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Figueiredo A, Auxtero MD, Santo M, Casimiro A, Costa IM. Risks of dairy derived excipients in medications for lactose intolerant and cow milk protein allergic patients. Sci Rep 2024; 14:15631. [PMID: 38972872 PMCID: PMC11228012 DOI: 10.1038/s41598-024-66380-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024] Open
Abstract
The use of lactose and cow milk protein (CMP) as potential allergens in pharmaceuticals and their ability to cause allergic reactions remains a significant concern in medicine. Lactose, a common pharmaceutical excipient due to its inert, inexpensive, and stable properties, is found in many prescription-only and over-the-counter medications. However, despite their widespread use, individuals with lactose intolerance (LI) or cow milk protein allergy (CMPA) may experience adverse reactions to these excipients. This study investigated the prevalence of lactose and other dairy-derived ingredients in pharmaceuticals marketed in Portugal. Using the Summary of Product Characteristics (SmPC) from the INFOMED database, various medications, including analgesics, antipyretics, non-steroidal anti-inflammatory drugs (NSAIDs), and antiasthmatics, were analyzed. Results showed a high prevalence of dairy-derived excipients, particularly in antiasthmatic drugs (62.6%) and NSAIDs (39%). Although CMP are not explicitly mentioned in SmPCs, the presence of lactose as an ingredient poses a risk of cross-contamination. The findings emphasize the need for healthcare professionals to be aware of potential allergens in medications and the importance of developing lactose-free alternatives to ensure the safety of patients with LI and CMPA. Further research is required to assess the safety and implications of lactose in medicines for these populations.
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Affiliation(s)
- Alexandra Figueiredo
- Instituto Universitário Egas Moniz (IUEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal.
- PharmSci Lab/ Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal.
| | - Maria Deolinda Auxtero
- Instituto Universitário Egas Moniz (IUEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
- PharmSci Lab/ Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
| | - Maria Santo
- Instituto Universitário Egas Moniz (IUEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
| | - Andreia Casimiro
- Instituto Universitário Egas Moniz (IUEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
- PharmSci Lab/ Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
| | - Isabel Margarida Costa
- Instituto Universitário Egas Moniz (IUEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
- PharmSci Lab/ Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário - Quinta da Granja, 2829-511, Monte de Caparica, Portugal
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Bansal N, Campbell SM, Lin CY, Ashcroft DM, Chen LC. Development of prescribing indicators related to opioid-related harm in patients with chronic pain in primary care-a modified e-Delphi study. BMC Med 2024; 22:5. [PMID: 38167142 PMCID: PMC10763174 DOI: 10.1186/s12916-023-03213-x] [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: 06/20/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Long-term opioid use is associated with dependency, addiction, and serious adverse events. Although a framework to reduce inappropriate opioid prescribing exists, there is no consensus on prescribing indicators for preventable opioid-related problems in patients with chronic pain in primary care in the UK. This study aimed to identify opioid prescription scenarios for developing indicators for prescribing opioids to patients with chronic pain in primary care. METHODS Scenarios of opioid prescribing indicators were identified from a literature review, guidelines, and government reports. Twenty-one indicators were identified and presented in various opioid scenarios concerning opioid-related harm and adverse effects, drug-drug interactions, and drug-disease interactions in certain disease conditions. After receiving ethics approval, two rounds of electronic Delphi panel technique surveys were conducted with 24 expert panellists from the UK (clinicians, pharmacists, and independent prescribers) from August 2020 to February 2021. Each indicator was rated on a 1-9 scale from inappropriate to appropriate. The score's median, 30th and 70th percentiles, and disagreement index were calculated. RESULTS The panel unanimously agreed that 15 out of the 21 opioid prescribing scenarios were inappropriate, primarily due to their potential for causing harm to patients. This consensus was reflected in the low appropriateness scores (median ranging from 1 to 3). There were no scenarios with a high consensus that prescribing was appropriate. The indicators were considered inappropriate due to drug-disease interactions (n = 8), drug-drug interactions (n = 2), adverse effects (n = 3), and prescribed dose and duration (n = 2). Examples included prescribing opioids during pregnancy, concurrently with benzodiazepines, long-term without a laxative prescription and prescribing > 120-mg morphine milligram equivalent per day or long-term duration over 3 months after surgery. CONCLUSIONS The high agreement on opioid prescribing indicators indicates that these potentially hazardous consequences are relevant and concerning to healthcare practitioners. Future research is needed to evaluate the feasibility and implementation of these indicators within primary care settings. This research will provide valuable insights and evidence to support opioid prescribing and deprescribing strategies. Moreover, the findings will be crucial in informing primary care practitioners and shaping quality outcome frameworks and other initiatives to enhance the safety and quality of care in primary care settings.
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Affiliation(s)
- Neetu Bansal
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK.
| | - Stephen M Campbell
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Molotlegi Street, Pretoria, 0208, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
| | - Chiu-Yi Lin
- Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Darren M Ashcroft
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
- NIHR Greater Manchester Patient Safety Research Collaboration, University of Manchester, Manchester, M13 9PL, UK
| | - Li-Chia Chen
- Drug Usage and Pharmacy Practice Group, Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, Centre for Pharmacoepidemiology and Drug Safety, Manchester Academic Health Science Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
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Kowalówka M, Kosewski G, Lipiński D, Przysławski J. A Comprehensive Look at the -13910 C>T LCT Gene Polymorphism as a Molecular Marker for Vitamin D and Calcium Levels in Young Adults in Central and Eastern Europe: A Preliminary Study. Int J Mol Sci 2023; 24:10191. [PMID: 37373338 DOI: 10.3390/ijms241210191] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Intolerance to dairy products resulting from the abnormal digestion of milk sugar (lactose) is a common cause of human gastrointestinal disorders. The aim of this study was to show that the -13910 C>T LCT gene polymorphism, together with genotypes of selected VDR gene polymorphisms and diet and nutritional status parameters, can impact the prevalence of vitamin D and calcium deficiency in young adults. This study was conducted on a group of 63 people, which comprised 21 individuals with primary adult lactase deficiency, and a control group of 42 individuals with no hypolactasia. The LCT and VDR gene genotypes were assessed using PCR restriction fragment length polymorphism (PCR-RFLP) analysis. A validated HPLC method was used to determine serum concentrations of 25(OH)D2 and 25(OH)D3. Atomic absorption spectrometry was used to determine calcium levels. Their diets (self-reported 7-day estimated food record), estimated calcium intakes based on the ADOS-Ca questionnaire and basic anthropometric parameters were assessed. The CC genotype associated with hypolactasia was found in 33.3% of the subjects. The presence of the CC variant of the LCT gene polymorphism in the study group of young Polish adults was found to be associated with significantly lower milk (134.7 ± 66.7 g/d vs. 342.5 ± 176 g/d; p = 0.012) and dairy product consumption (78.50 ± 36.2 g/d vs. 216.3 ± 102 g/d; p = 0.008) compared with lactase persistence. At the same time, people with adult-type primary intolerance were found to have statistically significant lower serum levels of vitamin D and calcium (p < 0.05). There was a higher chance of vitamin D and calcium deficiency and a lower intake in the group exhibiting lactase non-persistence (OR > 1). The AA variant of the VDR gene's BsmI polymorphism present in people with hypolactasia may further contribute to an increased risk of vitamin D deficiency. Exclusion of lactose from the diet, combined with impaired vitamin D metabolism, may also lead to inhibited calcium absorption by the body. Further research should be carried out on a larger group of subjects to clarify the relationship between lactase activity and vitamin D and calcium levels in young adults.
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Affiliation(s)
- Magdalena Kowalówka
- Department of Bromatology, Poznań University of Medical Sciences, Rokietnicka 3 Street, 60-806 Poznań, Poland
| | - Grzegorz Kosewski
- Department of Bromatology, Poznań University of Medical Sciences, Rokietnicka 3 Street, 60-806 Poznań, Poland
| | - Daniel Lipiński
- Department of Biochemistry and Biotechnology, Poznań University of Life Sciences, Dojazd 11 Street, 60-647 Poznań, Poland
| | - Juliusz Przysławski
- Department of Bromatology, Poznań University of Medical Sciences, Rokietnicka 3 Street, 60-806 Poznań, Poland
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Zakowiecki D, Hess T, Cal K, Mikolaszek B, Garbacz G, Haznar-Garbacz D. Directly compressible formulation of immediate release rosuvastatin calcium tablets stabilized with tribasic calcium phosphate. Pharm Dev Technol 2022; 27:425-434. [DOI: 10.1080/10837450.2022.2073370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Tobias Hess
- Chemische Fabrik Budenheim KG, Budenheim, Germany
| | - Krzysztof Cal
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Barbara Mikolaszek
- Department of Pharmaceutical Technology, Faculty of Pharmacy, Medical University of Gdansk, Gdansk, Poland
| | - Grzegorz Garbacz
- Physiolution Polska sp. z o.o, Wroclaw, Poland
- Physiolution GmbH, Greifswald, Germany
| | - Dorota Haznar-Garbacz
- Department of Drug Form Technology, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
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Porzi M, Burton-Pimentel KJ, Walther B, Vergères G. Development of Personalized Nutrition: Applications in Lactose Intolerance Diagnosis and Management. Nutrients 2021; 13:nu13051503. [PMID: 33946892 PMCID: PMC8145768 DOI: 10.3390/nu13051503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 12/23/2022] Open
Abstract
Recent discoveries in the “omics” field and the growing focus on preventive health have opened new avenues for personalized nutrition (PN), which is becoming an important theme in the strategic plans of organizations that are active in healthcare, food, and nutrition research. PN holds great potential for individual health optimization, disease management, public health interventions, and product innovation. However, there are still multiple challenges to overcome before PN can be truly embraced by the public and healthcare stakeholders. The diagnosis and management of lactose intolerance (LI), a common condition with a strong inter-individual component, is explored as an interesting example for the potential role of these technologies and the challenges of PN. From the development of genetic and metabolomic LI diagnostic tests that can be carried out in the home, to advances in the understanding of LI pathology and individualized treatment optimization, PN in LI care has shown substantial progress. However, there are still many research gaps to address, including the understanding of epigenetic regulation of lactase expression and how lactose is metabolized by the gut microbiota, in order to achieve better LI detection and effective therapeutic interventions to reverse the potential health consequences of LI.
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Affiliation(s)
- Millie Porzi
- Laboratory of Human Nutrition, Department of Health Sciences and Technology, ETH Zurich, 8092 Zurich, Switzerland;
| | - Kathryn J. Burton-Pimentel
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
| | - Barbara Walther
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
| | - Guy Vergères
- Agroscope, Federal Department of Economic Affairs, Education and Research EAER, 3003 Bern, Switzerland; (K.J.B.-P.); (B.W.)
- Correspondence: ; Tel.: +41-58-463-8154
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Reker D, Blum SM, Steiger C, Anger KE, Sommer JM, Fanikos J, Traverso G. "Inactive" ingredients in oral medications. Sci Transl Med 2019; 11:eaau6753. [PMID: 30867323 PMCID: PMC7122736 DOI: 10.1126/scitranslmed.aau6753] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 02/22/2019] [Indexed: 12/16/2022]
Abstract
Oral forms of medications contain "inactive" ingredients to enhance their physical properties. Using data analytics, we characterized the abundance and complexity of inactive ingredients in approved medications. A majority of medications contain ingredients that could cause adverse reactions, underscoring the need to maximize the tolerability and safety of medications and their inactive ingredients.
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Affiliation(s)
- Daniel Reker
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Steven M Blum
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christoph Steiger
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Kevin E Anger
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Jamie M Sommer
- Investigational Drug Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - John Fanikos
- Investigational Drug Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Giovanni Traverso
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
- Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- MIT-IBM Watson AI Lab, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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