetes, the most relevant being the greater excess risk of cardiovascular diseases in women with diabetes than in men. Drugs available for the treatment of diabetes have, meanwhile, increased in number and effectiveness over the last 20 years. Nonetheless, overall metabolic control of diabetes continues to be suboptimal, with a clear further disadvantage for women. Moreover, old and new glucose-lowering drugs present some sex-and-gender differences, although women continue to be underrepresented in all cardiovascular outcome trials testing their efficacy and protective effects. We conclude that pharmacology should wear gender glasses starting from preclinical research to overcome all these gender gaps.
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Affiliation(s)
- Ilaria Campesi
- Dipartimento di Scienze Biomediche, Università degli Studi di Sassari, 07100, Sassari, Italy; Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy.
| | | | - Flavia Franconi
- Laboratorio Nazionale di Farmacologia e Medicina di Genere, Istituto Nazionale Biostrutture Biosistemi, 07100, Sassari, Italy
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23
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Wiglusz K, Żurawska-Płaksej E, Rorbach-Dolata A, Piwowar A. How Does Glycation Affect Binding Parameters of the Albumin-Gliclazide System in the Presence of Drugs Commonly Used in Diabetes? In Vitro Spectroscopic Study. Molecules 2021; 26:molecules26133869. [PMID: 34202801 PMCID: PMC8270297 DOI: 10.3390/molecules26133869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022] Open
Abstract
In this research, the selected drugs commonly used in diabetes and its comorbidities (gliclazide, cilazapril, atorvastatin, and acetylsalicylic acid) were studied for their interactions with bovine serum albumin-native and glycated. Two different spectroscopic methods, fluorescence quenching and circular dichroism, were utilized to elucidate the binding interactions of the investigational drugs. The glycation process was induced in BSA by glucose and was confirmed by the presence of advanced glycosylation end products (AGEs). The interaction between albumin and gliclazide, with the presence of another drug, was confirmed by calculation of association constants (0.11-1.07 × 104 M-1). The nature of changes in the secondary structure of a protein depends on the drug used and the degree of glycation. Therefore, these interactions may have an influence on pharmacokinetic parameters.
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Affiliation(s)
- Katarzyna Wiglusz
- Department of Analytical Chemistry, Wroclaw Medical University, Borowska 211, PL-50556 Wrocław, Poland;
| | - Ewa Żurawska-Płaksej
- Department of Toxicology, Wroclaw Medical University, Borowska 211, PL-50556 Wrocław, Poland; (A.R.-D.); (A.P.)
- Department of Pharmaceutical Biochemistry, Wroclaw Medical University, Borowska 211, PL-50556 Wrocław, Poland
- Correspondence: ; Tel.: +48-71-784-0453
| | - Anna Rorbach-Dolata
- Department of Toxicology, Wroclaw Medical University, Borowska 211, PL-50556 Wrocław, Poland; (A.R.-D.); (A.P.)
| | - Agnieszka Piwowar
- Department of Toxicology, Wroclaw Medical University, Borowska 211, PL-50556 Wrocław, Poland; (A.R.-D.); (A.P.)
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24
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Sahana S, Sivadas A, Mangla M, Jain A, Bhoyar RC, Pandhare K, Mishra A, Sharma D, Imran M, Senthivel V, Divakar MK, Rophina M, Jolly B, Batra A, Sharma S, Siwach S, Jadhao AG, Palande NV, Jha GN, Ashrafi N, Mishra PK, Vidhya AK, Jain S, Dash D, Kumar NS, Vanlallawma A, Sarma RJ, Chhakchhuak L, Kalyanaraman S, Mahadevan R, Kandasamy S, Devi P, Rajagopal RE, Ramya JE, Devi PN, Bajaj A, Gupta V, Mathew S, Goswami S, Prakash S, Joshi K, Kumla M, Sreedevi S, Gajjar D, Soraisham R, Yadav R, Devi YS, Gupta A, Mukerji M, Ramalingam S, Binukumar BK, Sivasubbu S, Scaria V. Pharmacogenomic landscape of COVID-19 therapies from Indian population genomes. Pharmacogenomics 2021; 22:603-618. [PMID: 34142560 PMCID: PMC8216321 DOI: 10.2217/pgs-2021-0028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: Numerous drugs are being widely prescribed for COVID-19 treatment without any direct evidence for the drug safety/efficacy in patients across diverse ethnic populations. Materials & methods: We analyzed whole genomes of 1029 Indian individuals (IndiGen) to understand the extent of drug–gene (pharmacogenetic), drug–drug and drug–drug–gene interactions associated with COVID-19 therapy in the Indian population. Results: We identified 30 clinically significant pharmacogenetic variants and 73 predicted deleterious pharmacogenetic variants. COVID-19-associated pharmacogenes were substantially overlapped with those of metabolic disorder therapeutics. CYP3A4, ABCB1 and ALB are the most shared pharmacogenes. Fifteen COVID-19 therapeutics were predicted as likely drug–drug interaction candidates when used with four CYP inhibitor drugs. Conclusion: Our findings provide actionable insights for future validation studies and improved clinical decisions for COVID-19 therapy in Indians.
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Affiliation(s)
- S Sahana
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Ambily Sivadas
- Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India
| | - Mohit Mangla
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Abhinav Jain
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Rahul C Bhoyar
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Kavita Pandhare
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Anushree Mishra
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Disha Sharma
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Mohamed Imran
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Vigneshwar Senthivel
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Mohit Kumar Divakar
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Mercy Rophina
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Bani Jolly
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Arushi Batra
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sumit Sharma
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Sanjay Siwach
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Arun G Jadhao
- Department of Zoology, RTM Nagpur University, Nagpur, Maharashtra, 440033, India
| | - Nikhil V Palande
- Department of Zoology, Shri Mathuradas Mohota College of Science, Nagpur, Maharashtra, 440009, India
| | - Ganga Nath Jha
- Department of Anthropology, Vinoba Bhave University, Hazaribag, Jharkhand, 825301, India
| | - Nishat Ashrafi
- Department of Anthropology, Vinoba Bhave University, Hazaribag, Jharkhand, 825301, India
| | - Prashant Kumar Mishra
- Department of Biotechnology, Vinoba Bhave University, Hazaribag, Jharkhand, 825301, India
| | - A K Vidhya
- Department of Biochemistry, Dr. Kongu Science & Art College, Erode, Tamil Nadu, 638107, India
| | - Suman Jain
- Thalassemia & Sickle cell Society, Hyderabad, Telangana, 500052, India
| | - Debasis Dash
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | | | - Andrew Vanlallawma
- Department of Biotechnology, Mizoram University, Aizawl, Mizoram, 796004, India
| | - Ranjan Jyoti Sarma
- Department of Biotechnology, Mizoram University, Aizawl, Mizoram, 796004, India
| | | | | | - Radha Mahadevan
- TVMC, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, 627011, India
| | - Sunitha Kandasamy
- TVMC, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, 627011, India
| | - Pabitha Devi
- TVMC, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, 627011, India
| | | | - J Ezhil Ramya
- TVMC, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, 627011, India
| | - P Nirmala Devi
- TVMC, Tirunelveli Medical College, Tirunelveli, Tamil Nadu, 627011, India
| | - Anjali Bajaj
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Vishu Gupta
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Samatha Mathew
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sangam Goswami
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Savinitha Prakash
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Kandarp Joshi
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - Meya Kumla
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India
| | - S Sreedevi
- Department of Microbiology, St. Pious X Degree & PG College for Women, Hyderabad, Telangana, 500076, India
| | - Devarshi Gajjar
- Department of Microbiology, The Maharaja Sayajirao University of Baroda, Vadodara, Gujarat, 390002, India
| | - Ronibala Soraisham
- Department of Dermatology, Venereology & Leprology, Regional Institute of Medical Sciences, Imphal, Manipur, 795004, India
| | - Rohit Yadav
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Yumnam Silla Devi
- CSIR- North East Institute of Science & Technology, Jorhat, Assam, 785006, India
| | - Aayush Gupta
- Department of Dermatology, Dr. D.Y. Patil Medical College, Pune, Maharashtra, 411018, India
| | - Mitali Mukerji
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sivaprakash Ramalingam
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - B K Binukumar
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Sridhar Sivasubbu
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
| | - Vinod Scaria
- CSIR Institute of Genomics & Integrative Biology, Mathura Road, New Delhi, 110025, India.,Academy of Scientific & Innovative Research (AcSIR), Ghaziabad, Uttar Pradesh, 201002, India
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25
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Joseph CMC. Symptomatic Hypoglycemia During Treatment with a Therapeutic Dose of Metformin. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931311. [PMID: 34075013 PMCID: PMC8183305 DOI: 10.12659/ajcr.931311] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 58-year-old Final Diagnosis: Diabetes mellitus type 2 Symptoms: Confusion • diaphoresis • dizziness • dyspnea • palpitation • weakness Medication: Metformin Clinical Procedure: — Specialty: Endocrinology and Metabolic • General and Internal Medicine • Psychiatry
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Affiliation(s)
- Chenelle M C Joseph
- Department of Internal Medicine and Psychiatry, Altru Health System, Grand Forks, ND, USA
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26
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Wang S, Zhan J, Cheng M, Pan Q, Liang Z, Liu X, Peng W, Cao X, Luo Y, Kang D, Liu Y. Clinical expert consensus on standard care of blood glucose for residents in senior care facility in China (2021 edition). Aging Med (Milton) 2021; 4:93-108. [PMID: 34250427 PMCID: PMC8251856 DOI: 10.1002/agm2.12164] [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: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 02/05/2023] Open
Abstract
With the demographic changes, more and more elderly people have chosen to spend their retirement life in a senior care facility. The elderly people in senior care facility are commonly suffering from various geriatric syndromes, including declined daily living activities, cognitive dysfunction, frailty, comorbidities, and polypharmacy, which make them vulnerable to adverse effects, like hypoglycemia and fall. Therefore, layered management is necessary for this population with group disparities. However, the staff in senior care facility vary greatly in concepts and skills on management of senile diabetic population, which needs urgently to be standardized and improved. For this purpose, based on literature review and panel discussion, 28 recommendations are proposed in respect of the standardized management of blood glucose, covering the comprehensive assessment, layered management and grouping, exercise, nutrition, glucose monitoring, identification and treatment of severe hyperglycemia, identification of macrovascular and microvascular complications, management of hypoglycemic drugs, falls and choking and other common problems, blood glucose screening, hypoglycemia prevention, and blood glucose management in major public health events or serious natural disasters. This guideline aims to standardize management skills of medical staff and caregivers in senior care facility for the blood glucose of elderly people and improve their quality of life.
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Affiliation(s)
- Shuang Wang
- Center of GerontologyNational Clinical Research Center for Geriatric DisordersWest China HospitalSichuan UniversityChengduChina
| | - Junkun Zhan
- Department of Geriatrics and Geriatric EndocrinologyThe Second Xiangya Hospitaland the Institute of Aging and GeriatricsCentral South UniversityNational Clinical Research Center for Metabolic Diseases (The Second Xiangya Hospital)ChangshaChina
| | - Mei Cheng
- Department of GeriatricsDepartment of Geriatric EndocrinologyQilu HospitalShandong UniversityJinanChina
| | - Qi Pan
- Department of EndocrinologyBeijing HospitalNational Center of GerontologyBeijingChina
| | - Zhen Liang
- Department of GeriatricsShenzhen People's HospitalShenzhenChina
| | - Xiaohong Liu
- Department of GeriatricsPeking Union Medical College HospitalBeijingChina
| | - Wen Peng
- Department of General MedicineUnion Hospital Affiliated to the Tongji Medical College Huazhong University of Science and TechnologyWuhanChina
| | - Xiaopei Cao
- Department of EndocrinologyThe First Affiliated HospitalSun Yat‐sen UniversityGuangzhouChina
| | - Yingquan Luo
- Department of General MedicineThe Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Dongmei Kang
- Department of GeriatricsAnhui Provincial HospitalThe First Affiliated Hospital of University of Science and Technology of ChinaHefeiChina
| | - Youshuo Liu
- Department of Geriatrics and Geriatric EndocrinologyThe Second Xiangya Hospitaland the Institute of Aging and GeriatricsCentral South UniversityNational Clinical Research Center for Metabolic Diseases (The Second Xiangya Hospital)ChangshaChina
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27
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Putra AMP, Sari RP, Musiam S. Combination of Bawang Dayak Extract and Acarbose against Male White Rat Glucose Levels. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i2.1703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetes is a chronic metabolic disease with signs of increased blood glucose levels. Type 2 diabetes is common diabetes in adults. Bawang dayak is one of the plants believed to have the efficacy of curing various types of diseases. The purpose of this study was to find out the comparison of hypoglycemic effects between combinations of bawang dayak extract and acarbose with single acarbose. This study was an experimental study using 32 white mice divided into two groups. Group one was given a combination of bawang dayak at a dose of 100 mg/kg BW and acarbose at a dose of 40 mg/100 g BW, while group two was given acarbose at a dose of 40 mg/100 g BW. Treatment is administered after the test animal is induced with dexamethasone at a 1 mg/kg BW dose dissolved in NaCl 0.9% subcutaneously for 12 days. Measurement of glucose levels was carried out using a glucometer. Data retrieval was carried out every three days for 15 days after previously fulfilled for +10 hours. Blood glucose level data were analyzed with the General Linear Model test. The combination of bawang dayak-acarbose onion extract had a greater decrease in blood glucose levels than single acarbose. Average reduction in blood glucose levels for D+3; D+6; D+9; D+12; and D+15 was 187.31; 168.56; 140.81; 119.81; and 102.56 mg/dl, respectively. The General Linear Model test results showed a p <0.05 value that significantly impacted blood glucose levels between groups.
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28
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Gamede M, Mabuza L, Ngubane P, Khathi A. Preventing the onset of diabetes-induced chronic kidney disease during prediabetes: The effects of oleanolic acid on selected markers of chronic kidney disease in a diet-induced prediabetic rat model. Biomed Pharmacother 2021; 139:111570. [PMID: 33932738 DOI: 10.1016/j.biopha.2021.111570] [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: 09/04/2020] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The prevalence of prediabetes correlates with increased incidence of chronic kidney disease (CKD). This study was aimed at investigating the effects of oleanolic acid (OA) on markers associated with CKD in the prediabetic rat model. METHODS Prediabetes was induced by exposing male Sprague Dawley rats (150-180 g) to high-fat high- carbohydrate (HFHC) diet for 20 weeks. The prediabetic animals were further subdivided according to their treatment and treated for 12 weeks with either OA (80 mg/kg p.o) or metformin (500 mg/kg p.o) both with and without dietary intervention. 24 h fluid intake and urine output were measured every fourth week of the treatment period while the urine samples were also used for podocin quantification through PCR. The animals were then sacrificed with urine, plasma and kidneys being harvested for biochemical analysis including the measurement of aldosterone, kidney-injury-molecule-1(KIM-1), blood and urine electrolytes, estimated glomerular filtration rate (eGFR), and albumin/creatinine (Alb/Cr) ratio. RESULTS This study observed that OA could reduce oxidative stress in the kidney while restoring plasma aldosterone and KIM-1 as well as urine electrolytes which were found to be augmented in prediabetic animals. This also correlated with normalization of GFR and Alb/Cr ratio in the OA-treated groups in both the absence and presence of dietary intervention. CONCLUSIONS These findings suggest that OA can ameliorate renal complications in a prediabetic rat model. However, more research is needed for the elucidation of molecular mechanisms behind these effects.
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Affiliation(s)
- Mlindeli Gamede
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Lindokuhle Mabuza
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Phikelelani Ngubane
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Andile Khathi
- School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Ray CY, Wu VCC, Wang CL, Tu HT, Huang YT, Kuo CF, Chang SH. Hypoglycemia Associated With Drug-Drug Interactions in Patients With Type 2 Diabetes Mellitus Using Dipeptidylpeptidase-4 Inhibitors. Front Pharmacol 2021; 12:570835. [PMID: 34040513 PMCID: PMC8142266 DOI: 10.3389/fphar.2021.570835] [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: 06/09/2020] [Accepted: 03/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Dipeptidylpeptidase-4 inhibitors (DPP-4i′s) are considered to be safe for patients with type 2 diabetes mellitus (T2DM). However, little is known about drug–drug interactions between DPP-4i′s and concurrent medications. Methods: Data on patients using DPP-4i′s for T2DM during 2011–2017 were retrieved from Chang Gung Research database provided by Chang Gung Memorial Hospital. Patients were excluded if they were aged <30 years or >90 years; had incomplete demographic data; had insulinoma; or had records of concomitant insulin use. A generalized estimating equation–based Poisson model was employed for statistical analysis. The primary outcome was hypoglycemia events. Results: We retrieved data on a total of 97,227 patients using DPP-4i′s. After patients were excluded according to the mentioned criteria, the remaining 77,047 DPP-4i users were studied (mean age 64 ± 12 years, men 54.4%). The most common medications coprescribed with DPP4is over all person-quarters were acetaminophen, simvastatin, fluvastatin, and colchicine (all >20,000 person-quarters). The combinations of a DPP-4i with bumetanide, captopril, colchicine, acetaminophen, cotrimoxazole, and pantoprazole were associated with an increased risk of hypoglycemia. Compared with the ratios observed for person-quarters of DPP-4i use alone (reference category), the adjusted prevalence ratios per 100 person-years of hypoglycemia for person-quarters of DPP-4i use in combination with bumetanide, captopril, colchicine, acetaminophen, cotrimoxazole, and pantoprazole were 2.44 (95% confidence interval [CI], 1.78–3.36), 2.97 (95% CI, 2.26–3.90), 1.87 (95% CI, 1.44–2.42), 2.83 (95% CI, 2.44–3.29), 2.27 (95% CI, 1.27–4.04), and 3.03 (95% CI, 1.96–4.68), respectively. Conclusion: Among patients taking DPP-4i′s for T2DM, concurrent use of such inhibitors with bumetanide, captopril, acetaminophen, and pantoprazole was associated with an increased risk of hypoglycemia compared with the use of DPP-4i′s alone. Physicians prescribing DPP-4i′s should consider the potential risks associated with their concomitant use with other drugs.
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Affiliation(s)
- Chin-Ying Ray
- Department of Pharmacy, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Tzu Tu
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
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Jonsson-Schmunk K, Ghose R, Croyle MA. Immunization and Drug Metabolizing Enzymes: Focus on Hepatic Cytochrome P450 3A. Expert Rev Vaccines 2021; 20:623-634. [PMID: 33666138 DOI: 10.1080/14760584.2021.1899818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Infectious disease emergencies like the 2013-2016 Ebola epidemic and the 2009 influenza and current SARS-CoV-2 pandemics illustrate that vaccines are now given to diverse populations with preexisting pathologies requiring pharmacological management. Many natural biomolecules (steroid hormones, fatty acids, vitamins) and ~60% of prescribed medications are processed by hepatic cytochrome P450 (CYP) 3A4. The objective of this work was to determine the impact of infection and vaccines on drug metabolism. METHODS The impact of an adenovirus-based vaccine expressing Ebola glycoprotein (AdEBO) and H1N1 and H3N2 influenza viruses on hepatic CYP 3A4 and associated nuclear receptors was evaluated in human hepatocytes (HC-04 cells) and in mice. RESULTS CYP3A activity was suppressed by 55% in mice 24 h after administration of mouse-adapted H1N1, while ˂10% activity remained in HC-04 cells after infection with H1N1 and H3N2 due to global suppression of cellular translation capacity, indicated by reduction (70%, H1N1, 56%, H3N2) of phosphorylated eukaryotic translation initiation factor 4e (eIF4E). AdEBO suppressed CYP3A activity in vivo (44%) and in vitro (26%) 24 hours after infection. CONCLUSION As the clinical evaluation of vaccines for SARS-CoV-2 and other global pathogens rise, studies to evaluate the impact of new vaccines and emerging pathogens on CYP3A4 and other metabolic enzymes are warranted to avoid therapeutic failures that could further compromise the public health during infectious disease emergencies.
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Affiliation(s)
- Kristina Jonsson-Schmunk
- Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas, Austin, Texas, USA
| | - Romi Ghose
- Department of Pharmacological and Pharmaceutical Sciences, College of Pharmacy, University of Houston, Houston, Texas, USA
| | - Maria A Croyle
- Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas, Austin, Texas, USA.,LaMontagne Center for Infectious Disease, The University of Texas at Austin, Austin, Texas, USA
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Kern LM, Rajan M, Ringel JB, Colantonio LD, Muntner PM, Casalino LP, Pesko M, Reshetnyak E, Pinheiro LC, Safford MM. Healthcare Fragmentation and Incident Acute Coronary Heart Disease Events: a Cohort Study. J Gen Intern Med 2021; 36:422-429. [PMID: 33140281 PMCID: PMC7878592 DOI: 10.1007/s11606-020-06305-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 10/07/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Highly fragmented ambulatory care (i.e., care spread across many providers without a dominant provider) has been associated with excess tests, procedures, emergency department visits, and hospitalizations. Whether fragmented care is associated with worse health outcomes, or whether any association varies with health status, is unclear. OBJECTIVE To determine whether fragmented care is associated with the risk of incident coronary heart disease (CHD) events, overall and stratified by self-rated general health. DESIGN AND PARTICIPANTS We conducted a secondary analysis of the nationwide prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study (2003-2016). We included participants who were ≥ 65 years old, had linked Medicare fee-for-service claims, and had no history of CHD (N = 10,556). MAIN MEASURES We measured fragmentation with the reversed Bice-Boxerman Index. We used Cox proportional hazards models to determine the association between fragmentation as a time-varying exposure and adjudicated incident CHD events in the 3 months following each exposure period. KEY RESULTS The mean age was 70 years; 57% were women, and 34% were African-American. Over 11.8 years of follow-up, 569 participants had CHD events. Overall, the adjusted hazard ratio (HR) for the association between high fragmentation and incident CHD events was 1.14 (95% confidence interval (CI) 0.92, 1.39). Among those with very good or good self-rated health, high fragmentation was associated with an increased hazard of CHD events (adjusted HR 1.35; 95% CI 1.06, 1.73; p = 0.01). Among those with fair or poor self-rated health, high fragmentation was associated with a trend toward a decreased hazard of CHD events (adjusted HR 0.54; 95% CI 0.29, 1.01; p = 0.052). There was no association among those with excellent self-rated health. CONCLUSION High fragmentation was associated with an increased independent risk of incident CHD events among those with very good or good self-rated health.
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Affiliation(s)
| | | | | | | | - Paul M Muntner
- University of Alabama at Birmingham, Birmingham, AL, USA
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Hu N, Wang H, Qian Q, Jiang Y, Xie J, Zhang D, Li Q, Zou S, Chen R. P-glycoprotein associated with diabetes mellitus and survival of patients with pancreatic cancer: 8-year follow-up. ACTA ACUST UNITED AC 2020; 53:e10068. [PMID: 33053111 PMCID: PMC7552903 DOI: 10.1590/1414-431x202010168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/17/2020] [Indexed: 12/24/2022]
Abstract
Diabetes mellitus (DM) has a high prevalence in patients with pancreatic cancer (PaC), but the prognostic value of DM in PaC remains controversial. Alterations of P-glycoprotein (P-gp) and cytochrome P450 3A4 (CYP3A4) contribute to multidrug resistance and intestinal metabolism in a variety of cancer types, which may be implicated in DM development. This study aimed to explore the potential prognostic value of P-gp and CYP3A4 in PaC patients in the context of DM through long-term follow-up. We retrospectively reviewed the medical records of patients with PaC admitted at The First People's Hospital of Changzhou, Jiangsu, China, from January 2011 to November 2019 and identified two cohorts of adult patients with PaC, including 24 with DM and 24 without DM (non-DM). The baseline clinical characteristics and outcomes were compared. Immunohistochemistry showed that protein expression of P-gp, but not CYP3A, in duodenum tissues was significantly upregulated in PaC patients with DM compared with those without DM. Kaplan-Meier analysis and log-rank test showed that the survival of patients with PaC and DM/high expression of P-gp was not significantly reduced compared with that of patients without DM/low expression of P-gp. These findings suggested that P-gp expression levels were different in the DM and non-DM groups of patients with PaC, but DM and duodenal P-gp levels were not associated with the long-term survival of patients with PaC. It appears that the presence of DM or P-gp expression levels may not serve as effective prognostic markers for PaC.
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Affiliation(s)
- Nan Hu
- Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Hui Wang
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Qing Qian
- Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Yan Jiang
- Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Jun Xie
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Dachuan Zhang
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Qing Li
- Department of Pathology, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Sulan Zou
- Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
| | - Rong Chen
- Department of Pharmacy, The Third Affiliated Hospital of Soochow University, Changzhou, Jiangsu, China
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Khalilieh S, Yee KL, Sanchez R, Stoch SA, Wenning L, Iwamoto M. Clinical Pharmacokinetics of the Novel HIV-1 Non-Nucleoside Reverse Transcriptase Inhibitor Doravirine: An Assessment of the Effect of Patient Characteristics and Drug-Drug Interactions. Clin Drug Investig 2020; 40:927-946. [PMID: 32816220 PMCID: PMC7511279 DOI: 10.1007/s40261-020-00934-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Doravirine (MK-1439) is a novel non-nucleoside reverse transcriptase inhibitor indicated for the combination treatment of human immunodeficiency virus type-1 (HIV-1) infection. The recommended dose is 100 mg once daily. This review summarizes the pharmacokinetics of doravirine, the influence of intrinsic factors, and its drug-drug interaction (DDI) profile. Following oral administration, doravirine is rapidly absorbed (median time to maximum plasma concentration, 1-4 h) and undergoes cytochrome P450 (CYP)3A-mediated oxidative metabolism. Steady-state geometric means for AUC0-24, C24, and Cmax in individuals with HIV-1 following administration of doravirine 100 mg once daily are 37.8 μM·h, 930 nM, and 2260 nM, respectively. Age, gender, severe renal impairment, and moderate hepatic impairment have no clinically meaningful effect on doravirine pharmacokinetics, and there is limited potential for DDIs. No dose adjustment is necessary when doravirine is co-administered with strong CYP3A inhibitors. However, doravirine is contraindicated with strong CYP3A inducers (e.g., rifampin), and dose adjustment of doravirine is recommended for co-administration with the moderate CYP3A inducer, rifabutin. Included in this review are clinical trial data from phase I pharmacokinetic trials, including DDI trials and trials in participants with renal and hepatic disease but without HIV-1 infection (N = 326), as well as phase I, II, and III safety and efficacy trials in participants living with HIV-1 (N = 991). Based on these data, the pharmacokinetic profile of doravirine supports its use in diverse populations living with HIV-1 and allows co-administration with various antiretroviral agents and treatments for commonly occurring co-morbidities.
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Singh A, Zhao K, Bell C, Shah AJ. Effect of berberine on in vitro metabolism of sulfonylureas: A herb-drug interactions study. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2020; 34 Suppl 4:e8651. [PMID: 31721320 DOI: 10.1002/rcm.8651] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 06/10/2023]
Abstract
UNLABELLED Patients with type 2 diabetes may co-ingest herbal and prescription medicines to control their blood sugar levels. Competitive binding of drug and herb may mutually affect their metabolism. This can alter the level of drug and its kinetics in the body, potentially causing toxicities or loss of efficacy. Understanding how the metabolism of sulfonylureas like glyburide and gliclazide can be affected by the presence of berberine and vice versa can provide valuable information on the possible risk of toxicities caused by co-ingestion of drugs. METHODS Berberine and sulfonylureas (glyburide and gliclazide) were co-incubated with rat liver microsomes in the presence of a NADPH-regenerating system. The metabolites of berberine and sulfonylureas were analysed using liquid chromatography with high-resolution mass spectrometry in the positive ion mode. The role of individual isozymes in the metabolism of berberine, glyburide and gliclazide was investigated by using specific inhibitors. RESULTS In vitro metabolism of berberine led to the formation of demethyleneberberine (B1a) and its isomer B1b through demethylenation. Berberrubine (B2a) and its isomer B2b were formed through demethylation. The isozymes CYP3A and CYP2D were found to be involved in the metabolism of berberine. In vitro metabolism of glyburide and gliclazide led to the formation of hydroxylated metabolites. The isozymes CYP3A and CYP2C were found to be involved in the metabolism of glyburide. Gliclazide was metabolised by CYP2C. In vitro co-incubation of glyburide or gliclazide with berberine showed that each drug's metabolism was compromised as they share a common isozyme. A strong negative linear correlation of glyburide or gliclazide metabolite levels and the concentration of berberine confirmed the effect of berberine on the metabolism of sulfonylureas. CONCLUSIONS The metabolism of sulfonylureas and berberine was affected when these compounds were co-incubated with each other. This may be attributable to competitive binding of the herb and drug to the catalytic sites of the same isozymes.
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Affiliation(s)
- Amrinder Singh
- Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Kaicun Zhao
- Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Celia Bell
- Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
| | - Ajit J Shah
- Department of Natural Sciences, Middlesex University, The Burroughs, London, NW4 4BT, UK
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Benefits of Therapeutic Drug Monitoring of First Line Antituberculosis Drugs. ACTA MEDICA MARTINIANA 2020. [DOI: 10.2478/acm-2020-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Tuberculosis is an airborne infectious disease that remains a huge global health-related issue nowadays. Despite constant approvals of newly developed drugs, the use of first-line antituberculosis medicines seems reasonable in drug-susceptible Mycobacterium tuberculosis strains. Therapeutic drug monitoring presents a useful technique for the determination of plasma drug concentration to adjust appropriate dose regimes. In tuberculosis treatment, therapeutic drug monitoring is aiding clinicians in selecting an optimal therapeutic level, which is essential for the personalisation of therapy. This review is aimed at clarifying the use of therapeutic drug monitoring of the first-line antituberculosis drugs in routine clinical practice.
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Abstract
Aim: To identify patterns and characteristics of polypharmacy among elderly residents in Danish nursing homes in the Northern region of Denmark. Materials & methods: Twenty-five nursing homes were contacted, where each supplied 20 randomly selected anonymized residents’ information. Residents were 65 years or older, concurrently taking five or more medications. Drug–drug interactions and potential adverse effects were investigated. Results: One hundred residents (68% females; 32% males) were included. The most prevalent co-morbid condition was cardiovascular disease, and the most prevalent medications were for gastrointestinal- and metabolism-related conditions. Age influenced the number of drugs (p = 0.013) and drug–drug interactions per resident (p = 0.039), with a positive correlation. Conclusion: Elderly residents of the studied nursing homes were potentially affected by an inappropriate polypharmacy. Multimorbidity is common among elderly and a leading factor for polypharmacy. We conducted this study on 100 Danish elderly residents (>65 years, on ≥5 medications) in 25 nursing homes, anonymously and randomly chosen in Northern region of Denmark, to find characteristics of potential inappropriate polypharmacy. We found that age influenced the number of drugs (p = 0.013) and number of drug–drug interactions per resident (p = 0.039), but no sex-related difference was evident. Positive correlations were present between the number of drugs and drug–drug interactions. Elderly residents of the studied nursing homes were potentially affected by an inappropriate polypharmacy.
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Therapeutic management of HIV-infected patients with chronic kidney disease. J Nephrol 2020; 33:699-713. [PMID: 32020538 DOI: 10.1007/s40620-020-00701-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023]
Abstract
CKD and HIV infection are two chronic diseases impacting heavily on the survival of the affected patients. The interplay between HIV infection and chronic kidney disease (CKD) is complex and interactions occur at multiple levels. Approach to the management of HIV-infected patients requires special attention to face the numerous therapeutic difficulties ranging from drug-drug interactions to drug-toxicity. The most effective strategy is targeted to suppression of HIV viral load, as it dramatically changes the prognosis of the patients as well as prevents the development of HIV-associated kidney disease. As shown in this review, the approach to the therapeutic management of CKD in the setting of HIV infection varies in relation to the degree of renal impairment.
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Huh HW, Na YG, Bang KH, Kim SJ, Kim M, Kim KT, Kang JS, Kim YH, Baek JS, Lee HK, Cho CW. Extended Intake of Mulberry Leaf Extract Delayed Metformin Elimination via Inhibiting the Organic Cation Transporter 2. Pharmaceutics 2020; 12:pharmaceutics12010049. [PMID: 31936070 PMCID: PMC7022228 DOI: 10.3390/pharmaceutics12010049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 01/28/2023] Open
Abstract
Diabetes mellitus (DM) has become a major health problem in most countries of the world. DM causes many complications, including hyperglycemia, diabetic ketoacidosis, and death. In Asia, mulberry has been used widely in the treatment of DM. Combination of drugs with herbal medicine may reduce the unwanted side effects caused by drugs. In this study, the influence of extended mulberry leaves extract (MLE) intake on metformin (Met) was evaluated in terms of pharmacokinetics and pharmacodynamics in DM-induced rats. Three week-treatment of MLE alone produced the anti-hyperglycemic effect (around 24%) if compared to the control. Interestingly, Met administration after MLE treatment for 3 weeks enhanced about 49% of the anti-hyperglycemic effect of Met. In addition, the extended intake of MLE potentiated the anti-hyperglycemic effect of Met on various concentrations. This potentiated anti-hyperglycemic effect of Met appears to be due to the pharmacokinetic change of Met. In this study, 3 week-treatment of MLE reduced the elimination of Met in DM-induced rats. In addition, MLE reduced the human organic cation transporter 2 (hOCT2) activity in a concentration-dependent manner. Thus, these findings suggest that MLE lowered the elimination of Met via inhibiting the hOCT2.
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Affiliation(s)
- Hyun Wook Huh
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Young-Guk Na
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Ki-Hyun Bang
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Sung-Jin Kim
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Minki Kim
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Kyung-Tae Kim
- Food Science and Technology Major, Division of Applied Bioengineering, College of Engineering, Dong-Eui University, Busan 47340, Korea;
| | - Jong-Seong Kang
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Young-Ho Kim
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
| | - Jong-Suep Baek
- Department of Herbal Medicine Resource, Kangwon National University, Samcheok 25949, Korea;
| | - Hong-Ki Lee
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
- Correspondence: (H.-K.L.); (C.-W.C.); Tel.: +82-42-821-7301 (H.-K.L.); +82-42-821-5934 (C.-W.C.); Fax: +82-42-823-6566 (H.-K.L. & C.-W.C.)
| | - Cheong-Weon Cho
- College of Pharmacy, Chungnam National University, Daejeon 34134, Korea; (H.W.H.); (Y.-G.N.); (K.-H.B.); (S.-J.K.); (M.K.); (J.-S.K.); (Y.-H.K.)
- Correspondence: (H.-K.L.); (C.-W.C.); Tel.: +82-42-821-7301 (H.-K.L.); +82-42-821-5934 (C.-W.C.); Fax: +82-42-823-6566 (H.-K.L. & C.-W.C.)
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Mechessa DF, Kebede B. Drug-Related Problems and Their Predictors Among Patients with Diabetes Attending the Ambulatory Clinic of Gebre Tsadik Shawo General Hospital, Southwest Ethiopia. Diabetes Metab Syndr Obes 2020; 13:3349-3357. [PMID: 33061496 PMCID: PMC7524197 DOI: 10.2147/dmso.s267790] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with diabetes are vulnerable to experiencing drug-related problems. Thus, this study aimed to assess drug-related problems and their predictors among patients with diabetes attending the ambulatory clinic of Gebre Tsadik Shawo General Hospital. METHODS A cross-sectional study was conducted from September 1, 2019 to November 30, 2019. Drug-related problems were identified using the Pharmaceutical Care Network Europe version 5.01. Patient's written informed consent was obtained after explaining the purpose of the study. The data were collected using structured questionnaires and entered into Epi data version 4.0.2. Then, it was exported to SPSS version 21.0 for analysis. To identify predictors of the occurrence of drug-related problems, multiple stepwise backward logistic regression analysis was done. For the accuracy of data analysis, a 95% confidence interval was used, and statistical significance was considered at p-values <0.05. RESULTS From a total of 141 patients with diabetes included in the study, 58.2% of them had at least one drug-related problem during the 3-month study period. A total of 156 drug-related problems were identified in 141 patients. Drug interactions (30.76%) and drug choice problems (25%) were the most common type of drug-related problems identified. Presence of disease comorbidity (AOR=4.12, 95% CI=1.71-9.91), poly-pharmacy (AOR=6.27, 95% CI=1.67-23.52) and more than 5 years diabetes duration (AOR=3.89, 95% CI=1.52-9.95) were independent predictors of drug-related problems. CONCLUSION Drug-related problems were high among patients with diabetes in the study setting. Early detection of drug-related problems ensures the appropriateness of drug therapy. Therefore, a sustainable pharmaceutical care service is needed for early identification, prevention and resolution of drug-related problems.
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Affiliation(s)
- Desalegn Feyissa Mechessa
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
- Correspondence: Desalegn Feyissa Mechessa Tel +251917127556 Email
| | - Bezie Kebede
- Department of Pharmacy, College of Medicine and Health Science, Mizan-Tepi University, Mizan-Aman, Ethiopia
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May M, Framke T, Junker B, Framme C, Pielen* A, Schindler* C. How and why SGLT2 inhibitors should be explored as potential treatment option in diabetic retinopathy: clinical concept and methodology. Ther Adv Endocrinol Metab 2019; 10:2042018819891886. [PMID: 31853361 PMCID: PMC6906337 DOI: 10.1177/2042018819891886] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Patients suffering from type 2 diabetes are at an increased risk of developing classical microvascular complications such as retinopathy, neuropathy, and nephropathy, which represent a significant health burden. Tight control of blood glucose, blood pressure, and serum cholesterol reduce the risk of microvascular complications but effective pharmacologically targeted treatment options for the treatment and prevention of diabetic microangiopathy are still lacking. Pharmacological inhibition of sodium glucose cotransporter 2 (SGLT2) might have the potential to directly protect against microvascular complications and could represent a potential treatment option. Randomized controlled clinical proof of concept trials are needed to investigate a potential central role of SGLT2 inhibitors in the prevention of diabetic microangiopathy and its classical clinical complications of retinopathy, neuropathy, and nephropathy.
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Affiliation(s)
- Marcus May
- Hannover Medical School, MHH CRC Core Facility,
Feodor-Lynen-Strasse 15, Hannover, 30625, Germany
| | - Theodor Framke
- Institute of Biostatistics, Hannover Medical
School, Hannover, Germany
| | | | | | | | - Christoph Schindler*
- MHH Clinical Research Center Core Facility (OE
8660) and Center for Pharmacology and Toxicology, Hannover, Germany
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41
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Prídavková D, Samoš M, Bolek T, Škorňová I, Žolková J, Kubisz P, Staško J, Mokáň M. Type 2 Diabetes, Atrial Fibrillation, and Direct Oral Anticoagulation. J Diabetes Res 2019; 2019:5158308. [PMID: 31886279 PMCID: PMC6925766 DOI: 10.1155/2019/5158308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023] Open
Abstract
Type 2 diabetes (T2D) is an independent risk factor of stroke and systemic embolism in patients with atrial fibrillation (AF), and T2D patients with AF-associated stroke seem to have worse clinical outcome and higher risk of unfavorable clinical course compared to individuals without this metabolic disorder. Long-term anticoagulation is indicated in majority of T2D patients with AF to prevent adverse AF-associated embolic events. Direct oral anticoagulants (DOACs), direct oral thrombin inhibitor dabigatran, and direct oral factor Xa inhibitors, rivaroxaban, apixaban, and edoxaban, have emerged as a preferred choice for long-term prevention of stroke in AF patients offering potent and predictable anticoagulation and a favorable pharmacology with low risk of interactions. This article reviews the current data regarding the use of DOACs in individuals with T2D and AF.
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Affiliation(s)
- Dana Prídavková
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Matej Samoš
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Tomáš Bolek
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ingrid Škorňová
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Jana Žolková
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Peter Kubisz
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Ján Staško
- National Center of Hemostasis and Thrombosis, Department of Hematology and Blood Transfusion, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Marián Mokáň
- Department of Internal Medicine I, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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42
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Abou-Seri SM, Taha AM, Mohamed MA, Abdelkader NM. New Quinazoline-Sulfonylurea Conjugates: Design, Synthesis and Hypoglycemic Activity. Med Chem 2019; 15:634-647. [PMID: 30526467 DOI: 10.2174/1573406415666181208104543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/13/2018] [Accepted: 11/25/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sulphonylureas are the oldest and commonly used to treat diabetic patients, but its efficacy declines by time. It was reported that quinazoline nucleus exhibits a potent hypoglycemic effect in diabetic animal models. OBJECTIVE The current study aimed to synthesize new quinazoline-sulfonylurea conjugates and evaluate their hypoglycemic effects in alloxan-induced diabetic rats. METHODS The conjugates were synthesized by bioisosteric replacement of 5-chloro-2-methoxybenzamide moiety in glibenclamide or 1,3-dioxo-3,4-dihydroisoquinoline moiety in gliquidone with 6,7-dimethoxy-4-oxoquinazoline moiety (compounds 4a-4d, 9b-9c and 10b-10d). Diabetes was induced in rats by a single i.p. administration of alloxan, followed by treatment with the synthesized conjugates (5mg/kg Body weight). RESULTS All conjugates showed hypoglycemic effects with different efficacy indicated by the reduction in blood glucose and elevation of insulin levels. Moreover, these conjugates up-regulated the expression of pancreatic glucose transporter 2, muscle glucose transporter 4, and insulin receptor substrate-1 genes, compared to the diabetic group. A normal pancreatic tissue pattern was noticed in diabetic rats treated with compounds 9b, 9c, and 10c. CONCLUSION Conjugation of sulfonylurea with quinazoline (especially 9b, 9c, 10c) possessed a significant hypoglycemic effect through improving blood insulin level and insulin action and consequently increased the glucose uptake by the skeletal muscles.
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Affiliation(s)
- Sahar M Abou-Seri
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - AlShaimaa M Taha
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Mona A Mohamed
- Biochemistry Division, Department of Chemistry, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Nour M Abdelkader
- Department of Biochemistry, Faculty of Science, Ain Shams University, Cairo, Egypt
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43
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Weiss R, Fernandez E, Liu Y, Strong R, Salmon AB. Metformin reduces glucose intolerance caused by rapamycin treatment in genetically heterogeneous female mice. Aging (Albany NY) 2019; 10:386-401. [PMID: 29579736 PMCID: PMC5892694 DOI: 10.18632/aging.101401] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/16/2018] [Indexed: 12/25/2022]
Abstract
The use of rapamycin to extend lifespan and delay age-related disease in mice is well-established despite its potential to impair glucose metabolism which is driven partially due to increased hepatic gluconeogenesis. We tested whether a combination therapeutic approach using rapamycin and metformin could diminish some of the known metabolic defects caused by rapamycin treatment in mice. In genetically heterogeneous HET3 mice, we found that chronic administration of encapsulated rapamycin by diet caused a measurable defect in glucose metabolism in both male and female mice as early as 1 month after treatment. In female mice, this defect was alleviated over time by simultaneous treatment with metformin, also by diet, such that females treated with both drugs where indistinguishable from control mice during glucose tolerance tests. While rapamycin-mediated glucose intolerance was unaffected by metformin in males, we found metformin prevented rapamycin-mediated reduction in insulin and leptin concentrations following 9 months of co-treatment. Recently, the Interventions Testing Program showed that mice treated with metformin and rapamycin live at least as long as those treated with rapamycin alone. Together, our data provide compelling evidence that the pro-longevity effects of rapamycin can be uncoupled from its detrimental effects on metabolism through combined therapeutic approaches.
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Affiliation(s)
- Roxanne Weiss
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX 78294, USA.,The Sam and Ann Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Elizabeth Fernandez
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX 78294, USA.,The Sam and Ann Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Yuhong Liu
- The Sam and Ann Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Randy Strong
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX 78294, USA.,The Sam and Ann Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.,Department of Pharmacology, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
| | - Adam B Salmon
- Geriatric Research, Education and Clinical Center, South Texas Veterans Health Care System, San Antonio, TX 78294, USA.,The Sam and Ann Barshop Institute for Longevity and Aging Studies, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.,Department of Molecular Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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44
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Popular functional foods and herbs for the management of type-2-diabetes mellitus: A comprehensive review with special reference to clinical trials and its proposed mechanism. J Funct Foods 2019. [DOI: 10.1016/j.jff.2019.04.039] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
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45
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Maideen NMP. Drug interactions of dipeptidyl peptidase 4 inhibitors involving CYP enzymes and P-gp efflux pump. World J Meta-Anal 2019; 7:156-161. [DOI: 10.13105/wjma.v7.i4.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 04/21/2019] [Accepted: 04/23/2019] [Indexed: 02/06/2023] Open
Abstract
Dipeptidyl peptidase 4 (DPP4) inhibitors are oral antidiabetic drugs approved to manage type 2 diabetes mellitus. Saxagliptin is a substrate of CYP3A4/5 enzymes while other DPP4 inhibitors such as sitagliptin, linagliptin, gemigliptin and teneligliptin are weak substrates of CYP3A4. DPP4 inhibitors have also been identified as substrates of P-gp. Hence, the drugs inhibiting or inducing CYP3A4/5 enzymes and/or P-gp can alter the pharmacokinetics of DPP4 inhibitors. This review is aimed to identify the drugs interacting with DPP4 inhibitors. The plasma concentrations of saxagliptin have been reported to be increased significantly by the concomitant administration of ketoconazole or diltiazem while no significant interactions between various DPP4 inhibitors and drugs like warfarin, digoxin or cyclosporine have been identified.
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46
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Kostov K. Effects of Magnesium Deficiency on Mechanisms of Insulin Resistance in Type 2 Diabetes: Focusing on the Processes of Insulin Secretion and Signaling. Int J Mol Sci 2019; 20:ijms20061351. [PMID: 30889804 PMCID: PMC6470576 DOI: 10.3390/ijms20061351] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/09/2019] [Accepted: 03/14/2019] [Indexed: 02/06/2023] Open
Abstract
Magnesium (Mg2+) is an essential mineral for human health and plays an important role in the regulation of glucose homeostasis and insulin actions. Despite the widespread clinical evidences for the association of Mg2+ deficiency (MgD) and type 2 diabetes mellitus (T2D), molecular mechanisms by which Mg2+ contributes to insulin resistance (IR) are still under discussion. Mg2+ regulates electrical activity and insulin secretion in pancreatic beta-cells. Intracellular Mg2+ concentrations are critical for the phosphorylation of the insulin receptor and other downstream signal kinases of the target cells. Low Mg2+ levels result in a defective tyrosine kinase activity, post-receptor impairment in insulin action, altered cellular glucose transport, and decreased cellular glucose utilization, which promotes peripheral IR in T2D. MgD triggers chronic systemic inflammation that also potentiates IR. People with T2D may end up in a vicious circle in which MgD increases IR and IR causes MgD, that requires periodic monitoring of serum Mg2+ levels.
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Affiliation(s)
- Krasimir Kostov
- Department of Pathophysiology, Medical University-Pleven, 1 Kliment Ohridski Str., 5800 Pleven, Bulgaria.
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47
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The Role of the Diabetes Educator in Diabetes Formulary and Medical Device Decisions. DIABETES EDUCATOR 2018; 45:50-53. [DOI: 10.1177/0145721718820942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
It is the position of the American Association of Diabetes Educators that diabetes educators should be included as expert consultants for formulary decisions regarding diabetes medications and medical devices.
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48
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Panigrahy SK, Kumar A, Bhatt R. Hedychium coronarium Rhizomes: Promising Antidiabetic and Natural Inhibitor of α-Amylase and α-Glucosidase. J Diet Suppl 2018; 17:81-87. [DOI: 10.1080/19390211.2018.1483462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Suchitra K. Panigrahy
- Department of Biotechnology, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, Chhattisgarh, India
| | - Awanish Kumar
- Department of Biotechnology, National Institute of Technology (NIT), Raipur, Chhattisgarh, India
| | - Renu Bhatt
- Department of Biotechnology, Guru Ghasidas Vishwavidyalaya (A Central University), Bilaspur, Chhattisgarh, India
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49
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Thomford NE, Dzobo K, Chimusa E, Andrae-Marobela K, Chirikure S, Wonkam A, Dandara C. Personalized Herbal Medicine? A Roadmap for Convergence of Herbal and Precision Medicine Biomarker Innovations. ACTA ACUST UNITED AC 2018; 22:375-391. [DOI: 10.1089/omi.2018.0074] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Nicholas Ekow Thomford
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- School of Medical Sciences, University of Cape Coast, Cape Coast, PMB, Ghana
| | - Kevin Dzobo
- International Centre for Genetic Engineering and Biotechnology, Cape Town component, University of Cape Town, Cape Town, South Africa
- Department of Integrative Biomedical Science, Division of Medical Biochemistry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emile Chimusa
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kerstin Andrae-Marobela
- Molecular Cell Biology, Department of Biological Sciences, University of Botswana, Gaborone, Botswana
| | - Shadreck Chirikure
- Department of Archaeology, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Collet Dandara
- Pharmacogenomics and Drug Metabolism Research Group, Division of Human Genetics, Department of Pathology and Institute for Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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50
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Gunaratne K, Austin E, Wu PE. Unintentional sulfonylurea toxicity due to a drug-drug interaction: a case report. BMC Res Notes 2018; 11:331. [PMID: 29784014 PMCID: PMC5963053 DOI: 10.1186/s13104-018-3404-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sulfonylureas are widely used for type 2 diabetes mellitus, but these medications carry a risk of hypoglycemia. Drug-drug interactions that inhibit sulfonylurea metabolism and thus increase systemic exposure can cause unintentional sulfonylurea toxicity. CASE PRESENTATION A 56-year-old man presented with severe, recurrent hypoglycemia. He had a history of type 2 diabetes mellitus and was taking the sulfonylurea gliclazide with no prior episodes of hypoglycemia. The onset of his hypoglycemia occurred within days after starting voriconazole and subsequently fluconazole for a fungal pneumonia. Unintentional sulfonylurea toxicity developed due to an adverse drug-drug interaction between gliclazide and these antifungals. Azole antifungals inhibit the metabolism of sulfonylureas resulting in increased systemic exposure and consequent toxicity. After the diagnosis of sulfonylurea toxicity was recognized, the patient was treated initially with dextrose and then administered octreotide to prevent recurrent hypoglycemia. He was successfully managed, his hypoglycemic episodes resolved, and his medications were adjusted to avoid any further adverse interactions. CONCLUSIONS Adverse drug-drug interactions continue to pose challenges to clinicians. Both individual vigilance and system wide strategies are needed to prevent and mitigate consequences. This case highlights an important drug-drug interaction and reviews the presentation, management and antidotal therapy of sulfonylurea toxicity.
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Affiliation(s)
- Keith Gunaratne
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Emily Austin
- Department of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada.,Division of Clinical Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada
| | - Peter E Wu
- Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Clinical Pharmacology & Toxicology, University of Toronto, Toronto, ON, Canada. .,Division of General Internal Medicine, University Health Network, 200 Elizabeth St. 14EN206, Toronto, ON, M5G 2C4, Canada.
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