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Kabir MT, Ferdous Mitu J, Akter R, Akhtar MF, Saleem A, Al-Harrasi A, Bhatia S, Rahman MS, Damiri F, Berrada M, Rahman MH. Therapeutic potential of dopamine agonists in the treatment of type 2 diabetes mellitus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:46385-46404. [PMID: 35486279 DOI: 10.1007/s11356-022-20445-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
Diabetes is a global health concern that has affected almost 415 million people globally. Bromocriptine is a dopamine D2 agonist, which is a Food and Drug Administration (FDA)-approved drug to treat type 2 diabetes mellitus (T2DM) patients. However, it is considered that a novel treatment therapy is required which can be used in the treatment of diabetes with or without other antidiabetic agents. Dopamine agonists are usually used in neurological disorders like Parkinson's disease (PD), restless leg syndrome, and hyperprolactinemia. However, dopamine agonists including bromocriptine and cabergoline are also effective in reducing the glycemic level in T2DM patients. Bromocriptine was formerly used for the treatment of PD, hyperprolactinemia, and restless leg syndrome, but now it is used for improving glycemic levels as well as reducing free fatty acids and triglycerides. In addition, cabergoline has been found to be effective in glycemic control, but this drug is yet to be approved by the FDA due to its limitations and lack of study. Findings of the clinical trials of bromocriptine have suggested that it reduces almost 0.4-0.8% glycated hemoglobin and cardiovascular risk by 40% in insulin-resistant patients. Moreover, the safe use of bromocriptine in obese T2DM patients makes it a more attractive option as it causes weight loss. Indeed, bromocriptine is a novel therapy for T2DM patients, as its mechanism of action is unique in T2DM patients with minimal adverse effects. This review summarizes the potential of dopamine agonists in the treatment of T2DM.
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Affiliation(s)
- Md Tanvir Kabir
- Department of Pharmacy, Brac University, 66 Mohakhali, Dhaka, 1212, Bangladesh
| | | | - Raushanara Akter
- Department of Pharmacy, Brac University, 66 Mohakhali, Dhaka, 1212, Bangladesh
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University Lahore Campus, Lahore, Pakistan
| | - Ammara Saleem
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, Government College University Faisalabad, Faisalabad, Pakistan
| | - Ahmed Al-Harrasi
- Natural & Medical Sciences Research Center, University of Nizwa, 616 Birkat Al Mauz, P.O. Box 33, Nizwa, Oman
| | - Saurabh Bhatia
- Natural & Medical Sciences Research Center, University of Nizwa, 616 Birkat Al Mauz, P.O. Box 33, Nizwa, Oman
- School of Health Science, University of Petroleum and Energy Studies, Prem Nagar, Dehradun, Uttarakhand, 248007, India
| | - Md Sohanur Rahman
- Department of Biochemistry and Molecular Biology, Trust University, Barishal, Ruiya, Nobogram Road, Barishal, 8200, Bangladesh
| | - Fouad Damiri
- Laboratory of Biomolecules and Organic Synthesis (BIOSYNTHO), Department of Chemistry, Faculty of Sciences Ben M'Sick, University Hassan II of Casablanca, Casablanca, Morocco
| | - Mohammed Berrada
- Laboratory of Biomolecules and Organic Synthesis (BIOSYNTHO), Department of Chemistry, Faculty of Sciences Ben M'Sick, University Hassan II of Casablanca, Casablanca, Morocco
| | - Md Habibur Rahman
- Department of Pharmacy, Southeast University, Banani, Dhaka, 1213, Bangladesh.
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju, 26426, Gangwon-do, Korea.
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Naz F, Malik A, Riaz M, Mahmood Q, Mehmood MH, Rasool G, Mahmood Z, Abbas M. Bromocriptine Therapy: Review of mechanism of action, safety and tolerability. Clin Exp Pharmacol Physiol 2022; 49:903-922. [DOI: 10.1111/1440-1681.13678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Faiza Naz
- Punjab University College of Pharmacy University of the Punjab Lahore Pakistan
| | - Abdul Malik
- College of Pharmacy University of Sargodha Sargodha Pakistan
| | - Muhammad Riaz
- Department of Allied Health Sciences University of Sargodha Sargodha Pakistan
| | - Qaisar Mahmood
- College of Pharmacy University of Sargodha Sargodha Pakistan
| | - Malik Hassan Mehmood
- Department of Pharmacology, Faculty of Pharmaceutical Sciences Government College University Faisalabad Pakistan
| | - Ghulam Rasool
- Department of Allied Health Sciences University of Sargodha Sargodha Pakistan
| | - Zahed Mahmood
- Department of Biochemistry Government College University Faisalabad Pakistan
| | - Mazhar Abbas
- Department of Biochemistry College of Veterinary and Animal Sciences, University of Veterinary and Animal Sciences (Jhang Campus) Lahore Pakistan
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Kumar B, Pandey M, Pottoo FH, Fayaz F, Sharma A, Sahoo PK. Liposomes: Novel Drug Delivery Approach for Targeting Parkinson's Disease. Curr Pharm Des 2021; 26:4721-4737. [PMID: 32003666 DOI: 10.2174/1381612826666200128145124] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/18/2019] [Indexed: 11/22/2022]
Abstract
Parkinson's disease is one of the most severe progressive neurodegenerative disorders, having a mortifying effect on the health of millions of people around the globe. The neural cells producing dopamine in the substantia nigra of the brain die out. This leads to symptoms like hypokinesia, rigidity, bradykinesia, and rest tremor. Parkinsonism cannot be cured, but the symptoms can be reduced with the intervention of medicinal drugs, surgical treatments, and physical therapies. Delivering drugs to the brain for treating Parkinson's disease is very challenging. The blood-brain barrier acts as a highly selective semi-permeable barrier, which refrains the drug from reaching the brain. Conventional drug delivery systems used for Parkinson's disease do not readily cross the blood barrier and further lead to several side-effects. Recent advancements in drug delivery technologies have facilitated drug delivery to the brain without flooding the bloodstream and by directly targeting the neurons. In the era of Nanotherapeutics, liposomes are an efficient drug delivery option for brain targeting. Liposomes facilitate the passage of drugs across the blood-brain barrier, enhances the efficacy of the drugs, and minimize the side effects related to it. The review aims at providing a broad updated view of the liposomes, which can be used for targeting Parkinson's disease.
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Affiliation(s)
- Bhumika Kumar
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Mukesh Pandey
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Faheem H Pottoo
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, P.O. BOX 1982, Dammam 31441, Saudi Arabia
| | - Faizana Fayaz
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - Anjali Sharma
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
| | - P K Sahoo
- Department of Pharmaceutics, Delhi Institute of Pharmaceutical Sciences and Research, Sector-3, MB Road, Pushp Vihar, Delhi, 110017, India
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Mounier NM, Abdel-Maged AES, Wahdan SA, Gad AM, Azab SS. Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020. [DOI: https://doi.org/10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chemotherapy-induced cognitive impairment (CICI): An overview of etiology and pathogenesis. Life Sci 2020; 258:118071. [PMID: 32673664 DOI: 10.1016/j.lfs.2020.118071] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/08/2023]
Abstract
Many cancer patients treated with chemotherapy develop chemotherapy-induced cognitive impairment (CICI), often referred to as chemo-brain, which manifest during or post-treatment with variable degrees, onset and duration thereby affecting the patients' quality of life. Several chemotherapeutic agents have been studied to determine its possible association with cognitive impairment and to fully comprehend their contribution to CICI. A vast number of studies have emerged proposing several candidate underlying mechanisms and etiologies contributing to CICI such as direct neurotoxicity, BBB disruption, decreased hippocampal neurogenesis, white matter abnormalities, secondary neuro-inflammatory response and increased oxidative stress; however, the exact underlying mechanisms are still not well defined. This review summarizes CICI associated with most commonly used chemotherapeutic agents with emphasizes the possible underlying pathogenesis in both animal and clinical studies.
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van den Brand AD, Rubinstein E, van den Berg M, van Duursen MBM. GH3 and RC-4BC cell lines are not suitable as in vitro models to study prolactin modulation and AHR responsiveness in rat pituitary. Mol Cell Endocrinol 2019; 496:110520. [PMID: 31352040 DOI: 10.1016/j.mce.2019.110520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/21/2019] [Accepted: 07/24/2019] [Indexed: 01/10/2023]
Abstract
Some environmental contaminants and pharmaceuticals increase the incidence of uterine tumors in toxicological studies with rats. These tumors can result from a hormonal imbalance due to rat-specific disrupted pituitary prolactin regulation, and are therefore of questionable relevance for humans. In this study we compared in vitro prolactin regulation in rat primary pituitary cells to that in pituitary cell lines, GH3 and RC-4BC. Moreover, we assessed the potential effects of aryl hydrocarbon receptor (AHR) activation on prolactin regulation by using two different AHR agonists, 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and DELAQ, the N-deethylated minor metabolite of the pharmaceutical laquinimod. In rat primary pituitary cells, known prolactin stimulant thyrotropin-releasing hormone (TRH) marginally increased prolactin secretion (1.2-fold) and gene expression (1.3-fold). In contrast, synthetic dopamine receptor agonist quinpirole, a known inhibitor of prolactin release, significantly inhibited prolactin secretion (2.6-fold) and gene expression (3.6-fold). In GH3 cells, TRH strongly increased prolactin secretion (6.8-fold) and gene expression (30.8-fold), whereas quinpirole did not affect prolactin secretion nor gene expression. In RC-4BC cells, both TRH and quinpirole did not modulate prolactin secretion nor gene expression. Prolactin secretion and gene expression did not significantly change upon exposure to TCDD or DELAQ. However, DELAQ, but not TCDD, attenuated quinpirole-inhibited prolactin gene expression by 51% in primary pituitary cells. This study shows that pituitary prolactin regulation in rat primary pituitary cells in vitro is distinctly different from rat pituitary cell lines GH3 and RC-4BC. Therefore, effects on pituitary prolactin regulation in vitro should best be performed using rat primary pituitary cells. Additionally, AHR ligands may interact with rat pituitary prolactin regulation, but this appears to depend on the ligand and constitutive prolactin secretion. However, interpretation of the in vitro results with respect to occurrence of uterine tumors in rats should take the complex regulation of prolactin release in the pituitary into account as well as the in vivo hypothalamus-pituitary-gonadal (HPG) axis and its feedback loops.
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Affiliation(s)
- A D van den Brand
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM, the Netherlands.
| | - E Rubinstein
- TEVA Pharmaceutical Industries Ltd, Netanya, Israel
| | - M van den Berg
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM, the Netherlands
| | - M B M van Duursen
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 104, 3584 CM, the Netherlands; Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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Andersson JK, Khan Z, Weaver AL, Vaughan LE, Gemzell-Danielsson K, Stewart EA. Vaginal bromocriptine improves pain, menstrual bleeding and quality of life in women with adenomyosis: A pilot study. Acta Obstet Gynecol Scand 2019; 98:1341-1350. [PMID: 31025313 DOI: 10.1111/aogs.13632] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Adenomyosis is a benign uterine disease where endometrial glands and stroma are found within the myometrium surrounded by an area of hypertrophic myometrium. Symptomatology includes heavy menstrual bleeding and pelvic pain. The pathogenesis of adenomyosis is not known; however, animal models have shown increased uterine concentration of prolactin as a risk factor. Prolactin acts as a smooth muscle cell mitogen. If prolactin is central to adenomyosis pathogenesis, reducing uterine prolactin could be a possible medical treatment option. In this pilot study, we aim to evaluate the effect of bromocriptine, a prolactin inhibitor, on menstrual bleeding and pain in women with adenomyosis. MATERIAL AND METHODS 23 women with diffuse adenomyosis were enrolled from a university hospital in Sweden and a tertiary care center in the USA. Nineteen patients completed 6 months of treatment with vaginal bromocriptine at a dose of 5 mg daily. Participants completed validated measures at baseline, 3 and 6 months of treatment, and at 9 months (3 months after cessation of bromocriptine). Validated measures utilized included Pictorial Blood Loss Assessment Chart (PBLAC), Aberdeen Menorrhagia Clinical Outcomes Questionnaire (AMCOQ), Visual Analog Scale for pain (VAS), McGill Pain Questionnaire (MPQ), Endometriosis Health Profile (EHP-30), Female Sexual Function Index (FSFI) and the Fibroid Symptom Quality of Life (UFS-QOL) symptom severity and health-related quality of life (HRQL) subscores. Scores were compared between baseline and 9 months using the Wilcoxon signed rank test. RESULTS Mean age of participants was 44.8 years. About 77.8% reported PBLAC scores >250 and 68.4% reported moderate to severe pain at baseline. Compared with baseline, women had lower 9-month scores (median [interquartile range] for all) on PBLAC (baseline 349 [292-645] vs 9-month 233 [149-515], P = 0.003), VAS (5.0 [4-8.3] vs 2.5 [0-4.5], P < 0.001), EHP Core Pain (15.9 [9.1-50.0] vs 3.4 [2.3-34.1], P = 0.029), EHP Core Self-image (41.7 [16.7-58.3] vs 25 [0-5], P = 0.048) and Symptom Severity Score (60 [44-72] vs 44 [25-56], P < 0.001) and higher HRQL scores (57 [37-63] vs 72 [51-85], P < 0.001) following bromocriptine treatment. Other EHP core parameters and FSFI were not significantly different. CONCLUSIONS Significant improvement in menstrual bleeding, pain and quality of life after vaginal bromocriptine treatment suggests a novel therapeutic agent for adenomyosis.
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Affiliation(s)
- Johanna K Andersson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Lisa E Vaughan
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Kristina Gemzell-Danielsson
- Department of Women's and Children's Health, Division of Obstetrics and Gynecology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Elizabeth A Stewart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN, USA
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Seo EJ, Sugimoto Y, Greten HJ, Efferth T. Repurposing of Bromocriptine for Cancer Therapy. Front Pharmacol 2018; 9:1030. [PMID: 30349477 PMCID: PMC6187981 DOI: 10.3389/fphar.2018.01030] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/24/2018] [Indexed: 01/26/2023] Open
Abstract
Bromocriptine is an ergot alkaloid and dopamine D2 receptor agonist used to treat Parkinson's disease, acromegaly, hyperprolactinemia, and galactorrhea, and more recently diabetes mellitus. The drug is also active against pituitary hormone-dependent tumors (prolactinomas and growth-hormone producing adenomas). We investigated, whether bromocriptine also inhibits hormone-independent and multidrug-resistant (MDR) tumors. We found that bromocriptine was cytotoxic towards drug-sensitive CCRF-CEM, multidrug-resistant CEM/ADR5000 leukemic cells as well as wild-type or multidrug-resistant ABCB5-transfected HEK293 cell lines, but not sensitive or BCRP-transfected multidrug-resistant MDA-MB-231 breast cancer cells. Bromocriptine strongly bound to NF-κB pathway proteins as shown by molecular docking and interacted more strongly with DNA-bound NF-κB than free NF-κB, indicating that bromocriptine may inhibit NF-κB binding to DNA. Furthermore, bromocriptine decreased NF-κB activity by a SEAP-driven NF-κB reporter cell assay. The expression of MDR-conferring ABC-transporters (ABCB1, ABCB5, ABCC1, and ABCG2) and other resistance-mediating factors (EGFR, mutated TP53, and IκB) did not correlate with cellular response to bromocriptine in a panel of 60 NCI cell lines. There was no correlation between cellular response to bromocriptine and anticancer drugs usually involved in MDR (e.g., anthracyclines, Vinca alkaloids, taxanes, epipodophyllotoxins, and others). COMPARE analysis of microarray-based mRNA expression in these cell lines revealed that genes from various functional groups such as ribosomal proteins, transcription, translation, DNA repair, DNA damage, protein folding, mitochondrial respiratory chain, and chemokines correlated with cellular response to bromocriptine. Our results indicate that bromocriptine inhibited drug-resistant tumor cells with different resistance mechanisms in a hormone-independent manner. As refractory and otherwise drug-resistant tumors represent a major challenge to successful cancer chemotherapy, bromocriptine may be considered for repurposing in cancer therapy.
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Affiliation(s)
- Ean-Jeong Seo
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
| | - Yoshikazu Sugimoto
- Division of Chemotherapy, Faculty of Pharmacy, Keio University, Tokyo, Japan
| | | | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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Dänicke S. Toxic effects, metabolism, and carry-over of ergot alkaloids in laying hens, with a special focus on changes of the alkaloid isomeric ratio in feed caused by hydrothermal treatment. Mycotoxin Res 2016; 32:37-52. [PMID: 26809637 DOI: 10.1007/s12550-016-0238-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/29/2015] [Accepted: 01/03/2016] [Indexed: 12/01/2022]
Abstract
Ergot alkaloids (EA) are mycotoxins formed by Claviceps purpurea. Due to the large variation in EA content, the mass proportion of ergot (hardened sclerotia) in animal diets is not suited to establish safe levels of EA. Therefore, the aim of the present study was to examine the dose-dependent effects of dietary EA on laying hens. Ergoty rye or ergot-free rye (control diet) was included in the diets either untreated or after hydrothermal treatment ("expansion"). The total EA levels in five different diets containing 0-3% of untreated or expanded rye were 0.1-14.56 mg/kg (untreated rye) and 0.08-13.03 mg/kg (expanded rye). The average EA reduction amounted to 11% due to expanding. The proportions of the sum of all -inine isomers however were consistently higher (19.5-48.4%) compared to the sum of their -ine isomer counterparts which decreased at the same time. Most of the laying performance and reproductive traits were significantly compromised during the test period between weeks 22 and 42 of age when the diet with the highest EA content was fed. Toxic effects were less pronounced due to expanding. Relative weights of liver, proventriculus, and gizzard as well as the aspartate aminotransferase activity, the antibody titers to Newcastle disease virus, albumin, and total bilirubin concentrations were all significantly increased in hens fed at the highest dietary ergot level whereby expanding additionally modified the albumin and total bilirubin responses. No carry-over of EA into egg yolk and albumen, blood, liver, and breast muscle was found, but bile contained quantifiable levels of ergometrine and ergometrinine. Biological recovery of ingested individual alkaloids with the excreta varied from 2 to 22% and was strongly positive linearly related to the octanol to water partition coefficient (logkOW). This suggests the lipophilicity of alkaloids as a factor influencing their metabolism and elimination. Based on the overall results of this study, a lowest observed adverse effect level (LOAEL) of 14.56 mg EA/kg for laying hen diets can be proposed, while the no observed adverse effect level (NOAEL) corresponds to a dietary EA level of 3.72 mg/kg. However, it must be stressed that these critical levels apply for the specific EA pattern tested in the present experiment, while batches of ergot containing a less typical alkaloid composition, or other expanding conditions, might contribute to variations in the LOAEL/NOAEL.
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Affiliation(s)
- Sven Dänicke
- Institute of Animal Nutrition, Friedrich-Loeffler-Institute (FLI), Federal Research Institute for Animal Health, Braunschweig, Germany.
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Haghikia A, Podewski E, Berliner D, Sonnenschein K, Fischer D, Angermann CE, Böhm M, Röntgen P, Bauersachs J, Hilfiker-Kleiner D. Rationale and design of a randomized, controlled multicentre clinical trial to evaluate the effect of bromocriptine on left ventricular function in women with peripartum cardiomyopathy. Clin Res Cardiol 2015; 104:911-7. [PMID: 26026286 PMCID: PMC4623094 DOI: 10.1007/s00392-015-0869-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 05/13/2015] [Indexed: 01/01/2023]
Abstract
Background Peripartum cardiomyopathy (PPCM) is an idiopathic heart disease that develops in the last month of pregnancy and/or the first months following delivery in previously healthy women and may lead to acute heart failure. A cleaved fragment of the nursing hormone prolactin is considered essential in the pathophysiology of PPCM. To date, no specific therapy has been tested for PPCM in a randomized controlled trial of adequate size. Aims The purpose of this trial is to investigate the safety of the dopamin-D2-receptor agonist bromocriptine and its effects on left ventricular (LV) function in women with PPCM. Methods This is an 11 center German trial with a prospective randomized controlled open-label design. The trial enrolls females with newly diagnosed PPCM according to European Society of Cardiology criteria with a LV ejection fraction (LVEF) <35 %. Patients are randomized 1:1 to either best supportive care (BSC) including standard heart failure therapy plus 8 weeks of bromocriptine therapy (2.5 mg b.i.d. for 14 days and 2.5 mg q.d. from day 15 to 56) or to BSC plus 1 week of low-dose bromocriptine (2.5 mg q.d.) with anticoagulant therapy at a prophylactic dose administered during the period of bromocriptine treatment in both groups. The primary endpoint is change in LVEF from baseline to 6 months follow-up as assessed by cardiac magnetic resonance imaging (or echocardiography if CMR is not tolerated). The secondary endpoints are hospitalization for worsening heart failure, heart transplantation, and all-cause mortality during follow-up or a combination of these endpoints. A total of 60 patients will be recruited (including 6 potential dropouts) giving a power of 0.9 for an expected LVEF change of 10.8 % between treatment groups at 6 months. Perspective This trial will provide important knowledge on potential benefits and safety of prolonged inhibition of prolactin release with bromocriptine in addition to standard heart failure therapy in newly diagnosed PPCM. Trial registration: ClinicalTrials.gov Identifier: NCT00998556.
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Affiliation(s)
- Arash Haghikia
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Edith Podewski
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Dominik Berliner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kristina Sonnenschein
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Dieter Fischer
- Department of Cardiology and Angiology, University Hospital Muenster, Muenster, Germany
| | - Christiane E Angermann
- Department of Internal Medicine I, Comprehensive Heart Failure Center, University Hospital of Wuerzburg, Würzburg, Germany
| | - Michael Böhm
- Department of Internal Medicine III, University Hospital of Saarland, Homburg/Saar, Germany
| | - Philipp Röntgen
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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A peripherally restricted P2Y 12 receptor antagonist altered rat tumor incidences with no human relevance: Mode of action consistent with dopamine agonism. Toxicol Rep 2014; 1:1202-1212. [PMID: 28962330 PMCID: PMC5598522 DOI: 10.1016/j.toxrep.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/10/2014] [Accepted: 11/11/2014] [Indexed: 12/26/2022] Open
Abstract
Background Ticagrelor is an orally available, direct acting and reversible P2Y12 receptor antagonist approved for treatment of acute coronary syndrome. The objectives of these studies were to (1) evaluate the Ticagrelor 2-year rat carcinogenicity bioassay data; (2) investigate potential mode of action (MOA) and (3) interpret human relevance. Methods The following studies were done (1) rat two-year carcinogenicity study in male and female rats, (2) in vitro and in vivo genotoxicity assays, (3) quantitative whole body autoradiography (QWBA; male and female rats), (4) in vitro pharmacological profiling for more than 300 assays, and (5) in vivo ovariectomized rat assay. Results The carcinogenicity study indicated Ticagrelor increased uterine tumor incidence while decreasing mammary and pituitary tumors/hyperplasia incidences in only high dose female rats. However, this altered tumor incidences were not P2Y12 target related since marketed non-reversible P2Y12 receptor antagonists were not associated with alter tumor incidences. MOA studies determined Ticagrelor exposure in the anterior pituitary and Ticagrelor was (1) non-genotoxic, (2) peripherally-restricted, (3) a dopamine transport (DAT) inhibitor with an IC50 lower than systemic free exposure in the rat carcinogenic study and more than a log higher than the free systemic exposure seen in clinical trials and (4) an inhibitor of estradiol-induced prolactin secretion. Discussion Similar to Ticagrelor, centrally active dopamine agonists induce the same altered tumor incidence patterns that according to literature do not translate into the clinical setting, with a MOA involving decreased prolactin secretion. The Ticagrelor MOA data and literature suggest that altered dopamine levels in the hypophyseal part of the hypothalamus–hypophyseal axis (by Ticagrelor) will result in similar altered tumor incidences in rat that do not translate into the clinical setting, based on qualitative species differences. In conclusion Ticagrelor increased uterine tumors in the rat carcinogenesis study by a MOA consistent with reduced dopamine inhibition of prolactin, which is not a patient safety risk.
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Key Words
- ADP, adenosine-5′-diphosphate
- AUC, area under the curve
- CHO, Chinese hamster ovary
- Carcinogenicity
- Cmax, maximal concentration, DAT, dopamine transport
- Dopamine transport inhibitor
- E2, estradiol
- GLP, good laboratory practice
- H&E, hematoxylin and eosin
- IC50, inhibitory concentration fifty percent
- Ki, inhibition concentration
- LC-MS/MS, liquid chromatography-mass spectrometric
- LLOQ, lower limits of quantification
- MOA, mode of action
- MTD, maximum tolerated dose
- NH, Hill coefficient
- Prolactin
- QWBA, quantitative whole body autoradiography
- TK, toxicokinetics
- Translational
- Uterine tumor
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BADISA RAMESHB, FITCH-PYE CHERYLA, AGHARAHIMI MARYAM, PALM DONALDE, LATINWO LEKANM, GOODMAN CARLB. Milk thistle seed extract protects rat C6 astroglial cells from acute cocaine toxicity. Mol Med Rep 2014; 10:2287-92. [PMID: 25174449 PMCID: PMC4214335 DOI: 10.3892/mmr.2014.2524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Accepted: 07/09/2014] [Indexed: 12/14/2022] Open
Abstract
Cocaine is a powerful addictive drug, widely abused in most Western countries. It easily reaches various domains within and outside of the central nervous system (CNS), and triggers varying levels of cellular toxicity. No pharmacological treatment is available to alleviate cocaine-induced toxicity in the cells without side-effects. Here, we discerned the role of milk thistle (MT) seed extract against cocaine toxicity. First, we investigated acute cytotoxicity induced by treatment with 2, 3 and 4 mM cocaine for 1 h in astroglial, liver and kidney cells in vitro, and then in living shrimp larvae in vivo. We showed that astroglial cells are more sensitive to cocaine than liver, kidney cells or larvae. Cocaine exposure disrupted the general architecture of astroglial cells, induced vacuolation, decreased cell viability, and depleted the glutathione (GSH) level. These changes may represent the underlying pathology of cocaine in the astrocytes. By contrast, MT pretreatment (200 µg/ml) for 30 min sustained the cell morphological features and increased both cell viability and the GSH level. Besides its protective effects, the MT extract was revealed to be non-toxic to astroglial cells, and displayed high free-radical scavenging activity. The results from this study suggest that enhanced GSH level underlies cell protection, and indicate that compounds that promote GSH synthesis in the cells may be beneficial against cocaine toxicity.
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Affiliation(s)
- RAMESH B. BADISA
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - CHERYL A. FITCH-PYE
- Department of Biological Science, Florida State University, Tallahassee, FL 32310, USA
| | - MARYAM AGHARAHIMI
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - DONALD E. PALM
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
| | - LEKAN M. LATINWO
- Department of Biological Science, Florida A&M University, Tallahassee, FL 32307, USA
| | - CARL B. GOODMAN
- College of Pharmacy and Pharmaceutical Sciences, Florida A&M University, Tallahassee, FL 32307, USA
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Zhang Z, Wang J, Zhang X, Chen S, Wang Z, Zhang B, Liu C, Qu Q, Cheng Y, Li J, Cao H, Cai M, Zhu R. The efficacy and safety of ropinirole prolonged release tablets as adjunctive therapy in Chinese subjects with advanced Parkinson's disease: A multicenter, double-blind, randomized, placebo-controlled study. Parkinsonism Relat Disord 2013; 19:1022-6. [DOI: 10.1016/j.parkreldis.2013.07.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/27/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
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14
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Liu H, Jiang J, Wang H, Chen X, Liu T, Cao H, Palmer J, Gu A, Hu P. A single and multiple dose study to investigate the pharmacokinetics of a prolonged release formulation of ropinirole in healthy Chinese subjects. Clin Pharmacol Drug Dev 2013; 3:84-92. [PMID: 27128453 DOI: 10.1002/cpdd.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 03/11/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Hongzhong Liu
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
| | - Ji Jiang
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
| | - Hongyun Wang
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
| | - Xia Chen
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
| | - Tao Liu
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
| | - Haijun Cao
- GlaxoSmithKline (China) R&D Company Limited; Shanghai China
| | | | - Anita Gu
- GlaxoSmithKline Emerging Markets & Asia Pacific; Shanghai China
| | - Pei Hu
- Clinical Pharmacology Research Centre; Peking Union Medical College Hospital; Beijing China
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Luciano AA, Lanzone A, Goverde AJ. Management of female infertility from hormonal causes. Int J Gynaecol Obstet 2013; 123 Suppl 2:S9-17. [DOI: 10.1016/j.ijgo.2013.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Stocchi F, Destée A. Co-administration of ropinirole and domperidone during rapid dose escalation of the dopamine agonist. Parkinsonism Relat Disord 2012; 4:183-8. [PMID: 18591109 DOI: 10.1016/s1353-8020(98)00041-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/1998] [Revised: 11/25/1998] [Accepted: 12/01/1998] [Indexed: 11/29/2022]
Abstract
In patients naive to dopaminergic therapy, reducing the side-effects associated with dopamine agonist treatment will permit faster titration to effective therapeutic doses. The primary aim of this study was to compare the incidence of dopaminergic side-effects in parkinsonian patients undergoing fast titration with ropinirole under domperidone cover with that of patients undergoing slow titration with matched domperidone placebo. Patients in the former group experienced nausea on significantly fewer days than patients in the latter group. The fast-titration regimen with domperidone cover was well tolerated and allowed ropinirole to be introduced quickly.
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Affiliation(s)
- F Stocchi
- Department of Neurological Science, University "la Sapienza" Roma and Neuromed, Pozzilli (IS), Rome, Italy
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Abstract
Prolactin-secreting pituitary tumors are a common cause of amenorrhea and infertility in premenopausal women. The goals of therapy are to normalize prolactin, restore gonadal function and fertility, and reduce tumor size, and dopamine agonists are the preferred therapy. Clinically significant tumor enlargement during pregnancy is uncommon and dependent on tumor size and prepregnancy treatment.
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Affiliation(s)
- Amal Shibli-Rahhal
- Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Iowa, Iowa City, USA
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18
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Hargreaves A, Harleman J. Preclinical risk assessment of drug-induced hypo- and hyperprolactinemia. J Appl Toxicol 2011; 31:599-607. [DOI: 10.1002/jat.1723] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Revised: 07/08/2011] [Accepted: 07/08/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Adam Hargreaves
- Pathology Department; Safety Assessment, Astrazeneca Pharmaceuticals; Alderley Park; Cheshire; SK10 4TG; UK
| | - Johannes Harleman
- Pathology Department; Safety Assessment, Astrazeneca Pharmaceuticals; Alderley Park; Cheshire; SK10 4TG; UK
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Via MA, Chandra H, Araki T, Potenza MV, Skamagas M. Bromocriptine approved as the first medication to target dopamine activity to improve glycemic control in patients with type 2 diabetes. Diabetes Metab Syndr Obes 2010; 3:43-8. [PMID: 21437075 PMCID: PMC3047985 DOI: 10.2147/dmsott.s9575] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) continues to rise in prevalence in the United States and worldwide. Despite advances in medical treatments for T2DM, many patients remain uncontrolled. By targeting centrally mediated pathways of glucose metabolism, bromocriptine represents a novel therapeutic option in T2DM. Several small clinical trials demonstrate improvements in insulin resistance and glycemic control. After the submission of data from four recent, large clinical trials, the US Food and Drug Administration has approved the use of bromocriptine in T2DM. We review the available data from these four trials and other published studies. Bromocriptine is a promising therapy for diabetes patients and demonstrates modest improvements in glycemic control.
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Affiliation(s)
- Michael A Via
- Division of Endocrinology and Metabolism, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY, USA
- Correspondence: Michael Via, 55 East 34th St, New York, NY 10016, USA, Fax +1 (212) 252-6179, Email
| | - Himani Chandra
- Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, James J Peters VA Medical Center, New York, NY, USA
| | - Takako Araki
- Division of Endocrinology and Metabolism, Albert Einstein College of Medicine, Beth Israel Medical Center, New York, NY, USA
| | | | - Maria Skamagas
- Division of Endocrinology, Diabetes and Bone Disease, Mount Sinai School of Medicine, New York, NY, USA
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Abstract
Prolactinomas are the most frequent pituitary tumors. Treatment of infertility in such tumors usually is very successful. On the other hand, reports of pituitary tumor growth during pregnancy have been described since bromocriptine started to be used. Since then, dopamine agonists (DA) have been increasingly used as the first-choice treatment of prolactinomas, with surgery being reserved for resistance or persistent intolerance to DA or for special situations. More recently other DA, such as quinagolide and cabergoline have shown better tolerance than bromocriptine with similar or greater efficacy. Cabergoline is now the first choice drug but its use in pregnancy is still under evaluation. We followed 71 term pregnancies in women bearing microprolactinomas. Of the 22 patients with previous surgery, none presented symptoms of tumor growth. Of the 41 pregnant patients treated with bromocriptine alone, only one (2.4%) presented with headaches, which regressed with drug reintroduction. Fifty one term pregnancies in patients with macroprolactinomas were followed by us. Of those, 21 were in patients with previous surgery and none of them presented clinical evidence of tumor growth. On the other hand, of the 30 patients treated only with pre-gestational bromocriptine, 11 (37%) manifested complaints related to tumor growth. A non-hormonal contraceptive should be the use along with a DA drug until tumor shrinkage within sellar boundaries has been evidenced. After pregnancy has been confirmed, the DA can be withdrawn and the patient must be closely followed. If tumor expansion is suspected, confirmation can be made through MRI and by visual field testing. Reintroduction of bromocriptine in such cases can lead to tumor reduction and clinical improvement. Surgery can also be employed as treatment for symptomatic tumor growth in pregnancy.
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Affiliation(s)
- Marcello Delano Bronstein
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of S. Paulo Medical School, Av 9 de Julho 3858, 01406-100, S. Paulo, SP, Brazil.
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Fassnacht M, Capeller B, Arlt W, Steck T, Allolio B. Octreotide LAR treatment throughout pregnancy in an acromegalic woman. Clin Endocrinol (Oxf) 2001; 55:411-5. [PMID: 11589686 DOI: 10.1046/j.1365-2265.2001.01304.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report a 24-year-old woman with active acromegaly despite pituitary surgery and irradiation who received continuous octreotide LAR treatment for the control of GH excess throughout her pregnancy. The patient delivered a healthy girl following an uneventful pregnancy. Despite a substantial materno-fetal transfer of octreotide, postnatal development was normal with length parameters around the 50th percentile at 3 months of age. In almost all previously described cases (n = 13) octreotide was stopped after the diagnosis of pregnancy was established. No side-effects of mother or fetus have been reported. Octreotide treatment in pregnancy seems to be feasible and safe. Due to the still-limited number of reported cases, the potential benefits of octreotide treatment should be weighed carefully against its possible risks.
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Affiliation(s)
- M Fassnacht
- Department of Endocrinology, University of Wuerzburg, Germany.
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23
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Cincotta AH, Meier AH, Cincotta M. Bromocriptine improves glycaemic control and serum lipid profile in obese Type 2 diabetic subjects: a new approach in the treatment of diabetes. Expert Opin Investig Drugs 1999; 8:1683-1707. [PMID: 11139820 DOI: 10.1517/13543784.8.10.1683] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Bromocriptine, a potent dopamine D(2) receptor agonist, has been shown to reduce insulin resistance, glucose intolerance and hyperlipidaemia in both numerous animal studies and in Phase II studies. Bromocriptine has been used worldwide for over 20 years to treat Parkinson's disease, macroprolactinoma and other disorders; it has been found to be generally safe. We therefore investigated the possible beneficial effects of Ergoset(R) (Ergo Science Corp.), a new quick release formulation of bromocriptine, on glycaemic control and serum lipid profile in obese Type 2 diabetic subjects in two large Phase III studies. A large, randomised, double-blind placebo-controlled study was conducted in which Ergoset was given once daily at 8 am. (4.8 mg maximum dose) for 24 weeks as adjunctive therapy to sulphonylurea (485 subjects) to obese Type 2 diabetics held on a weight- maintaining diet. Treatment efficacy parameters included change from baseline in glycated haemoglobin A(1c) (HbA(1c)), fasting and post-prandial serum glucose, insulin, triglyceride and free fatty acid levels. Baseline glycated haemoglobin, fasting glucose, insulin, triglyceride and free fatty acid levels did not differ between treatment groups. and on average were 9.4 +/- 0.05%, 222 +/- 2 mg/dl, 24 +/- 1 µU/ml, 248 +/- 11 mg/dl, and 850 +/- 32 µEq/l, respectively. A similarly designed study of Ergoset as monotherapy in Type 2 diabetics (154 subjects) with similar baseline clinical characteristics was conducted. Addition of Ergoset treatment to sulphonylurea reduced percent glycated HbA(1c) by 0.55 (P < 0.0001) (approximately 1.0 for responders, 65% of population), fasting and post-prandial glucose by 23 and 26 mg/dl (P < 0.0002), fasting and post-prandial triglycerides by 72 and 63 mg/dl (P < 0.005) and fasting and post-prandial free fatty acids by 150 and 165 µEq/l (P < 0.05), relative to placebo. Twelve percent of all Ergoset subjects, compared to 3% of placebo subjects, withdrew from the study due to adverse events. The most common events causing withdrawal were nausea, dizziness, asthenia, and rhinitis (representing 4.5, 3.3, 2.0, and 0.8% of the total Ergoset populations, respectively). The incidence of serious adverse events did not differ between Ergoset- (3.4%) and placebo- (4.3%) treated subjects. Ergoset as monotherapy also improved glycaemic control (0.56 HbA(1c) decrease relative to placebo after 24 weeks of treatment; P < 0.02). Once daily Ergoset treatment improves glycaemic control and serum lipid profile and is well-tolerated in obese Type 2 diabetics.
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Affiliation(s)
- A H Cincotta
- Ergo Science Corp., North Andover Mills, 43 High Street, North Andover, MA 01845, USA.
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Abstract
PURPOSE To identify the drugs associated with pleural disease and to review the clinical, radiographic, and pleural fluid findings that occur, the natural history of the pleural reaction, and the response to therapy. DATA SOURCES English-language articles published from January 1966 through April 1998 were identified through searches of the MEDLINE database, selective bibliographies, and personal files. DATA EXTRACTION Case reports, letters, and review articles were assessed for relevancy. Reports of drug-associated pleural effusion, pleuritis, and/or pleural thickening were analyzed. Drug effect was believed to be causal when exposure induced pleural disease, when the pleural response remitted on discontinuation of the drug, and when the pleural disease recurred with reexposure. Drug association was inferred when the pleural disease occurred following drug exposure and remitted after drug discontinuation. The incidence, clinical presentation, dose and duration of drug therapy, chest radiographic findings, pleural fluid analysis, and response to therapy were recorded. CONCLUSIONS A relatively small number of drugs were found to induce pleural disease when compared to the number of drugs implicated in causing disease of the lung parenchyma. Treatment of drug-induced pleural disease consists of drug therapy withdrawal and corticosteroids for refractory cases. Knowledge of the potential of drug-induced pleural disease will provide a clinical advantage to the physician and should lead to decreased morbidity and economic burden for the patient by avoidance of further diagnostic testing.
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Affiliation(s)
- S Y Morelock
- Division of Pulmonary and Critical Care Medicine, Allergy and Clinical Immunology, Medical University of South Carolina, Charleston 29425, USA
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Hagell P, Odin P, Vinge E. Pregnancy in Parkinson's disease: a review of the literature and a case report. Mov Disord 1998; 13:34-8. [PMID: 9452323 DOI: 10.1002/mds.870130110] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Pregnancy is rare in Parkinson's disease (PD). In the literature on studies of antiparkinsonian drugs in animals during pregnancy, there are reports on malformations of the skeletal and circulatory system. However, the majority of studies in animals have not shown any teratogenicity. Amantadine has been teratogenic in rats and selegiline has caused neurochemical and behavioral alterations in rats when coadministered with clorgyline. The published experience with humans consists of 35 pregnancies among 26 women suffering from PD, including this report, and a number of cases treated with antiparkinsonian agents for other reasons. With the exception of the majority of the cases where amantadine was used, complications have been rare. However, there are indications that suggest a possible risk of a woman's parkinsonism worsening in connection with pregnancy. We also report the case of a woman with PD who was treated with L-dopa-benserazide during an uncomplicated pregnancy and gave birth to a healthy boy without experiencing any worsening of her PD.
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Affiliation(s)
- P Hagell
- Section of Restorative Neurology, Wallenberg Neuroscience Center, University Hospital, Lund, Sweden
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Abstract
Ovulation-induction agents are commonly used in the treatment of infertility in patients with or without ovulatory disturbances. These agents include clomifene, bromocriptine, gonadotrophin preparations and gonadotrophin-releasing hormone (GnRH) and its analogues. Each agent is associated with its own specific adverse effects. Although many of these adverse effects are benign and self-limited, some, in particular those effects associated with gonadotrophins, may be life-threatening. Commonly noted adverse effects encountered with the use of pharmacological agents to treat infertility include the following. Clomifene has been associated with hot flushes, multiple gestation, visual disturbances, cervical mucus abnormalities and luteal phase deficiency. Similarly, most of the adverse symptoms associated with bromocriptine are short-lived, such as nausea and postural hypotension. On the other hand, gonadotrophin therapy, even when used appropriately, may lead to the ovarian hyperstimulation syndrome (which is occasionally life-threatening) and a high incidence of multiple gestation. Pulsatile GnRH therapy maybe accompanied by similar adverse effects to those of gonadotrophins, but with a far lower incidence. With regards to the long term safety of these medications, the relationship between fertility drugs and epithelial ovarian cancer is controversial, and causality has yet to be proven. Indeed, a working knowledge of the many adverse effects associated with these medications is essential to any physician prescribing ovulation induction agents, in order to ensure maximum patient safety, compliance and understanding.
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Affiliation(s)
- S G Derman
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore, USA
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Postpartum Hypertension, Bromocriptine and Phenylpropanolamine. Clin Drug Investig 1994. [DOI: 10.1007/bf03258485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Cocaine abuse is an increasing problem in the obstetric population. It not only poses a health risk to the pregnant woman, but can precipitate premature labor and abruptio placentae, and has been associated with a number of physical and behavioral problems in the newborn. Evaluation and management of the pregnant cocaine abuser is similar in most respects to that of nonpregnant adults, but diagnosis, psychotherapy, and pharmacotherapy is strongly influenced by the pregnancy. This article describes the risks of cocaine use during pregnancy and outlines the evaluation and management of the pregnant cocaine abuser.
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Affiliation(s)
- M E James
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia
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Rojas FJ, Djannati E, Rojas IM. The effect of bromocriptine on the motility of human spermatozoa and its capacity to penetrate the cervical mucus. Fertil Steril 1991; 55:48-52. [PMID: 1986972 DOI: 10.1016/s0015-0282(16)54057-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We investigated the direct effects of bromocriptine on the motility of the human ejaculated spermatozoa and its capacity to penetrate the cervical mucus (CM) in vitro. Washed sperm were incubated with a wide range of bromocriptine concentrations (0.005 to 5 mM). Progressive and total motility was evaluated after 15, 30, 60, and 180 minutes. No reduction of motility was observed at any concentration tested. Similar results were observed with semen samples. Failure to alter sperm motility was evident in samples with either good or reduced motility. Also, CM penetration as measured after 90 minutes by Penetrak assay (Serono Diagnostics, Randolph, MA) was not impaired by a concentration as high as 5 mM bromocriptine. We conclude that bromocriptine in a wide range of concentrations does not inhibit sperm motility nor does it impair the capability of the sperm to penetrate the CM. These data support the therapeutic use of daily vaginal bromocriptine for the treatment of infertility.
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Affiliation(s)
- F J Rojas
- Department of Obstetrics and Gynecology, University of California Irvine Medical Center, Orange 92668
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Abstract
The use of bromocriptine in the treatment of Parkinson's disease is increasing. More than 20 cases of suggested drug-induced pleuropulmonary disorders during bromocriptine therapy have been reported. We describe four male parkinsonian patients taking bromocriptine in whom pleuropulmonary abnormalities were discovered in a pulmonary hospital during a one-year period. In only one case were the roentgenographic changes reversible after withdrawal of the drug. Pleural fluid from two patients was analyzed and showed lymphocyte-predominant chronic inflammatory changes. Raised erythrocyte sedimentation rate (ESR) and C-reactive protein values decreased after cessation of bromocriptine. Lung function studies demonstrated volume restriction with normal or high CO transfer coefficient. The frequency of pleuropulmonary changes during bromocriptine therapy may be greater than assumed, and such patients may initially present with nonrespiratory symptoms. Follow-up of patients during bromocriptine treatment by ESR, C-reactive protein, and chest roentgenogram is recommended.
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Affiliation(s)
- E Kinnunen
- Department of Pulmonary Medicine, Meltola Hospital, Helsinki, Finland
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