1
|
Joung JY, Son CG. Evaluating the Safety of Herbal Medicine on Renal Function: A Comprehensive Analysis from Six Randomized Controlled Trials Conducted with Four Formulations from Traditional Korean Medicine. Pharmaceuticals (Basel) 2024; 17:544. [PMID: 38794115 PMCID: PMC11124499 DOI: 10.3390/ph17050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/26/2024] Open
Abstract
The growing popularity of herbal medicine raises concerns about potential nephrotoxicity risks, while limited evidence hinders a comprehensive impact assessment. This study aims to investigate the overall risk features of herbal medicine on kidney injury. We conducted a retrospective analysis on renal function changes, including blood urea nitrogen (BUN), serum creatinine, and estimated glomerular filtration rate (eGFR), through data from six randomized controlled trials (RCTs) in South Korea. A total of 407 participants (142 males, 265 females) received either one of four different herbal medicines (240 participants) or a placebo (167 participants). When comparing changes in eGFR regarding the mean, 90th-percentile value, and 20% reduction after treatment, there was no significant difference between the herbal-treated and placebo groups. This study provided a helpful reference for examining the safety issues of herbal remedies, especially regarding kidney function.
Collapse
Affiliation(s)
- Jin-Yong Joung
- Department of Internal Medicine, Daejeon Good-Morning Oriental Hospital, Dunsan-ro 123 beon-gil 21, Seo-gu, Daejeon 35240, Republic of Korea;
- Department of Korean Medicine, Korean Medical College, Daejeon University, Daehak-ro 62, Dong-gu, Daejeon 34520, Republic of Korea
| | - Chang-Gue Son
- Department of Korean Medicine, Korean Medical College, Daejeon University, Daehak-ro 62, Dong-gu, Daejeon 34520, Republic of Korea
- Liver and Immunology Research Center, Daejeon Oriental Hospital of Daejeon University, Daedukdae-ro 176 bun-gil 75, Seo-gu, Daejeon 35235, Republic of Korea
| |
Collapse
|
2
|
Jung YS, Jin BH, Choi JE, Park MS, Kim YW, Kang HW, Cho S, Kim CO. Assessment of Pharmacokinetic Effects of Herbal Medicines on Escitalopram. Ther Clin Risk Manag 2024; 20:151-160. [PMID: 38434107 PMCID: PMC10906722 DOI: 10.2147/tcrm.s448090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Herbal medicines are occasionally used in combination with conventional antidepressants to mitigate various depression-associated symptoms. However, there is limited information on herb-antidepressant interactions. In this study, we investigated the pharmacokinetic (PK) effects of four herbal medicines (Gami-soyosan, Banhasasim-tang, Ojeok-san, and Bojungikgi-tang) on escitalopram, a commonly used antidepressant. Patients and Methods In this open-label, fixed-sequence, three-period, crossover study, 18 participants were enrolled and divided into two groups. Each group received a 10 mg oral dose of escitalopram in period 1. Participants took escitalopram once daily and their assigned herbal medicines thrice a day for 7 d in periods 2 (group 1: Gami-soyosan, group 2: Ojeok-san) and 3 (group 1: Banhasasim-tang; group 2: Bojungikgi-tang). The primary endpoints were Cmax,ss and AUCtau,ss of escitalopram. Cmax,ss and AUCtau,ss in period 1 were obtained using nonparametric superposition from single-dose data. The PK endpoints were classified according to the CYP2C19 phenotype. Results Of 18 participants, 16 completed the study. Systemic exposure to escitalopram resulted in a minor increase in the presence of each herbal medicine. The geometric mean ratios (GMRs, combination with herbal medicines/escitalopram monotherapy) and their 90% confidence intervals (CIs) for Cmax,ss and AUCtau,ss were as follows: Gamisoyosan- 1.1454 (0.9201, 1.4258) and 1.0749 (0.8084, 1.4291), Banhasasim-tang-1.0470 (0.7779, 1.4092) and 1.0465 (0.7035, 1.5568), Ojeok-san-1.1204 (0.8744, 1.4357) and 1.1267 (0.8466, 1.4996), and Bojungikgi-tang-1.1264 (0.8594, 1.4762) and 1.1400 (0.8515, 1.5261), respectively. Furthermore, no significant differences in the GMRs of Cmax,ss and AUCtau,ss were observed across different CYP2C19 phenotypes in any of the groups. Conclusion The co-administration of escitalopram with Gami-soyosan, Banhasasim-tang, Ojeok-san, or Bojungikgi-tang did not exert significant PK effects on escitalopram. These findings provide valuable insights into the safe use of herbal medicines along with escitalopram.
Collapse
Affiliation(s)
- Yun Seob Jung
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hak Jin
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Ju Eun Choi
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Min Soo Park
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Woo Kim
- School of Korean Medicine, Dongguk University, Gyeongju, Korea
| | - Hyung Won Kang
- College of Korean Medicine, Wonkwang University, Iksan, Korea
| | | | - Choon Ok Kim
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| |
Collapse
|
3
|
Kang SM, Won JH, Han JE, Kim JH, Kim KH, Jeong HI, Sung SH. Chromatographic Method for Monitoring of Pesticide Residues and Risk Assessment for Herbal Decoctions Used in Traditional Korean Medicine Clinics. Molecules 2023; 28:molecules28083343. [PMID: 37110577 PMCID: PMC10142989 DOI: 10.3390/molecules28083343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The presence of pesticide residues in herbs and the herbal products derived from them raises serious health concerns. This study was conducted to investigate the residual pesticide concentrations and assess potential human health risks from herbal medicines used in traditional Korean medicine clinics. A total of 40 samples of herbal decoctions were collected from 10 external herbal dispensaries. The pesticide residues were analyzed by the multiresidue method for 320 different pesticides using liquid chromatography tandem mass spectrometry (LC-MS/MS) and gas chromatography tandem mass spectrometry (GC-MS/MS). As a result of the monitoring, carbendazim was detected at 0.01 and 0.03 μg/g in eight samples and no pesticide was detected in the other herbal decoctions. Carbendazim was set for each individual item as less than 0.05 μg/g in Paeoniae radix, less than 0.05 μg/g in Cassiae semen, less than 2.0 μg/g in Lycii fructus, and less than 10 μg/g in Schisandrae fructus (dried). Therefore, the results of this study suggested that the detected pesticide residues in herbal decoctions could not be considered as posing a serious health risk.
Collapse
Affiliation(s)
- Se-Mi Kang
- Department of Public Infrastructure Operation, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Jae-Hee Won
- Department of Public Infrastructure Operation, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Ji-Eun Han
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Jong-Hyun Kim
- Department of Medical Classics and History, College of Korean Medicine, Gachon University, Seongnam-si 13120, Republic of Korea
| | - Kyeong-Han Kim
- Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Jeonju-si 54986, Republic of Korea
| | - Hye-In Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Soo-Hyun Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| |
Collapse
|
4
|
Sung SH, Lee HJ, Han JE, Sung ADM, Park M, Shin S, Jeong HI, Jang S, Lee G. Bee Venom Acupuncture for Neck Pain: A Review of the Korean Literature. Toxins (Basel) 2023; 15:toxins15020129. [PMID: 36828443 PMCID: PMC9967438 DOI: 10.3390/toxins15020129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/08/2023] Open
Abstract
Bee venom is a natural toxin that is effective in treating various types of pain. The purpose of this paper was to review all the features of clinical studies conducted on bee venom acupuncture (BVA) for the treatment of neck pain in Korean publications. Six Korean databases and 16 Korean journals were searched in August 2022 for clinical studies on BVA for neck pain. We identified 24 trials that met our inclusion criteria, of which 316 patients with neck pain were treated with BVA. The most common diagnosis in the patients with neck pain was herniated intervertebral discs (HIVDs) of the cervical spine (C-spine) (29.2%), and the concentration and dosage per session were 0.05-0.5 mg/mL and 0.1-1.5 mL, respectively. The visual analog scale was most often measured for neck pain severity (62.5%), and all clinical research reported improvements in 16 outcome measures. This study shows that BVA could be recommended for the treatment of neck pain, especially HIVD of the C-spine; however, the adverse effects of BVA must be examined in future studies.
Collapse
Affiliation(s)
- Soo-Hyun Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Hee-Jung Lee
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Ji-Eun Han
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Angela Dong-Min Sung
- Department of Policy Development, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Minjung Park
- Center for Development of Innovative Technologies in Korean Medicine, National Institute of Korean Medicine Development, Seoul 04554, Republic of Korea
| | - Seungwon Shin
- Department of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Hye In Jeong
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Soobin Jang
- Department of Preventive Medicine, College of Korean Medicine, Daegu Haany University, Gyeongsan 38609, Republic of Korea
| | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju 58245, Republic of Korea
- Correspondence:
| |
Collapse
|
5
|
Han JE, Park M, An TEB, Park JH, Oh D, Kim KH, Sung SH. Quality Control of Pharmacopuncture: A Comparative Study of Good Manufacturing Practice and External Herbal Dispensary Standards. J Pharmacopuncture 2021; 24:59-67. [PMID: 34249396 PMCID: PMC8220506 DOI: 10.3831/kpi.2021.24.2.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives We aimed to compare the external herbal dispensary (EHD) evaluation criteria for pharmacopuncture and the Korea Good Manufacturing Practice (KGMP) sterile medicine standards to contribute to the establishment of quality control criteria for pharmacopuncture. Methods We obtained the KGMP standards from the Ministry of Food and Drug Safety and the pharmacopuncture certification criteria from the Ministry of Health and Welfare of South Korea. The EHD evaluation items were classified into three categories facilities, quality control, and validation. The evaluation items were compared with the KGMP sterile medicine criteria to determine their conformance with each other, followed by a discussion among the committee of six experts and their consensus to suggest the items to complement the EHD evaluation criteria. Results Among the KGMP sterile medicine criteria, 44 were related to the management of the facilities, and 32 pharmacopuncture evaluation items corresponded to these KGMP items (66.7%). Fifty-eight KGMP criteria were related to quality management, and 42 pharmacopuncture evaluation items corresponded to these KGMP items (72.4%). Twenty-five KGMP sterile medicine criteria were related to validation, and 11 pharmacopuncture evaluation items corresponded to these KGMP items (44.0%). Sixteen items under the pharmacopuncture EHD criteria corresponded to the KGMP sterile medicine criteria based on the consent of the experts. Among these, 4 were related to facility management, 6 were related to quality control, and 6 were related to validation. Conclusion For the safety and quality control of pharmacopuncture, there is a need to select the criteria for the mandatory items among the proposed pharmacopuncture-EHD criteria laws and systems to ensure that the pharmacopuncture materials are produced under the pharmacopuncture-EHD in compliance with the relevant requirements. More studies are needed to secure the safety level of pharmacopuncture materials corresponding to that of conventional medicine.
Collapse
Affiliation(s)
- Ji-Eun Han
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul, Republic of Korea
| | - Minjung Park
- National Agency for Development of Innovative Technologies in Korean Medicine, Seoul, Republic of Korea
| | - Tteul-E-Bom An
- Kind Cloud Korean Medicine Clinic, Jinju, Republic of Korea
| | - Jong-Hyun Park
- Department of Pathology, College of Korean Medicine, Dae-Gu Haany University, Gyeongsan, Republic of Korea
| | - Danny Oh
- Grauate School of Social Welfare, Soongsil University, Seoul, Republic of Korea
| | - Kyeong Han Kim
- Department of Preventive Medicine, College of Korean Medicine, Woosuk University, Wanju, Republic of Korea
| | - Soo-Hyun Sung
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Sung SH, Kim JW, Han JE, Shin BC, Park JK, Lee G. Animal Venom for Medical Usage in Pharmacopuncture in Korean Medicine: Current Status and Clinical Implication. Toxins (Basel) 2021; 13:toxins13020105. [PMID: 33535603 PMCID: PMC7912904 DOI: 10.3390/toxins13020105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 02/08/2023] Open
Abstract
Animal venoms, widespread throughout the world, are complex mixtures, the composition of which depends on the venom-producing species. The objective of this study was to contribute to the development of animal venom-based medicines by investigating the use of animal venom pharmacopuncture in Korean medicine (KM) institutions. We surveyed 256 public health centers from 1 through 31 October 2019 as guided by the Ministry of Health and Welfare (MoHW). A questionnaire developed by an expert group was distributed and collected for statistical analysis. The survey identified three types of animal venom-based pharmacopuncture: bee, snake, and toad venoms. The medications are based on a single animal venom ingredient and produced in 11 external herbal dispensaries (EHDs). Each animal venom is processed, refined, and freeze-dried in a cleanroom to produce a powder formulation that is later measured, diluted, filtered, filled, sealed, sterilized, and packaged as pharmacopuncture injections used in KM institutions. Bee venom therapy is effective in treating musculoskeletal pain, snake venom therapy is effective in controlling bleeding during surgery, and toad venom therapy is effective in cancer treatment. The study suggests that bee, snake, and toad venoms could be used in medical institutions and have the potential for drug development.
Collapse
Affiliation(s)
- Soo-Hyun Sung
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Ji-Won Kim
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Ji-Eun Han
- Department of Policy Development, National Development Institute of Korean Medicine, Seoul 04554, Korea; (S.-H.S.); (J.-W.K.); (J.-E.H.)
| | - Byung-Cheul Shin
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea; (B.-C.S.); (J.-K.P.)
| | - Jang-Kyung Park
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan 50612, Korea; (B.-C.S.); (J.-K.P.)
| | - Gihyun Lee
- College of Korean Medicine, Dongshin University, Naju 58245, Korea
- Correspondence:
| |
Collapse
|