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Gorin M, Shabani M, Votat S, Lebrun L, Foukmeniok Mbokou S, Pontié M. Application of fungal-based microbial fuel cells for biodegradation of pharmaceuticals: Comparative study of individual vs. mixed contaminant solutions. CHEMOSPHERE 2024; 363:142849. [PMID: 39009093 DOI: 10.1016/j.chemosphere.2024.142849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 06/04/2024] [Accepted: 07/13/2024] [Indexed: 07/17/2024]
Abstract
The present study focuses on the application of fungal-based microbial fuel cells (FMFC) for the degradation of organic pollutants including Acetaminophen (APAP), Para-aminophenol (PAP), Sulfanilamide (SFA), and finally Methylene Blue (MB). The objective is to investigate the patterns of degradation (both individually and as a mixture solution) of the four compounds in response to fungal metabolic processes, with an emphasis on evaluating the possibility of generating energy. Linear Sweep Voltammetry (LSV) has been used for electrochemical analysis of the targeted compounds on a Glassy Carbon Electrode (GCE). A dual chamber MFC has been applied wherein the cathodic compartment, the reduction reaction of oxygen was catalyzed by an elaborated biofilm of Trametes trogii, and the anodic chamber consists of a mixed solution of 200 mg L-1 APAP, PAP, MB, and SFA in 0.1 M PBS and an elaborated biofilm of Trichoderma harzianum. The obtained results showed that all the tested molecules were degraded over time by the Trichoderma harzianum. The biodegradation kinetics of all the tested molecules were found to be in the pseudo-first-order. The results of half-lives and the degradation rate reveal that APAP in its individual form degrades relatively slower (0.0213 h-1) and has a half-life of 33 h compared to its degradation in a mixed solution with a half-life of 20 h. SFA showed the longest half-life in the mixed condition (98 h) which is the opposite of its degradation as individual molecules (20 h) as the fastest molecule compared to other pollutants. The maximum power density of the developed MFC dropped from 0.65 mW m-2 to 0.32 mW m-2 after 45.5 h, showing that the decrease of the residual concentration of molecules in the anodic compartment leads to the decrease of the MFC performance.
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Affiliation(s)
- Melody Gorin
- University of Angers, Group Analysis and Processes (GA&P), Dept. of Chemistry, 2 Bd. A. de Lavoisier 49045 Angers cedex 01, France
| | - Mehri Shabani
- University of Angers, Group Analysis and Processes (GA&P), Dept. of Chemistry, 2 Bd. A. de Lavoisier 49045 Angers cedex 01, France; ESAIP La Salle, CERADE, 18, rue du 8 mai 1945, Saint-Barthélemy d'Anjou, Cedex, 49180, France.
| | - Sébastien Votat
- Normandie Université, Université Rouen Normandie, CNRS UMR, 6270, Polymères, Biopolymères, Surfaces, 76821, Mont Saint Aignan, France
| | - Laurent Lebrun
- Normandie Université, Université Rouen Normandie, CNRS UMR, 6270, Polymères, Biopolymères, Surfaces, 76821, Mont Saint Aignan, France
| | - Serge Foukmeniok Mbokou
- University of Angers, Group Analysis and Processes (GA&P), Dept. of Chemistry, 2 Bd. A. de Lavoisier 49045 Angers cedex 01, France
| | - Maxime Pontié
- University of Angers, Group Analysis and Processes (GA&P), Dept. of Chemistry, 2 Bd. A. de Lavoisier 49045 Angers cedex 01, France
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Hossen MS, Akter A, Azmal M, Rayhan M, Islam KS, Islam MM, Ahmed S, Abdullah-Al-Shoeb M. Unveiling the molecular basis of paracetamol-induced hepatotoxicity: Interaction of N-acetyl- p-benzoquinone imine with mitochondrial succinate dehydrogenase. Biochem Biophys Rep 2024; 38:101727. [PMID: 38766381 PMCID: PMC11098724 DOI: 10.1016/j.bbrep.2024.101727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/13/2024] [Accepted: 04/30/2024] [Indexed: 05/22/2024] Open
Abstract
Background and aim N-acetyl-p-benzoquinoneimine (NAPQI), a toxic byproduct of paracetamol (Acetaminophen, APAP), can accumulate and cause liver damage by depleting glutathione and forming protein adducts in the mitochondria. These adducts disrupt the respiratory chain, increasing superoxide production and reducing ATP. The goal of this study was to provide computational proof that succinate dehydrogenase (SDH), a subunit of complex II in the mitochondrial respiratory chain, is a favorable binding partner for NAPQI in this regard. Method Molecular docking, molecular dynamics simulation, protein-protein interaction networks (PPI), and KEGG metabolic pathway analysis were employed to identify binding characteristics, interaction partners, and their associations with metabolic pathways. A lipid membrane was added to the experimental apparatus to mimic the natural cellular environment of SDH. This modification made it possible to develop a context for investigating the role and interactions of SDH within a cellular ecosystem that was more realistic and biologically relevant. Result The molecular binding affinity score for APAP and NAPQI with SDH was predicted -6.5 and -6.7 kcal/mol, respectively. Furthermore, RMSD, RMSF, and Rog from the molecular dynamics simulations study revealed that NAPQI has slightly higher stability and compactness compared to APAP at 100 ns timeframe with mitochondrial SDH. Conclusion This study serves to predict the mechanistic process of paracetamol toxicity by using different computational approaches. In addition, this study will provide information about the drug target against APAP hepatotoxicity.
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Affiliation(s)
- Md Sahadot Hossen
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Adiba Akter
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Mahir Azmal
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Mostakim Rayhan
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Kazi Saiful Islam
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Md Mahmodul Islam
- Department of Pharmacy, Noakhali Science and Technology University, Noakhali 3814, Bangladesh
| | - Shamim Ahmed
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
| | - Mohammad Abdullah-Al-Shoeb
- Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh
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Ricci E, Glavasc A, Morandini B, Grassi MC, La Torre G. The Effectiveness of Paracetamol to Reduce the Post-Vaccination SARS-CoV-2 Adverse Effects in an Italian Vaccination Center. Vaccines (Basel) 2023; 11:1493. [PMID: 37766169 PMCID: PMC10534772 DOI: 10.3390/vaccines11091493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/13/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
The arrival of specific vaccines was crucial for the eradication of COVID-19. Despite the security of the vaccination, the administration of COVID-19 mRNA vaccines often causes systemic side effects for a short time after the injection, such as headache, fatigue, fever, muscle pain and nausea. These side effects can limit the adherence to COVID-19 vaccines administration, especially in healthcare workers. This study aims to analyze the impact of the prophylactic use of paracetamol to reduce the post-vaccination Comirnaty/Pfizer adverse effects. The study took place at the San Giovanni Battista Hospital in Rome and included all hospital employees who received two doses of Pfizer-BioNTech. The vaccination health personnel recommended the preventive intake of 1 g of paracetamol before the inoculation of the vaccine and then every 6 h in the first 24 h. Information was collected through forms and subsequent telephone recall. A total of 403 volunteers were involved in the study, with 391 of them receiving two doses and twelve individuals only one dose of the vaccine. The main results demonstrated that the prophylactic therapy influenced the lower onset of asthenia in the first and second doses. However, there were no significant differences between the two groups in terms of fever, headache and localized pain. Paracetamol had a good impact on the side effect of COVID-19 vaccination, reducing asthenia in both doses and mitigating the total of symptoms during the second vaccination.
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Affiliation(s)
- Eleonora Ricci
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
| | - Anamaria Glavasc
- San Giovanni Battista Hospital, 00148 Roma, Italy; (A.G.); (B.M.)
| | | | - Maria Caterina Grassi
- Department of Physiology and Pharmacology “V. Erspamer”, Sapienza University of Rome, 00185 Rome, Italy;
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy;
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Raza SA, Keith MB, Koh KC. Perspectives on Using Fast-Dissolving Paracetamol for Mild-to-Moderate Pain Management in Elderly or Diabetic Patients with Delayed Gastric Emptying Rates: An Exploratory Study. J Pain Res 2022; 15:3675-3688. [DOI: 10.2147/jpr.s373666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022] Open
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Ferroptosis: Shedding Light on Mechanisms and Therapeutic Opportunities in Liver Diseases. Cells 2022; 11:cells11203301. [PMID: 36291167 PMCID: PMC9600232 DOI: 10.3390/cells11203301] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 11/17/2022] Open
Abstract
Cell death is a vital physiological or pathological phenomenon in the development process of the organism. Ferroptosis is a kind of newly-discovered regulated cell death (RCD), which is different from other RCD patterns, such as apoptosis, necrosis and autophagy at the morphological, biochemical and genetic levels. It is a kind of iron-dependent mode of death mediated by lipid peroxides and lipid reactive oxygen species aggregation. Noteworthily, the number of studies focused on ferroptosis has been increasing exponentially since ferroptosis was first found in 2012. The liver is the organ that stores the most iron in the human body. Recently, it was frequently found that there are different degrees of iron metabolism disorder and lipid peroxidation and other ferroptosis characteristics in various liver diseases. Numerous investigators have discovered that the progression of various liver diseases can be affected via the regulation of ferroptosis, which may provide a potential therapeutic strategy for clinical hepatic diseases. This review aims to summarize the mechanism and update research progress of ferroptosis, so as to provide novel promising directions for the treatment of liver diseases.
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Sahin B, Karabulut S, Filiz AK, Özkaraca M, Gezer A, Akpulat HA, Ataseven H. Galium aparine L. protects against acetaminophen-induced hepatotoxicity in rats. Chem Biol Interact 2022; 366:110119. [PMID: 36029804 DOI: 10.1016/j.cbi.2022.110119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/08/2022] [Accepted: 08/16/2022] [Indexed: 11/25/2022]
Abstract
The toxicity of acetaminophen (N-acetyl-para-aminophenol (APAP)) is the most frequent cause of drug-induced liver damage. Galium aparine L. (GA) is traditionally used to treat jaundice. We aimed to investigate the hepatoprotective potential of GA in the APAP-induced hepatic encephalopathy (HE) rat model. Qualitative phytochemical characterization of GA was performed by LC/Q-TOF/MS analysis. Wistar rats were pretreated with GA (250 and 500 mg/kg b.wt. per oral) for five days. On the 6th day, the rats were exposed to APAP (1500 mg/kg b.wt. oral gavage) and behavioral tests (open field and passive avoidance tests) were applied on the 7th and 8th days. The animals were killed, and biochemical and histopathological parameters were assessed in blood and hepatic specimens. GA pretreated rats exhibited a significant reduction in APAP-induced liver damage, evidenced by the reduction in liver necrosis and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and bilirubin (BIL). GA demonstrated an anxiolytic effect, as seen in the acquisition trial and grooming behavior. The short-term memory performances of animals were not changed in all groups, suggesting that APAP intoxication did not affect hippocampal function. These results show that GA extract markedly exerts hepatoprotective activity, while its effect on hepatic encephalopathy was limited.
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Affiliation(s)
- Bilal Sahin
- Department of Medical Physiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Sebahattin Karabulut
- Department of Medical Services and Techniques, Vocational School of Health Services, Sivas Cumhuriyet University, Sivas, Turkey.
| | - Ahmet Kemal Filiz
- Department of Medical Physiology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Mustafa Özkaraca
- Department of Veterinary Pathology, Faculty of Veterinary Medicine, Sivas Cumhuriyet University, Sivas, Turkey
| | - Arzu Gezer
- Department of Health Care Services, Vocational School of Health Services, Atatürk University, Erzurum, Turkey
| | | | - Hilmi Ataseven
- Department of Internal Medicine, Discipline of Gastroenterology, Faculty of Medicine, Sivas Cumhuriyet University, Sivas, Turkey
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Antony B, Benny M, Kuruvilla BT, Gupta NK, Jacob S. Acute and sub chronic toxicity studies with herbal pain relieving formula (Rhuleave-K™) in rats. Regul Toxicol Pharmacol 2022; 133:105214. [PMID: 35781033 DOI: 10.1016/j.yrtph.2022.105214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/17/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
Rhuleave-K™ is a proprietary combination of Curcuma longa extract, Boswellia serrata extract and black sesame seed oil. Acute toxicity was evaluated as per OECD guidelines 423. Rhuleave-K™ was fed at 2000 mg/kg to overnight fasted female rats. Clinical signs of abnormality and mortality was observed daily for 14 days. Sub-chronic toxicity was studied by feeding Rhuleave-K™ at 100, 500 and 1000 mg/kg/day to rats as per OECD guidelines 408. After 90 days feeding, heamatological and biochemical parameters were analyzed. Histopathology of all the major organs was also studied. In the acute toxicity study, there was no clinical sign of toxicity in any of the rat at maximum dose of 2000 mg/kg. The LD50 was computed as >2000 mg/kg in rats. The repeated dosing of Rhuleave-K™ at the maximum dose level of 1000 mg/kg for 90 days did not induce any observable toxic effects in rats, when compared to its corresponding control. The hematology and biochemistry profile of treated rats was similar to control animals and difference was non-significant (p > 0.05). The histopathology of major organs of all the control and treated animals was normal. In this study the NOAEL for Rhuleave-K™ was calculated as 1000 mg/kg daily in rats.
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Affiliation(s)
- Benny Antony
- Research and Development Laboratory, Arjuna Natural Private Ltd., Erumathala PO, Aluva, Kerala, 683112, India
| | - Merina Benny
- Research and Development Laboratory, Arjuna Natural Private Ltd., Erumathala PO, Aluva, Kerala, 683112, India.
| | - Binu T Kuruvilla
- Research and Development Laboratory, Arjuna Natural Private Ltd., Erumathala PO, Aluva, Kerala, 683112, India
| | - Nishant Kumar Gupta
- Research and Development Laboratory, Arjuna Natural Private Ltd., Erumathala PO, Aluva, Kerala, 683112, India
| | - Sherina Jacob
- Research and Development Laboratory, Arjuna Natural Private Ltd., Erumathala PO, Aluva, Kerala, 683112, India
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Alchin J, Dhar A, Siddiqui K, Christo PJ. Why paracetamol (acetaminophen) is a suitable first choice for treating mild to moderate acute pain in adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, or who are older. Curr Med Res Opin 2022; 38:811-825. [PMID: 35253560 DOI: 10.1080/03007995.2022.2049551] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Acute pain is among the most common reasons that people consult primary care physicians, who must weigh benefits versus risks of analgesics use for each patient. Paracetamol (acetaminophen) is a first-choice analgesic for many adults with mild to moderate acute pain, is generally well tolerated at recommended doses (≤4 g/day) in healthy adults and may be preferable to non-steroidal anti-inflammatory drugs that are associated with undesirable gastrointestinal, renal, and cardiovascular effects. Although paracetamol is widely used, many patients and physicians still have questions about its suitability and dosing, especially for older people or adults with underlying comorbidities, for whom there are limited clinical data or evidence-based guidelines. Inappropriate use may increase the risks of both overdosing and inadequate analgesia. To address knowledge deficits and augment existing guidance in salient areas of uncertainty, we have researched, reviewed, and collated published evidence and expert opinion relevant to the acute use of paracetamol by adults with liver, kidney, or cardiovascular diseases, gastrointestinal disorders, asthma, or/and who are older. A concern is hepatotoxicity, but this is rare among adults who use paracetamol as directed, including people with cirrhotic liver disease. Putative epidemiologic associations of paracetamol use with kidney or cardiovascular disease, hypertension, gastrointestinal disorders, and asthma largely reflect confounding biases and are of doubtful relevance to short-term use (<14 days). Paracetamol is a suitable first-line analgesic for mild to moderate acute pain in many adults with liver, kidney or cardiovascular disease, gastrointestinal disorders, asthma, and/or who are older. No evidence supports routine dose reduction for older people. Rather, dosing for adults who are older and/or have decompensated cirrhosis, advanced kidney failure, or analgesic-induced asthma that is known to be cross-sensitive to paracetamol, should be individualized in consultation with their physician, who may recommend a lower effective dose appropriate to the circumstances.
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Affiliation(s)
- John Alchin
- Pain Management Centre, Burwood Hospital, Burwood, New Zealand
| | - Arti Dhar
- GlaxoSmithKline Consumer Healthcare Pte. Ltd, Singapore
| | | | - Paul J Christo
- Department of Anesthesiology and Critical Care Medicine, Division of Pain Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Cendejas-Hernandez J, Sarafian JT, Lawton VG, Palkar A, Anderson LG, Larivière V, Parker W. Paracetamol (acetaminophen) use in infants and children was never shown to be safe for neurodevelopment: a systematic review with citation tracking. Eur J Pediatr 2022; 181:1835-1857. [PMID: 35175416 PMCID: PMC9056471 DOI: 10.1007/s00431-022-04407-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/26/2022]
Abstract
Although widely believed by pediatricians and parents to be safe for use in infants and children when used as directed, increasing evidence indicates that early life exposure to paracetamol (acetaminophen) may cause long-term neurodevelopmental problems. Furthermore, recent studies in animal models demonstrate that cognitive development is exquisitely sensitive to paracetamol exposure during early development. In this study, evidence for the claim that paracetamol is safe was evaluated using a systematic literature search. Publications on PubMed between 1974 and 2017 that contained the keywords "infant" and either "paracetamol" or "acetaminophen" were considered. Of those initial 3096 papers, 218 were identified that made claims that paracetamol was safe for use with infants or children. From these 218, a total of 103 papers were identified as sources of authority for the safety claim. Conclusion: A total of 52 papers contained actual experiments designed to test safety, and had a median follow-up time of 48 h. None monitored neurodevelopment. Furthermore, no trial considered total exposure to drug since birth, eliminating the possibility that the effects of drug exposure on long-term neurodevelopment could be accurately assessed. On the other hand, abundant and sufficient evidence was found to conclude that paracetamol does not induce acute liver damage in babies or children when used as directed. What is Known: • Paracetamol (acetaminophen) is widely thought by pediatricians and parents to be safe when used as directed in the pediatric population, and is the most widely used drug in that population, with more than 90% of children exposed to the drug in some reports. • Paracetamol is known to cause liver damage in adults under conditions of oxidative stress or when used in excess, but increasing evidence from studies in humans and in laboratory animals indicates that the target organ for paracetamol toxicity during early development is the brain, not the liver. What is New: • This study finds hundreds of published reports in the medical literature asserting that paracetamol is safe when used as directed, providing a foundation for the widespread belief that the drug is safe. • This study shows that paracetamol was proven to be safe by approximately 50 short-term studies demonstrating the drug's safety for the pediatric liver, but the drug was never shown to be safe for neurodevelopment. Paracetamol is widely believed to be safe for infants and children when used as directed, despite mounting evidence in humans and in laboratory animals indicating that the drug is not safe for neurodevelopment. An exhaustive search of published work cited for safe use of paracetamol in the pediatric population revealed 52 experimental studies pointing toward safety, but the median follow-up time was only 48 h, and neurodevelopment was never assessed.
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Affiliation(s)
- Jasmine Cendejas-Hernandez
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
- WPLab, Inc, 1023 Wells St, Durham, NC 27707 USA
| | - Joshua T. Sarafian
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
| | - Victoria G. Lawton
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
| | - Antara Palkar
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
| | - Lauren G. Anderson
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
| | - Vincent Larivière
- École de Bibliothéconomie Et Des Sciences de L’information, Université de Montréal, Montreal, Canada
| | - William Parker
- Department of Surgery, Duke University School of Medicine, Durham, NC USA
- WPLab, Inc, 1023 Wells St, Durham, NC 27707 USA
- Duke Global Health Institute, Duke University and Duke University Medical Center, Durham, NC 27710 USA
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Noor SS, Najjad MK, Ahmed N, Anwar K, Memon A, Riaz T, Hanif M, Maqbool N, Ahmed S, Ahmed I, Khanzada AY. Clinical Response of Nuberol Forte® for Pain Management With Musculoskeletal Conditions in Routine Pakistani Practice (NFORTE-EFFECT). Cureus 2022; 14:e23011. [PMID: 35415025 PMCID: PMC8994056 DOI: 10.7759/cureus.23011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well-known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives The current study aimed to assess the clinical response of Nuberol Forte® (paracetamol 650 mg + orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Methods A prospective, observational multicenter study (NFORT-EFFECT: Safety & Efficacy of Nuberol Forte in Pain Management). Three hundred ninety-nine patients with known prescreened musculoskeletal pain were recruited from 10 major healthcare facilities across six (6) major cities of Pakistan, as per the inclusion/exclusion criteria. After the baseline visit (Visit 1), the patients were followed up one to two weeks (Visit 2) after the treatment as per the physician's discretion. Data were collected using the Case Report Form (CRF) designed for the study, and adverse events (AEs) were also monitored to assess drug safety. Pain intensity was assessed through a visual analog scale (VAS), and QoL was assessed using the Muscle and Joint Measure (MJM) scale. Results Out of 399 enrolled patients, 49.4% were males and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with knee osteoarthritis (OA), i.e., 148 (38%), followed by backache 70 (18.2%). A significant reduction in the mean pain score was observed after treatment with the combination of paracetamol and orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only 10 patients reported mild adverse events (AEs), namely, dryness of the mouth, dizziness, gastric irritation, tachycardia, restlessness, etc. Conclusion The combination of paracetamol and orphenadrine (Nuberol Forte) exhibited effective pain management among patients with musculoskeletal conditions and improved their QoL.
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de Sire A, Marotta N, Lippi L, Scaturro D, Farì G, Liccardi A, Moggio L, Letizia Mauro G, Ammendolia A, Invernizzi M. Pharmacological Treatment for Acute Traumatic Musculoskeletal Pain in Athletes. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57111208. [PMID: 34833426 PMCID: PMC8618079 DOI: 10.3390/medicina57111208] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 12/14/2022]
Abstract
Pain management is a crucial issue for athletes who train and compete at the highest performance levels. There are still evidence gaps for the use of analgesics for sports injuries despite the growing interest in training and competition settings. However, high-quality research is needed to determine the most appropriate and optimal timing and formulations in non-steroidal anti-inflammatory drug and opioid management, particularly given the strictness of anti-doping regulations. Indeed, the role of pharmacological therapy in reducing acute traumatic pain in athletes should still be addressed to minimize the timing of return to sport. Therefore, the aim of this comprehensive review was to summarize the current evidence about pain management in the setting of acute injury in elite athletes, providing the most informed strategy for pain relief and performance recovery.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
- Correspondence: ; Tel.: +39-0961712819
| | - Nicola Marotta
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
| | - Dalila Scaturro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Giacomo Farì
- Motor and Sports Sciences, Department of Sciences and Biological and Environmental Technologies, Salento University, 73100 Lecce, Italy;
| | - Alfonso Liccardi
- Department of Biomedical Sciences for Health, University of Milan, 20122 Milan, Italy;
| | - Lucrezia Moggio
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Giulia Letizia Mauro
- Physical and Rehabilitative Medicine, Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, 90100 Palermo, Italy; (D.S.); (G.L.M.)
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, 88100 Catanzaro, Italy; (N.M.); (L.M.); (A.A.)
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, 28100 Novara, Italy; (L.L.); (M.I.)
- Translational Medicine, Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Honorary Professor Garry Graham. Inflammopharmacology 2021; 29:1255-1259. [PMID: 34533655 DOI: 10.1007/s10787-021-00872-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
An appreciation of the contribution of Professor Gary Graham to anti-inflammatory and antirheumatic pharmacology and clinical pharmacology.
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Mishriky J, Stupans I, Chan V. Low back pain management - What Australian community pharmacists recommend and how this compares to current clinical guidelines. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:336-343. [PMID: 33950187 DOI: 10.1093/ijpp/riab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/12/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Low back pain (LBP) is a serious and debilitating condition that necessitates proper assessment and management. Community pharmacists are ideally positioned to interact with these patients and provide therapeutic recommendations in line with LBP clinical guidelines, which have changed in recent years. Understanding what therapeutic strategies pharmacists recommend and why, can provide insights into whether these recommendations are in line with current clinical resources. OBJECTIVES The objectives of this study were to examine community pharmacists' views, knowledge and practices in LBP management compared to current clinical guidelines; and investigate their views regarding the accessibility and use of clinical LBP resources. METHODS A cross-sectional study of Australian community pharmacists was conducted using a structured, self-administered, anonymous online survey. Primary outcomes assessed were pharmacists' views, practices and recommendations in low back pain of different severities, as well as views on the use and accessibility of clinical guidelines. KEY FINDINGS A total of 176 pharmacists completed the survey. Most recommended non-pharmacological strategies to manage mild symptoms for both adult and teenage groups, escalating to pharmacological with increasing symptom severity. Approximately 75% reported they would recommend ibuprofen over paracetamol for low back pain. Approximately 40% agreed there is difficulty in finding and accessing clinical resources and more than 40% reported being unaware that there are specific guidelines available for the management of LBP symptoms. CONCLUSION Results from this study highlight an important need to further improve the knowledge and awareness of pharmacists in low back pain management, including locating and accessing clinical resources.
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Affiliation(s)
- John Mishriky
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ieva Stupans
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Vincent Chan
- Pharmacy, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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Gokkaya EO, Yesilot S, Ozgocmen M, Aslankoc R, Aydin Acar C. Protective effects of resveratrol and avocado oil against paracetamol-induced hepatotoxicity in rats. Drug Chem Toxicol 2021; 45:2131-2139. [PMID: 33832400 DOI: 10.1080/01480545.2021.1908716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study sought to assess the protective effects of resveratrol and avocado oil in relation to paracetamol-induced hepatotoxicity in rats. The rats were divided into five groups, namely the control, paracetamol (600 mg/kg), resveratrol (RES; 10 mg/kg) + paracetamol, avocado oil (AVO; 200 mg/kg) + paracetamol, and RES + AVO + paracetamol groups. The hepatoprotective activity was evaluated by measuring biochemical parameters such as the total antioxidant status (TAS) and the total oxidant status (TOS) in each rat's liver homogenates. Any DNA damage was assessed by means of a comet assay. The results showed that the TOS levels were significantly increased in the paracetamol group when compared with the control group. The TOS levels were found to be significantly lower in the paracetamol groups, in comparison with the RES, AVO, and RES + AVO groups. Moreover, the TAS levels significantly increased in the RES and RES + AVO groups when compared with the paracetamol group. The histopathological examination revealed necrotic areas in the rats' livers. Pretreatment with both RES and RES + AVO was found to reverse the oxidative stress parameters, DNA damage, and necrosis induced by paracetamol. These results suggest that a combination of REV and AVO may protect against paracetamol-induced hepatotoxicity due to their antioxidant properties.
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Affiliation(s)
- Erdi Onur Gokkaya
- Department of Health and Biomedical Sciences, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Sukriye Yesilot
- Bucak School of Health, Department of Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
| | - Meltem Ozgocmen
- Department of Histology and Embryology, Faculty of Medicine, Suleyman Demirel University, Burdur, Turkey
| | - Rahime Aslankoc
- Department of Physiology, Faculty of Medicine, Suleyman Demirel University, Burdur, Turkey
| | - Cigdem Aydin Acar
- Bucak School of Health, Department of Nursing, Burdur Mehmet Akif Ersoy University, Burdur, Turkey
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Pietruk K, Gbylik-Sikorska M, Łebkowska-Wieruszewska B, Gajda A, Giorgi M, Sartini I, Jedziniak P. Development of a Multimatrix UHPLC-MS/MS Method for the Determination of Paracetamol and Its Metabolites in Animal Tissues. Molecules 2021; 26:molecules26072046. [PMID: 33918518 PMCID: PMC8038326 DOI: 10.3390/molecules26072046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
Paracetamol/acetaminophen (APAP) is one of the most popular pharmacologically active substances used as an analgesic and antipyretic agent. The metabolism of this drug occurs in the liver and leads to the formation of two main metabolites-glucuronic acid and sulfate derivate. Despite the wide use of paracetamol in veterinary medicine, a handful of analytical methods were published for the determination of paracetamol residues in animal tissues. In this paper, a multimatrix method has been developed for the determination of paracetamol and two metabolites-paracetamol sulfate (PS) and p-Acetamidophenyl β-D-glucuronide (PG). A validation procedure was conducted to verify method reliability and fit purpose as a tool for analyzing acetaminophen and metabolites in muscle, liver, lung, and kidney samples from different species of animals. Established validation parameters were in agreement with acceptable criteria laid by the European legislation. The initial significant matrix effect was successfully reduced by implementing an internal standard-4-Acetamidophenyl β-D-glucuronide-d3 (PG-d3, IS). The usefulness of the developed method was verified by analyzing samples from an experiment in which paracetamol was administrated to geese.
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Affiliation(s)
- Konrad Pietruk
- Department of Pharmacology and Toxicology, National Veterinary Research Institute, 24-100 Pulawy, Poland; (M.G.-S.); (A.G.); (P.J.)
- Correspondence: ; Tel.: +48 81-889-3169
| | - Małgorzata Gbylik-Sikorska
- Department of Pharmacology and Toxicology, National Veterinary Research Institute, 24-100 Pulawy, Poland; (M.G.-S.); (A.G.); (P.J.)
| | - Beata Łebkowska-Wieruszewska
- Department of Pharmacology, Toxicology and Environmental Protection, University of Life Sciences, 20-950 Lublin, Poland;
| | - Anna Gajda
- Department of Pharmacology and Toxicology, National Veterinary Research Institute, 24-100 Pulawy, Poland; (M.G.-S.); (A.G.); (P.J.)
| | - Mario Giorgi
- Department of Veterinary Sciences, University of Pisa, 56126 Pisa, Italy;
- Department of Veterinary Medicine, PhD School, University of Sassari, 07100 Sassari, Italy;
| | - Irene Sartini
- Department of Veterinary Medicine, PhD School, University of Sassari, 07100 Sassari, Italy;
| | - Piotr Jedziniak
- Department of Pharmacology and Toxicology, National Veterinary Research Institute, 24-100 Pulawy, Poland; (M.G.-S.); (A.G.); (P.J.)
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Assis JB, Cogliati B, Esteves E, Capurro ML, Fonseca DM, Sá-Nunes A. Aedes aegypti mosquito saliva ameliorates acetaminophen-induced liver injury in mice. PLoS One 2021; 16:e0245788. [PMID: 33556084 PMCID: PMC7869984 DOI: 10.1371/journal.pone.0245788] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023] Open
Abstract
Acetaminophen (N-acetyl-p-aminophenol, APAP) overdose is the most common cause of drug-induced liver injury (DILI). Although the primary hepatic damage is induced by APAP-derived toxic intermediates resulting from cytochrome P450 metabolism, immune components also play an important role in DILI pathophysiology. Aedes aegypti saliva is a source of bioactive molecules with in vitro anti-inflammatory and immunomodulatory activities. However, evidences on the therapeutic use of Ae. aegypti salivary preparations in animal models of relevant clinical conditions are still scarce. Thus, the present study was designed to evaluate the protective role of Ae. aegypti saliva in a murine model of APAP-induced DILI. C57BL/6 mice were exposed to Ae. aegypti bites 2 hours after APAP overdose. Biochemical and immunological parameters were evaluated in blood and liver samples at different time points after APAP administration. Exposure to Ae. aegypti saliva attenuated liver damage, as demonstrated by reduced hepatic necrosis and serum levels of alanine aminotransferase in APAP-overdosed mice. The levels of hepatic CYP2E1, the major enzyme responsible for the bioactivation of APAP, were not changed in Ae. aegypti exposed animals, suggesting no effects in the generation of hepatotoxic metabolites. On the other hand, mice treated with Ae. aegypti saliva following APAP overdose presented lower serum concentration of TNF-α, IL-6, IL-1β and IL-10, as well as reduced frequency of inflammatory cell populations in the liver, such as NKT cells, macrophages and dendritic cells. These findings show that Ae. aegypti saliva has bioactive molecules with therapeutic properties and may represent a prospective source of new compounds in the management of DILI-associated inflammatory disorders and, perhaps, many other inflammatory/autoimmune diseases.
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Affiliation(s)
- Josiane B. Assis
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Bruno Cogliati
- Departamento de Patologia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brazil
| | - Eliane Esteves
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Margareth L. Capurro
- Departamento de Parasitologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Conselho Nacional de Desenvolvimento Científico e Tecnológico (INCT-EM/CNPq), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Denise M. Fonseca
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Anderson Sá-Nunes
- Departamento de Imunologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
- Instituto Nacional de Ciência e Tecnologia em Entomologia Molecular, Conselho Nacional de Desenvolvimento Científico e Tecnológico (INCT-EM/CNPq), Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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Przybyła GW, Szychowski KA, Gmiński J. Paracetamol - An old drug with new mechanisms of action. Clin Exp Pharmacol Physiol 2021; 48:3-19. [PMID: 32767405 DOI: 10.1111/1440-1681.13392] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
Paracetamol (acetaminophen) is the most commonly used over-the-counter (OTC) drug in the world. Despite its popularity and use for many years, the safety of its application and its mechanism of action are still unclear. Currently, it is believed that paracetamol is a multidirectional drug and at least several metabolic pathways are involved in its analgesic and antipyretic action. The mechanism of paracetamol action consists in inhibition of cyclooxygenases (COX-1, COX-2, and COX-3) and involvement in the endocannabinoid system and serotonergic pathways. Additionally, paracetamol influences transient receptor potential (TRP) channels and voltage-gated Kv7 potassium channels and inhibits T-type Cav3.2 calcium channels. It also exerts an impact on L-arginine in the nitric oxide (NO) synthesis pathway. However, not all of these effects have been clearly confirmed. Therefore, the aim of our paper was to summarize the current state of knowledge of the mechanism of paracetamol action with special attention to its safety concerns.
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Affiliation(s)
| | - Konrad A Szychowski
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Jan Gmiński
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
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The Late-Stage Protective Effect of Mito-TEMPO against Acetaminophen-Induced Hepatotoxicity in Mouse and Three-Dimensional Cell Culture Models. Antioxidants (Basel) 2020; 9:antiox9100965. [PMID: 33050213 PMCID: PMC7601533 DOI: 10.3390/antiox9100965] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 10/06/2020] [Indexed: 02/06/2023] Open
Abstract
An overdose of acetaminophen (APAP), the most common cause of acute liver injury, induces oxidative stress that subsequently causes mitochondrial impairment and hepatic necroptosis. N-acetyl-L-cysteine (NAC), the only recognized drug against APAP hepatotoxicity, is less effective the later it is administered. This study evaluated the protective effect of mitochondria-specific Mito-TEMPO (Mito-T) on APAP-induced acute liver injury in C57BL/6J male mice, and a three dimensional (3D)-cell culture model containing the human hepatoblastoma cell line HepG2. The administration of Mito-T (20 mg/kg, i.p.) 1 h after APAP (400 mg/kg, i.p.) injection markedly attenuated the APAP-induced elevated serum transaminase activity and hepatic necrosis. However, Mito-T treatment did not affect key factors in the development of APAP liver injury including the activation of c-jun N-terminal kinases (JNK), and expression of the transcription factor C/EBP homologous protein (CHOP) in the liver. However, Mito-T significantly reduced the APAP-induced increase in the hepatic oxidative stress marker, nitrotyrosine, and DNA fragmentation. Mito-T markedly attenuated cytotoxicity induced by APAP in the HepG2 3D-cell culture model. Moreover, liver regeneration after APAP hepatotoxicity was not affected by Mito-T, demonstrated by no changes in proliferating cell nuclear antigen formation. Therefore, Mito-T was hepatoprotective at the late-stage of APAP overdose in mice.
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Lemos SG, Gonzalez-Rodriguez J. Three-dimensional voltammetry: Use of chronoamperometric E-t-i data to achieve second-order advantage. Anal Chim Acta 2020; 1132:36-46. [PMID: 32980109 DOI: 10.1016/j.aca.2020.07.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/30/2022]
Abstract
This work studied the use of three-dimensional voltammetry, particularly potential-time-current (E-t-i) data, on the development of electroanalytical methods. E-t-i data was obtained by taking chronoamperograms at potentials applied as pulses on a staircase waveform. By using this three-way kind of data and appropriate calibration algorithms, the possibility of achieving the second-order advantage was evaluated in the determination of ferrocyanide in the presence of the uncalibrated interference hydroquinone as a model system. The determination of acetaminophen in urine samples, where ascorbic acid and uric acid play the major roles as interferents was also studied. Parallel factor analysis (PARAFAC) and multivariate curve resolution alternating least-squares (MCR-ALS) were the algorithms employed in this work. Both algorithms successfully achieved the second-order advantage by correctly predicting the concentrations of the validation synthetic samples. Excellent predictions were obtained in the direct analysis of acetaminophen-spiked urine samples by E-t-i data and MCR-ALS.
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Affiliation(s)
| | - Jose Gonzalez-Rodriguez
- School of Chemistry, College of Science, University of Lincoln, Brayford Pool, Lincoln, LN67TS, United Kingdom.
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20
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Rudrappa GH, Chakravarthi PT, Benny IR. Efficacy of high-dissolution turmeric-sesame formulation for pain relief in adult subjects with acute musculoskeletal pain compared to acetaminophen: A randomized controlled study. Medicine (Baltimore) 2020; 99:e20373. [PMID: 32664057 PMCID: PMC7360261 DOI: 10.1097/md.0000000000020373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Acetaminophen (paracetamol) is one of the most commonly used over-the-counter for pain relief. Management of acute pain with plant-based nutrients has remained suboptimal due to an absence of data supporting acute relief of pain. In the present study, it was hypothesized that high-dissolution liquid treatment of black sesame extract oil, Curcuma longa and Boswellia serrata may provide pain relief in people with acute musculoskeletal pain as quickly as acetaminophen. METHODS In this randomized active controlled open label study, 88 healthy subjects with acute musculoskeletal pain were randomized to receive treatment capsule (Rhuleave-K; 1,000 mg/d) or 1,000 mg/d acetaminophen for 7 days. Change in pain intensity and pain relief at first 6 hours, 3 days, and 7 days were measured. The onset of analgesia was measured by perceptible pain relief and meaningful pain relief. Other measures were McGill Pain Questionnaire and Patient Global Impression Change. RESULTS The treatment formulation resulted in average magnitude of pain relief comparable to the acetaminophen. Sixty-six percent of subjects in the treatment group reported positive response in pain relief (≥50% max TOTPAR; total pain relief) after 6 hours, compared to 73% of control. Seventy-three percent of subjects on treatment were considered positive responders, compared to 80% in the control group. The average time of onset of analgesia was 1 hour for the treatment group, versus 0.83 hour for control. At the end of day 3 and 7, there was significant improvement (P < .001 for day 3 and day 7) in the pain condition of treatment group and was comparable to control (P = .436 for day 3 and P = .529 for day 7). The total McGill Pain score showed significant reduction in pain with the treatment irrespective of the pain intensity statistically equal (P = .468) to control. Both the groups were equal in providing sensory pain relief (P = .942), but the treatment was 8.57 times significantly better (P = .027) than acetaminophen in reducing the unpleasantness and emotional aspects (affective domain) involved with acute pain. CONCLUSION The results showed that the treatment used in the study may act as a natural, fast acting, and safe alternative for acute pain relief comparable to acetaminophen.
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Affiliation(s)
- Girish H. Rudrappa
- Department of Orthopedics, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, Karnataka
| | - Pruthvi T. Chakravarthi
- Department of Orthopedics, Sapthagiri Institute of Medical Sciences and Research Center, Bangalore, Karnataka
| | - Irin Rosanna Benny
- Amala Institute of Medical Sciences, Amala Nagar, Thrissur, Kerala, India
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Kawakami J, Abe T, Higaki E, Hosoi T, Fukaya M, Komori K, Ito S, Nakatochi M, Nagino M, Shimizu Y. Scheduled intravenous acetaminophen versus nonsteroidal anti-inflammatory drugs (NSAIDs) for better short-term outcomes after esophagectomy for esophageal cancer. Surg Today 2020; 50:1168-1175. [DOI: 10.1007/s00595-020-02001-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/06/2020] [Indexed: 11/28/2022]
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Zemtsova VM, Fedorov AY, Fedorova EA, Boa C, Arkhipov SG, Rychkov DA, Minkov VS, Pulham CR, Boldyreva EV. A novel crystal form of metacetamol: the first example of a hydrated form. ACTA CRYSTALLOGRAPHICA SECTION C-STRUCTURAL CHEMISTRY 2019; 75:1465-1470. [PMID: 31686655 DOI: 10.1107/s2053229619012981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/19/2019] [Indexed: 02/05/2023]
Abstract
We report the crystal structure and crystallization conditions of a first hydrated form of metacetamol (a hemihydrate), C8H9NO2·0.5H2O. It crystallizes from metacetamol-saturated 1:1 (v/v) water-ethanol solutions in a monoclinic structure (space group P21/n) and contains eight metacetamol and four water molecules per unit cell. The conformations of the molecules are the same as in polymorph II of metacetamol, which ensures the formation of hydrogen-bonded dimers and R22(16) ring motifs in its crystal structure similar to those in polymorph II. Unlike in form II, however, these dimers in the hemihydrate are connected through water molecules into infinite hydrogen-bonded molecular chains. Different chains are linked to each other by metacetamol-water and metacetamol-metacetamol hydrogen bonds, the latter type being also present in polymorph I. The overall noncovalent network of the hemihydrate is well developed and several types of hydrogen bonds are responsible for its formation.
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Affiliation(s)
- Viktoria M Zemtsova
- Novosibirsk State University, Pirogova str. 2, Novosibirsk 630090, Russian Federation
| | - Alexey Yu Fedorov
- Novosibirsk State University, Pirogova str. 2, Novosibirsk 630090, Russian Federation
| | - Elizaveta A Fedorova
- Boreskov Institute of Catalysis SB RAS, Lavrentiev Ave. 5, Novosibirsk 630090, Russian Federation
| | - Callum Boa
- The University of Edinburgh, School of Chemistry, Joseph Black Building, David Brewster Road, Edinburgh EH9 3FJ, Scotland
| | - Sergey G Arkhipov
- Novosibirsk State University, Pirogova str. 2, Novosibirsk 630090, Russian Federation
| | - Denis A Rychkov
- Novosibirsk State University, Pirogova str. 2, Novosibirsk 630090, Russian Federation
| | - Vasily S Minkov
- Max-Planck Institute for Chemistry, Hahn-Meitner-Weg 1, Mainz 55128, Germany
| | - Colin R Pulham
- The University of Edinburgh, School of Chemistry, Joseph Black Building, David Brewster Road, Edinburgh EH9 3FJ, Scotland
| | - Elena V Boldyreva
- Novosibirsk State University, Pirogova str. 2, Novosibirsk 630090, Russian Federation
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Kuwano A, Kohjima M, Suzuki H, Yamasaki A, Ohashi T, Imoto K, Kurokawa M, Morita Y, Kato M, Ogawa Y. Recombinant human soluble thrombomodulin ameliorates acetaminophen-induced liver toxicity in mice. Exp Ther Med 2019; 18:1323-1330. [PMID: 31316624 DOI: 10.3892/etm.2019.7665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Recombinant human soluble thrombomodulin alpha (rhTM) has been developed as an anticoagulant with anti-inflammatory activity. Notably, acetaminophen (APAP) -induced liver disease (AILI) is caused by direct metabolite-induced hepatotoxicity as well as hepatic hyper-coagulation. To evaluate the utility of anticoagulant for the treatment of AILI, rhTM was administered in a mouse AILI model and liver damage was analyzed. AILI was induced in 8-week-old mice by intraperitoneal injection of APAP. rhTM (20 mg/kg) or placebo was injected at the same time as APAP administration. Serum alanine aminotransferase, fibrin degradation products and high-mobility group box 1 levels were significantly decreased in the rhTM-treated group compared with the control group. Furthermore, rhTM reduced the necrotic area and fibrin deposition in liver sections. rhTM suppressed the mRNA expression of heme oxygenase-1, plasminogen activator inhibitor type-1, tissue factors, and inflammatory cytokines compared with the control group. rhTM did not change the hepatic GSH content at 2 h after APAP injection, but restored them at 4 h after the insult. rhTM ameliorated liver damage in mice with AILI, probably via the improvement in liver perfusion induced by it's anticoagulant acitivity, which can lead to the suppression of secondary liver damage.
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Affiliation(s)
- Akifumi Kuwano
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Motoyuki Kohjima
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Hideo Suzuki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Akihiro Yamasaki
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Tomoko Ohashi
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Koji Imoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Miho Kurokawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yusuke Morita
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Masaki Kato
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.,Department of Molecular and Cellular Metabolism, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan.,CREST, Japan Agency for Medical Research and Development, Tokyo 100-0004, Japan
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24
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Girard P, Sourdet S, Cantet C, de Souto Barreto P, Rolland Y. Acetaminophen Safety: Risk of Mortality and Cardiovascular Events in Nursing Home Residents, a Prospective Study. J Am Geriatr Soc 2019; 67:1240-1247. [PMID: 30912588 DOI: 10.1111/jgs.15861] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Acetaminophen is the most widely used analgesic today. A recent systematic review found increased adverse events and mortality at therapeutic dosage. Our aim was to challenge these results in a large sample of older adults living in nursing homes (NHs). DESIGN Prospective study using data from the Impact of Educational and Professional Supportive Interventions on Nursing Home Quality Indicators project (IQUARE), a multicenter, individually tailored, nonrandomized controlled trial in NHs across southwestern France. SETTING/PARTICIPANTS We studied data from 5429 participants living in 175 NHs (average age, 86.1 ± 8.1 years; 73.9% women). MEASUREMENTS All prescriptions obtained at baseline were analyzed by a pharmacist for acetaminophen use as stand-alone or associated. Myocardial infarction (MI) and strokes were reported from participants' medical records at 18-month follow-up. Dates of death were obtained. Data collection was done through an online questionnaire at baseline and at 18 months by NH staff. Analyses were realized in our total population and a population matched on propensity score of acetaminophen intake. Six models were run for each outcome. RESULTS A total of 2239 participants were taking, on average, 2352 ± 993 mg of acetaminophen daily. Results for mortality were: hazard ratio (HR) = 0.97 (95% confidence interval [CI] = 0.86-1.10). No associations between acetaminophen intake and the risk of mortality or MI were found. In one of our models, acetaminophen intake was associated with a significant increased risk of stroke in diabetic subjects (OR = 3.19; 95% CI = 1.25-8.18; P = .0157). [Correction added March 16, 2019, after first publication online. In the previous sentence, "HR" was mistakenly used instead of "OR".] CONCLUSION: Despite old age, polypharmacy, and polymorbidity, acetaminophen was found safe for most, but not all, of our NH study population. Pain management in NHs is a health priority, and acetaminophen remains a good therapeutic choice as a first-line analgesic. More studies are needed on older diabetic patients.
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Affiliation(s)
- Philippe Girard
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France
| | - Sandrine Sourdet
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Christelle Cantet
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Philipe de Souto Barreto
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
| | - Yves Rolland
- Gérontopôle, Centre Hospitalo-Universitaire de Toulouse, Toulouse, France.,Inserm unité mixte de recherche 1027, Université de Toulouse III Paul Sabatier, Toulouse, France
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Sofi FA, Bhat MA, Majid K. Cu2+-BTC based metal–organic framework: a redox accessible and redox stable MOF for selective and sensitive electrochemical sensing of acetaminophen and dopamine. NEW J CHEM 2019. [DOI: 10.1039/c8nj06224b] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A Cu2+ plus benzenetricarboxylate (BTC) based ‘3D’ metal–organic framework HKUST-1 was synthesized via a facile microwave assisted route.
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Affiliation(s)
- Feroz Ahmad Sofi
- Department of Chemistry
- National Institute of Technology
- Srinagar
- India
| | | | - Kowsar Majid
- Department of Chemistry
- National Institute of Technology
- Srinagar
- India
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26
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Modified glassy carbon electrode with Polydopamine-multiwalled carbon nanotubes for simultaneous electrochemical determination of biocompounds in biological fluids. J Pharm Biomed Anal 2018; 161:66-72. [DOI: 10.1016/j.jpba.2018.08.034] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/21/2022]
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Leheup BF, Ducousso S, Picard S, Alluin R, Goetz C. Subcutaneous administration of paracetamol-Good local tolerability in palliative care patients: An observational study. Palliat Med 2018; 32:1216-1221. [PMID: 29737243 DOI: 10.1177/0269216318772472] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The subcutaneous route is widely used in both palliative care and geriatrics. Numerous compounds are administered by this route, including paracetamol. However, there is no recommendation on which to base this latter practice and, in the absence of published evidence, nothing is known regarding its local tolerability in palliative care patients. AIM The main objective of this study was to assess the local tolerability of paracetamol when administered subcutaneously for analgesic or antipyretic purposes in patients hospitalized in the palliative care unit. The secondary objective was to identify the factors favoring the occurrence of local adverse events. DESIGN This is a prospective multicenter observational study (NCT02884609). PARTICIPANTS Study conducted in 160 patients hospitalized in the palliative care units of three hospitals in metropolitan France from 2014 to 2017. RESULTS Of the 160 patients, 44 (28%) presented at least one non-serious local adverse event (edema in 29, erythema in 5, pain in 15, hematoma in 2, pruritus in 1, and local heat in 2). No serious adverse events were observed. Factors associated with the occurrence of local adverse events were younger age, administration in the arm and thorax, and a high number of daily administrations. CONCLUSION This first ever study carried out on this subject reveals that subcutaneous administration of paracetamol in palliative care patients was well tolerated locally.
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Affiliation(s)
- Benoît F Leheup
- 1 Palliative Care Department, Metz-Thionville Regional Hospital, Metz, France
| | - Stéphanie Ducousso
- 1 Palliative Care Department, Metz-Thionville Regional Hospital, Metz, France
| | - Stéphane Picard
- 2 Palliative Care Unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Raphaël Alluin
- 1 Palliative Care Department, Metz-Thionville Regional Hospital, Metz, France
| | - Christophe Goetz
- 3 Clinical Research Support Unit, Metz-Thionville Regional Hospital, Metz, France
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28
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Shahbakhsh M, Noroozifar M. Copper polydopamine complex/multiwalled carbon nanotubes as novel modifier for simultaneous electrochemical determination of ascorbic acid, dopamine, acetaminophen, nitrite and xanthine. J Solid State Electrochem 2018. [DOI: 10.1007/s10008-018-4013-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Acetaminophen (APAP) is the leading cause of acute liver failure (ALF), although the worldwide frequency is variable. APAP hepatotoxicity develops either following intentional overdose or unintentional ingestion (therapeutic misadventure) in the background of several factors, such as concomitant use of alcohol and certain medications that facilitate the formation of reactive and toxic metabolites. Spontaneous survival is more common in APAP-induced ALF compared with non-APAP etiologies. N-acetylcysteine is recommended for all patients with APAP-induced ALF and it reduces mortality. Liver transplantation should be offered early to those who are unlikely to survive based on described prognostic criteria.
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Meridor D, Cohen A, Khalfin B, Uppalapati L, Kasher R, Nathan I, Parola AH. The Protective Effect of Humanin Derivative AGA(C8R)-HNG17 Against Acetaminophen-Induced Liver Injury in Mice. Int J Pept Res Ther 2018. [DOI: 10.1007/s10989-018-9700-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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31
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Le paracétamol à dose thérapeutique : quelles populations à risque d’hépatotoxicité ? TOXICOLOGIE ANALYTIQUE ET CLINIQUE 2018. [DOI: 10.1016/j.toxac.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Progress in surgical acute pain management has allowed most foot and ankle surgery to be performed in ambulatory outpatient surgical centers. Multimodal analgesia focuses on improving postoperative pain by combining pharmacologic and other modalities, addressing multiple pain mechanisms and receptor pathways while reducing adverse effects through lower doses of oral medications. Local anesthesia techniques provide excellent pain relief with few adverse events. Multimodal analgesia in foot and ankle surgery provides superior pain relief, and reduced opioid dependence and opioid-related side effects, improving patient satisfaction, safety, and timely return to function.
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Affiliation(s)
- Jessica M Kohring
- Department of Orthopaedics, The University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
| | - Nathan G Orgain
- Department of Anesthesiology, The University of Utah, SOM 3C444, 30 North 1900 East, Salt Lake City, UT 84132, USA
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Bahramsoltani R, Rahimi R, Farzaei MH. Pharmacokinetic interactions of curcuminoids with conventional drugs: A review. JOURNAL OF ETHNOPHARMACOLOGY 2017; 209:1-12. [PMID: 28734960 DOI: 10.1016/j.jep.2017.07.022] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 07/14/2017] [Accepted: 07/15/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Herb-drug interactions are of great concern in health practices. Curcumin is a natural polyphenol extracted from turmeric, a spice widely used all over the world. Curcumin is clinically used due to its acceptable safety profile and therapeutic efficacy. AIM OF THE STUDY Current paper aims to highlight the effect of curcumin on concomitantly used drugs. METHODS Electronic databases including PubMed, Scopus and Science Direct were searched with the keywords "curcumin" in the title/abstract and "drug interaction," "drug metabolism," "cytochrome," "P-glycoprotein" and "P450" in the whole text. RESULTS Curcumin can induce pharmacokinetic alterations such as changes in Cmax and AUC when concomitantly used with pharmacological agents like cardiovascular drugs, antidepressants, anticoagulants, antibiotics, chemotherapeutic agents, and antihistamines. The underlying mechanisms of these interactions include inhibition of cytochrome (CYP) isoenzymes and P-glycoprotein. There is only one clinical trial which proved a significant alteration of conventional drugs in concomitant use with curcumin indicating the need for further human studies. CONCLUSIONS Although in vitro and in vivo studies do not provide enough evidence to judge the clinical drug interactions of curcumin, physicians must remain cautious and avoid drug combinations which may lead to curcumin-drug interactions.
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Affiliation(s)
- Roodabeh Bahramsoltani
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran 1417614411, Iran; PhytoPharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Roja Rahimi
- Department of Traditional Pharmacy, School of Traditional Medicine, Tehran University of Medical Sciences, Tehran 1417614411, Iran; PhytoPharmacology Interest Group (PPIG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Mohammad Hosein Farzaei
- Pharmaceutical Sciences Research Center, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran; Medical Biology Research Center, Kermanshah University of Medical Sciences, Kermanshah 6734667149, Iran.
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Hainline B, Derman W, Vernec A, Budgett R, Deie M, Dvořák J, Harle C, Herring SA, McNamee M, Meeuwisse W, Lorimer Moseley G, Omololu B, Orchard J, Pipe A, Pluim BM, Ræder J, Siebert C, Stewart M, Stuart M, Turner JA, Ware M, Zideman D, Engebretsen L. International Olympic Committee consensus statement on pain management in elite athletes. Br J Sports Med 2017; 51:1245-1258. [DOI: 10.1136/bjsports-2017-097884] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 06/10/2017] [Accepted: 06/26/2017] [Indexed: 12/18/2022]
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Zhang J, Zhang L, Sun X, Yang Y, Kong L, Lu C, Lv G, Wang T, Wang H, Fu F. Acetylcholinesterase Inhibitors for Alzheimer's Disease Treatment Ameliorate Acetaminophen-Induced Liver Injury in Mice via Central Cholinergic System Regulation. J Pharmacol Exp Ther 2016; 359:374-382. [PMID: 27535978 DOI: 10.1124/jpet.116.233841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/12/2016] [Indexed: 01/30/2023] Open
Abstract
Acetaminophen (APAP) is widely used as an analgesic and antipyretic agent, but it may induce acute liver injury at high doses. Alzheimer's disease patients, while treated with acetylcholinesterase inhibitor (AChEI), may take APAP when they suffer from cold or pain. It is generally recognized that inhibiting acetylcholinesterase activity may also result in liver injury. To clarify whether AChEI could deteriorate or attenuate APAP hepatotoxicity, the effects of AChEI on APAP hepatotoxicity were investigated. Male C57BL/6J mice were administrated with the muscarinic acetylcholine receptor (mAChR) blocker atropine (Atr), or classic α7 nicotine acetylcholine receptor (α7nAChR) antagonist methyllycaconitine (MLA) 1 hour before administration of AChEIs-donepezil (4 mg/kg), rivastigmine (2 mg/kg), huperzine A (0.2 mg/kg), or neostigmine (0.15 mg/kg)-followed by APAP (300 mg/kg). Eight hours later, the mice were euthanized for histopathologic examination and biochemical assay. The results demonstrated that the tested AChEIs, excluding neostigmine, could attenuate APAP-induced liver injury, accompanied by reduced reactive oxygen species formation, adenosine triphosphate and cytochrome C loss, c-Jun N-terminal kinase 2 (JNK2) phosphorylation, and cytokines. However, Atr or MLA significantly weakened the protective effect of AChEI by affecting mitochondrial function or JNK2 phosphorylation and inflammation response. These results suggest that central mAChR and α7nAChR, which are activated by accumulated acetylcholine resulting from AChEI, were responsible for the protective effect of AChEIs on APAP-induced liver injury. This indicates that Alzheimer's patients treated with AChEI could take APAP, as AChEI is unlikely to deteriorate the hepatotoxicity of APAP.
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Affiliation(s)
- Jianqiao Zhang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Leiming Zhang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Xue Sun
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Yanting Yang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Liang Kong
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Chengwen Lu
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Guangyao Lv
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Tian Wang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Hongbo Wang
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
| | - Fenghua Fu
- Key Laboratory of Molecular Pharmacology and Drug Evaluation (Ministry of Education of China), School of Pharmacy, Yantai University, Yantai, People's Republic of China
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Nayyer NV, Byers J, Marney C. Identifying adults at risk of paracetamol toxicity in the acute dental setting: development of a clinical algorithm. Br Dent J 2016; 216:229-35. [PMID: 24603244 DOI: 10.1038/sj.bdj.2014.146] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2013] [Indexed: 11/09/2022]
Abstract
Paracetamol is widely used and effective for the management of dental pain in the UK. Acute dental pain is a recognised precipitant of unintentional paracetamol overdose and in a small but significant number of cases this results in hepatotoxicity. Patients' understanding of the risks of excess paracetamol ingestion remains poor and risk of over-medication before presentation is increased due to a variety of factors including dental anxiety and fragmented provision of dental emergency services. Early recognition of overdose is crucial to preventing significant hepatotoxicity and death. Dentists have a role to play in recognising unintentional overdose cases and directing patients timeously to appropriate medical care. Guidelines on the treatment of paracetamol toxicity are readily available but our data suggests some dental settings may present a weak link in the care pathway and overdose may not be readily recognised. We have developed an algorithm and training package targeted at dentists in the acute dental setting with the aim of improving recognition of paracetamol toxicity in adults and directing onward referral appropriately. This paper also revises the key pharmacokinetics and pharmacodynamics of paracetamol and is intended to raise awareness of issues of toxicity for dentists.
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Affiliation(s)
- N V Nayyer
- Department of Oral Surgery, Dundee Dental Hospital, 2 Park Place, Dundee, DD1 4HN
| | - J Byers
- Department of Oral Surgery and Oral Medicine, Glasgow Dental Hospital, 378 Sauchiehall Street, Glasgow, G2 3JZ, Scotland
| | - C Marney
- Department of Oral Surgery and Oral Medicine, Glasgow Dental Hospital, 378 Sauchiehall Street, Glasgow, G2 3JZ, Scotland
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Gonzalez-Valcarcel J, Sissani L, Labreuche J, Bousser MG, Chamorro A, Fisher M, Ford I, Fox KM, Hennerici MG, Mattle HP, Rothwell PM, Steg PG, Vicaut E, Amarenco P. Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke. Stroke 2016; 47:1045-52. [PMID: 26979864 DOI: 10.1161/strokeaha.115.012091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/11/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE The presumed safety of paracetamol in high-cardiovascular risk patients has been questioned. We determined whether paracetamol or ibuprofen use is associated with major cardiovascular events (MACE) or major bleeding in 19 120 patients with recent ischemic stroke or transient ischemic attack of mainly atherothrombotic origin included in the Prevention of cerebrovascular and cardiovascular events of ischemic origin with terutroban in patients with a history of ischemic stroke or transient ischemic attack (PERFORM) trial. METHODS We performed 2 nested case-control analysis (2153 cases with MACE during trial follow-up and 4306 controls matched on Essen stroke risk score; 809 cases with major bleeding matched with 1616 controls) and a separate time-varying analysis. RESULTS 12.3% were prescribed paracetamol and 2.5% ibuprofen. Median duration of treatment was 14 (interquartile range 5-145) days for paracetamol and 9 (5-30) days for ibuprofen. Paracetamol, but not ibuprofen, was associated with increased risk of MACE (odds ratio 1.21, 95% confidence interval [CI] 1.04-1.42) or a major bleeding (odds ratio 1.60, 95% CI 1.26-2.03), with no impact of daily dose and duration of paracetamol treatment. Time-varying analysis found an increased risk of MACE with both paracetamol (hazard ratio 1.22, 95% CI 1.05-1.43) and ibuprofen (hazard ratio 1.47, 95% CI 1.06-2.03) and of major bleeding with paracetamol (hazard ratio 1.95, 95% CI 1.45-2.62). CONCLUSIONS There was a weak and inconsistent signal for association between paracetamol or ibuprofen and MACE or major bleeding, which may be related to either a genuine but modest effect of these drugs or to residual confounding. CLINICAL TRIAL REGISTRATION http://www.isrctn.com. Unique identifier: ISRCTN66157730.
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Affiliation(s)
- Jaime Gonzalez-Valcarcel
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Leila Sissani
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Julien Labreuche
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Marie-Germaine Bousser
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Angel Chamorro
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Marc Fisher
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Ian Ford
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Kim M Fox
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Michael G Hennerici
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Heinrich P Mattle
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Peter M Rothwell
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Philippe Gabriel Steg
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Eric Vicaut
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.)
| | - Pierre Amarenco
- From the Université Paris Diderot, Paris, France (J.G.-V., M.-G.B., P.G.S., E.V., P.A.); INSERM LVTS (Laboratory for VascularTranslational Sciences) 1148 and Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodelling), Paris, France (L.S., J.L., P.G.S., P.A.); Department of Neurology and Stroke Centre, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris France (J.G.-V., L.S., J.L., P.A.); Université de Lille, CHU Lille, EA 2694-Santé publique: épidémiologie et qualité des soins, Lille, France (J.L.); Department of Neurology, hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France (M.-G.B.); Department of Neurology, Hospital Clinic de Barcelona, University of Barcelona, Barcelona, Spain (A.C.); Department of Neurology, Harvard University, Brigham and Women Hospital, MA (M.F.); Robertson Centre for Biostatistics, Department of Biostatistics, University of Glasgow, Glasgow, UK (I.F.); Department of Cardiology, NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK (K.M.F.; P.G.S.); Department of Neurology, University of Heidelberg, UMM, Mannheim, Germany (M.G.H.); Neurologische Klinik und Poliklinik, Universität Bern, Inselspital, Bern (H.P.M.); Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK (P.M.R.); and Department of Biostatistics, Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, Paris France (E.V.).
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Jiang Y, Fu Y, Xing XP, Li M, Wang O, Xia WB, Meng XW. Zoledronic acid-induced hepatotoxicity relieved after subsequent infusions in a Chinese woman with glucocorticoid-induced osteoporosis. Eur J Med Res 2015; 20:68. [PMID: 26297149 PMCID: PMC4546306 DOI: 10.1186/s40001-015-0161-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 08/11/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Zoledronic acid (ZOL) is widely used for treatment of glucocorticoid-induced osteoporosis. The most common adverse effects of ZOL treatment are post-dose symptoms. ZOL-induced hepatotoxicity has very rarely been reported. CASE REPORT Here, we described a 50-year-old Chinese woman who had vertebral fractures and severe back pain after glucocorticoid therapy for Behcet disease for 13 years. Three days after ZOL 5 mg infusion in April 2012, serum alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyltransferase (GGT) levels increased by 7.7, 4.9 and 3.0 times, respectively, compared with pre-treatment values. Liver protective agents were administered per os. Her hepatic enzyme levels returned to nearly normal range 9 days post-infusion. In the subsequent ZOL infusion with 1 year interval, serum ALT, AST and GGT levels increased slightly after the second infusion and were sustained to be normal after the third infusion. Her post-dose symptoms alleviated in the meantime. CONCLUSIONS Hepatotoxicity due to ZOL therapy is a rare, but possible adverse effect which may be relieved after subsequent infusions.
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Affiliation(s)
- Yan Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Yong Fu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Xiao-ping Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Mei Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Ou Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
| | - Wei-bo Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China.
| | - Xun-wu Meng
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, 100730, Beijing, China
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Palabiyik SS, Karakus E, Akpinar E, Halici Z, Bayir Y, Yayla M, Kose D. The Role of Urotensin Receptors in the Paracetamol-Induced Hepatotoxicity Model in Mice: Ameliorative Potential of Urotensin II Antagonist. Basic Clin Pharmacol Toxicol 2015; 118:150-9. [DOI: 10.1111/bcpt.12447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 07/02/2015] [Indexed: 12/13/2022]
Affiliation(s)
- Saziye S. Palabiyik
- Department of Pharmaceutical Toxicology; Faculty of Pharmacy; Ataturk University; Erzurum Turkey
| | - Emre Karakus
- Department of Pharmacology and Toxicology; Faculty of Veterinary Medicine; Ataturk University; Erzurum Turkey
| | - Erol Akpinar
- Department of Pharmacology; Faculty of Medicine; Ataturk University; Erzurum Turkey
| | - Zekai Halici
- Department of Pharmacology; Faculty of Medicine; Ataturk University; Erzurum Turkey
| | - Yasin Bayir
- Department of Biochemistry; Faculty of Pharmacy; Ataturk University; Erzurum Turkey
| | - Muhammed Yayla
- Department of Pharmacology; Faculty of Medicine; Ataturk University; Erzurum Turkey
| | - Duygu Kose
- Department of Pharmacology; Faculty of Medicine; Ataturk University; Erzurum Turkey
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Ju SM, Jang HJ, Kim KB, Kim J. High-Throughput Cytotoxicity Testing System of Acetaminophen Using a Microfluidic Device (MFD) in HepG2 Cells. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2015; 78:1063-1072. [PMID: 26241707 DOI: 10.1080/15287394.2015.1068650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A lab-on-a-chip (LOC) is a microfluidic device (MFD) that integrates several lab functions into a single chip of only millimeters in size. LOC provides several advantages, such as low fluidic volumes consumption, faster analysis, compactness, and massive parallelization. These properties enable a microfluidic-based high-throughput drug screening (HTDS) system to acquire cell-based abundant cytotoxicity results depending on linear gradient concentration of drug with only few hundreds of microliters of the drug. Therefore, a microfluidic device was developed containing an array of eight separate microchambers for cultivating HepG2 cells to be exposed to eight different concentrations of acetaminophen (APAP) through a diffusive-mixing-based concentration gradient generator. Every chamber array with eight different concentrations (0, 5.7, 11.4, 17.1, 22.8, 28.5, 34.2, or 40 mM) APAP had four replicating cell culture chambers. Consequently, 32 experimental results were acquired with a single microfluidic device experiment. The microfluidic high-throughput cytotoxicity device (μHTCD) and 96-well culture system showed comparable cytotoxicity results with increasing APAP concentration of 0 to 40 mM. The HTDS system yields progressive concentration-dependent cytotoxicity results using minimal reagent and time. Data suggest that the HTDS system may be applicable as alternative method for cytotoxicity screening for new drugs in diverse cell types.
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Affiliation(s)
- Seon Min Ju
- a Department of Biomedical Science , Dankook University Graduate School, Dankook University , Cheonan , Chungnam , Republic of Korea
| | - Hyun-Jun Jang
- b College of Pharmacy , Dankook University, Dankook University , Cheonan , Chungnam , Republic of Korea
| | - Kyu-Bong Kim
- b College of Pharmacy , Dankook University, Dankook University , Cheonan , Chungnam , Republic of Korea
| | - Jeongyun Kim
- a Department of Biomedical Science , Dankook University Graduate School, Dankook University , Cheonan , Chungnam , Republic of Korea
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Combining ibuprofen and acetaminophen for acute pain management after third-molar extractions: translating clinical research to dental practice. J Am Dent Assoc 2015; 144:898-908. [PMID: 23904576 DOI: 10.14219/jada.archive.2013.0207] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Effective and safe drug therapy for the management of acute postoperative pain has relied on orally administered analgesics such as ibuprofen, naproxen and acetaminophen, or N-acetyl-p-aminophenol (APAP), as well as combination formulations containing opioids such as hydrocodone with APAP. The combination of ibuprofen and APAP has been advocated in the last few years as an alternative therapy for postoperative pain management. The authors conducted a critical analysis to evaluate the scientific evidence for using the ibuprofen-APAP combination and propose clinical treatment recommendations for its use in managing acute postoperative pain in dentistry. TYPES OF STUDIES REVIEWED The authors used quantitative evidence-based reviews published by the Cochrane Collaboration to determine the relative analgesic efficacy and safety of combining ibuprofen and APAP. They found additional articles by searching the Ovid MEDLINE, PubMed and ClinicalTrials.gov databases. CONCLUSIONS The results of the quantitative systematic reviews indicated that the ibuprofen-APAP combination may be a more effective analgesic, with fewer untoward effects, than are many of the currently available opioid-containing formulations. In addition, the authors found several randomized controlled trials that also indicated that the ibuprofen-APAP combination provided greater pain relief than did ibuprofen or APAP alone after third-molar extractions. The adverse effects associated with the combination were similar to those of the individual component drugs. Practical Implications. Combining ibuprofen with APAP provides dentists with an additional therapeutic strategy for managing acute postoperative dental pain. This combination has been reported to provide greater analgesia without significantly increasing the adverse effects that often are associated with opioid-containing analgesic combinations. When making stepwise recommendations for the management of acute postoperative dental pain, dentists should consider including ibuprofen-APAP combination therapy.
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Koh W, Nguyen KP, Jahr JS. Intravenous non-opioid analgesia for peri- and postoperative pain management: a scientific review of intravenous acetaminophen and ibuprofen. Korean J Anesthesiol 2015; 68:3-12. [PMID: 25664148 PMCID: PMC4318862 DOI: 10.4097/kjae.2015.68.1.3] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 07/11/2014] [Accepted: 07/15/2014] [Indexed: 11/25/2022] Open
Abstract
Pain is a predictable consequence following operations, but the management of postoperative pain is another challenge for anesthesiologists and inappropriately controlled pain may lead to unwanted outcomes in the postoperative period. Opioids are indeed still at the mainstream of postoperative pain control, but solely using only opioids for postoperative pain management may be connected with risks of complications and adverse effects. As a consequence, the concept of multimodal analgesia has been proposed and is recommended whenever possible. Acetaminophen is one of the most commonly used analgesic and antipyretic drug for its good tolerance and high safety profiles. The introduction of intravenous form of acetaminophen has led to a wider flexibility of its use during peri- and postoperative periods, allowing the early initiation of multimodal analgesia. Many studies have revealed the efficacy, safety and opioid sparing effects of intravenous acetaminophen. Intravenous ibuprofen has also shown to be well tolerated and demonstrated to have significant opioid sparing effects during the postoperative period. However, the number of randomized controlled trials confirming the efficacy and safety is small and should be used in caution in certain group of patients. Intravenous acetaminophen and ibuprofen are important options for multimodal postoperative analgesia, improving pain and patient satisfaction.
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Affiliation(s)
- Wonuk Koh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kimngan Pham Nguyen
- Department of Anesthesiology and Perioperative Medicine, UCLA College of Arts and Letters, CA, USA
| | - Jonathan S Jahr
- David Geffen School of Medicine at UCLA Ronald Regan UCLA Medical Center, CA, USA
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Imani F, Motavaf M, Safari S, Alavian SM. The therapeutic use of analgesics in patients with liver cirrhosis: a literature review and evidence-based recommendations. HEPATITIS MONTHLY 2014; 14:e23539. [PMID: 25477978 PMCID: PMC4250965 DOI: 10.5812/hepatmon.23539] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 09/30/2014] [Accepted: 10/04/2014] [Indexed: 12/11/2022]
Abstract
CONTEXT Pain management in cirrhotic patients is a major clinical challenge for medical professionals. Unfortunately there are no concrete guidelines available regarding the administration of analgesics in patients with liver cirrhosis. In this review we aimed to summarize the available literature and suggest appropriate evidence-based recommendations regarding to administration of these drugs. EVIDENCE ACQUISITION An indexed MEDLINE search was conducted in July 2014, using keywords "analgesics", "hepatic impairment", "cirrhosis", "acetaminophen or paracetamol", "NSAIDs or nonsteroidal anti-inflammatory drugs", "opioid" for the period of 2004 to 2014. All randomized clinical trials, case series, case report and meta-analysis studies with the above mentioned contents were included in review process. In addition, unpublished information from the Food and Drug Administration are included as well. RESULTS Paracetamol is safe in patients with chronic liver disease but a reduced dose of 2-3 g/d is recommended for long-term use. Non-steroidal anti-inflammatory drugs (NSAIDs) are best avoided because of risk of renal impairment, hepatorenal syndrome, and gastrointestinal hemorrhage. Most opioids can have deleterious effects in patients with cirrhosis. They have an increased risk of toxicity and hepatic encephalopathy. They should be administrated with lower and less frequent dosing in these patients and be avoided in patients with a history of encephalopathy or addiction to any substance. CONCLUSIONS No evidence-based guidelines exist on the use of analgesics in patients with liver disease and cirrhosis. As a result pain management in these patients generates considerable misconception among health care professionals, leading under-treatment of pain in this population. Providing concrete guidelines toward the administration of these agents will lead to more efficient and safer pain management in this setting.
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Affiliation(s)
- Farnad Imani
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mahsa Motavaf
- Department of Genetics, Faculty of Biological Sciences, Tarbiat Modares University, Tehran, IR Iran
- Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran
| | - Saeid Safari
- Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Moayed Alavian
- Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding Author: Seyed Moayed Alavian, Department of Molecular Hepatology, Middle East Liver Disease Center, Tehran, IR Iran. Tel: +98-2188945186, Fax: +98-2188945188, E-mail:
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Mobasher MA, de Toro-Martín J, González-Rodríguez Á, Ramos S, Letzig LG, James LP, Muntané J, Álvarez C, Valverde ÁM. Essential role of protein-tyrosine phosphatase 1B in the modulation of insulin signaling by acetaminophen in hepatocytes. J Biol Chem 2014; 289:29406-19. [PMID: 25204659 DOI: 10.1074/jbc.m113.539189] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Many drugs are associated with the development of glucose intolerance or deterioration in glycemic control in patients with pre-existing diabetes. We have evaluated the cross-talk between signaling pathways activated by acetaminophen (APAP) and insulin signaling in hepatocytes with or without expression of the protein-tyrosine phosphatase 1B (PTP1B) and in wild-type and PTP1B-deficient mice chronically treated with APAP. Human primary hepatocytes, Huh7 hepatoma cells with silenced PTP1B, mouse hepatocytes from wild-type and PTP1B-deficient mice, and a mouse model of chronic APAP treatment were used to examine the mechanisms involving PTP1B in the effects of APAP on glucose homeostasis and hepatic insulin signaling. In APAP-treated human hepatocytes at concentrations that did not induce death, phosphorylation of JNK and PTP1B expression and enzymatic activity were increased. APAP pretreatment inhibited activation of the early steps of insulin signaling and decreased Akt phosphorylation. The effects of APAP in insulin signaling were prevented by suramin, a PTP1B inhibitor, or rosiglitazone that decreased PTP1B levels. Likewise, PTP1B deficiency in human or mouse hepatocytes protected against APAP-mediated impairment in insulin signaling. These signaling pathways were modulated in mice with chronic APAP treatment, resulting in protection against APAP-mediated hepatic insulin resistance and alterations in islet alpha/beta cell ratio in PTP1B(-/-) mice. Our results demonstrate negative cross-talk between signaling pathways triggered by APAP and insulin signaling in hepatocytes, which is in part mediated by PTP1B. Moreover, our in vivo data suggest that chronic use of APAP may be associated with insulin resistance in the liver.
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Affiliation(s)
- Maysa Ahmed Mobasher
- From the Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM), 28029 Madrid, Spain, the Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salid Carlos III, 28029 Madrid
| | - Juan de Toro-Martín
- the Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salid Carlos III, 28029 Madrid, the Departamento de Bioquímica y Biología Molecular II, Facultad de Farmacia, Universidad Complutense de Madrid, 28034 Madrid, Spain
| | - Águeda González-Rodríguez
- From the Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM), 28029 Madrid, Spain, the Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salid Carlos III, 28029 Madrid
| | - Sonia Ramos
- the Instituto de Ciencia y Tecnología de Alimentos y Nutrición (ICTAN-CSIC), 28040 Madrid, Spain
| | - Lynda G Letzig
- the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, and
| | - Laura P James
- the Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, and
| | - Jordi Muntané
- the Department of General Surgery, Institute of Biomedicine of Seville, Hospital Universitary "Virgen del Rocío"/CSIC/University of Seville, 41013 Seville, Spain
| | - Carmen Álvarez
- the Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salid Carlos III, 28029 Madrid, the Departamento de Bioquímica y Biología Molecular II, Facultad de Farmacia, Universidad Complutense de Madrid, 28034 Madrid, Spain
| | - Ángela M Valverde
- From the Instituto de Investigaciones Biomédicas Alberto Sols (CSIC-UAM), 28029 Madrid, Spain, the Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salid Carlos III, 28029 Madrid,
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Sanders R, Lamb K. An exploration of the benefits and drawbacks of intrapartum pain management strategies. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.9.642] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ruth Sanders
- Student Midwife School of Nursing Sciences University of East Anglia
| | - Kathryn Lamb
- Student Midwife School of Nursing Sciences University of East Anglia
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Shimizu D, Ishitsuka Y, Miyata K, Tomishima Y, Kondo Y, Irikura M, Iwawaki T, Oike Y, Irie T. Protection afforded by pre- or post-treatment with 4-phenylbutyrate against liver injury induced by acetaminophen overdose in mice. Pharmacol Res 2014; 87:26-41. [PMID: 24951965 DOI: 10.1016/j.phrs.2014.06.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 12/23/2022]
Abstract
Acetaminophen (paracetamol, N-acetyl-p-aminophenol; APAP) is a widely used analgesic/antipyretic drug with few adverse effects at therapeutic doses; suicidal or unintentional overdose of APAP frequently induces severe hepatotoxicity. To explore a new and effective antidote for APAP hepatotoxicity, this study examined the effects of sodium 4-phenylbutyrate (4-PBA) on liver injury induced by APAP overdose in mice. Liver injury was induced in C57BL/6 male mice by intraperitoneal injection of APAP (400mg/kg). The effects of 4-PBA (100-200mg/kg) treatment at 1h before the APAP injection were evaluated with serum alanine aminotransferase (ALT) and blood ammonia levels, hepatic pathological changes, including histopathology, DNA damage, nitrotyrosine formation, and mRNA or protein expression involved in the development of hepatotoxicity, such as X-box binding protein-1 (XBP1), c-Jun N-terminal kinase (JNK), C/EBP homologous protein (CHOP) and B-cell lymphoma 2 interacting mediator of cell death (Bim). In addition, glutathione depletion and CYP2E1 protein expression, which are measures of the metabolic conversion of APAP to a toxic metabolite, were examined. Furthermore, we examined the effects of post-treatment with 4-PBA against APAP-induced hepatotoxicity in mice. When administered at 1h before APAP injection, 4-PBA significantly prevented the increase in serum ALT and blood ammonia levels, centrilobular necrosis of hepatocytes, DNA fragmentation, and nitrotyrosine formation induced by APAP in mice. 4-PBA also inhibited hepatic Xbp1 mRNA splicing and JNK phosphorylation induced by APAP, but did not suppress CHOP and Bim mRNA and protein expression. In addition, 4-PBA had little effect on hepatic glutathione depletion and CYP2E1 expression, parameters of toxic APAP metabolite production. Post-treatment with 4-PBA administration at 1 or 2h after APAP injection also attenuated the increase in serum ALT and blood ammonia levels and hepatic pathological changes in APAP-induced hepatotoxicity in mice. Although post-treatment with 4-PBA did not show any effects on hepatic Xbp1 mRNA splicing and JNK phosphorylation, it drastically attenuated the DNA fragmentation induced by APAP. The precise molecular mechanisms of the protection afforded by 4-PBA against APAP hepatotoxicity in mice are unclear, but they seem to involve inhibition of hepatocellular DNA fragmentation. We suggest that 4-PBA is a promising candidate as an antidote against APAP-induced liver injury.
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Affiliation(s)
- Daisuke Shimizu
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yoichi Ishitsuka
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan.
| | - Keishi Miyata
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Yoshiro Tomishima
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Yuki Kondo
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
| | - Mitsuru Irikura
- Laboratory of Evidence-Based Pharmacotherapy, College of Pharmaceutical Sciences, Daiichi University, 22-1 Tamagawa-Cho, Minami-Ku, Fukuoka 815-8511, Japan
| | - Takao Iwawaki
- Iwawaki Lab, Advanced Scientific Research Leaders Development Unit, Gunma University, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yuichi Oike
- Department of Molecular Genetics, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 860-8556, Japan
| | - Tetsumi Irie
- Department of Clinical Chemistry and Informatics, Graduate School of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan; Center for Clinical Pharmaceutical Sciences, Faculty of Pharmaceutical Sciences, Kumamoto University, 5-1 Oe-honmachi, Chuo-ku, Kumamoto 862-0973, Japan
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Effects of prophylactic and therapeutic paracetamol treatment during vaccination on hepatitis B antibody levels in adults: two open-label, randomized controlled trials. PLoS One 2014; 9:e98175. [PMID: 24897504 PMCID: PMC4045752 DOI: 10.1371/journal.pone.0098175] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/25/2014] [Indexed: 12/03/2022] Open
Abstract
Worldwide, paracetamol is administered as a remedy for complaints that occur after vaccination. Recently published results indicate that paracetamol inhibits the vaccination response in infants when given prior to vaccination. The goal of this study was to establish whether paracetamol exerts similar effects in young adults. In addition, the effect of timing of paracetamol intake was investigated. In two randomized, controlled, open-label studies 496 healthy young adults were randomly assigned to three groups. The study groups received paracetamol for 24 hours starting at the time of (prophylactic use) - or 6 hours after (therapeutic use) the primary (0 month) and first booster (1 month) hepatitis B vaccination. The control group received no paracetamol. None of the participants used paracetamol around the second booster (6 months) vaccination. Anti-HBs levels were measured prior to and one month after the second booster vaccination on ADVIA Centaur XP. One month after the second booster vaccination, the anti-HBs level in the prophylactic paracetamol group was significantly lower (p = 0.048) than the level in the control group (4257 mIU/mL vs. 5768 mIU/mL). The anti-HBs level in the therapeutic paracetamol group (4958 mIU/mL) was not different (p = 0.34) from the level in the control group. Only prophylactic paracetamol treatment, and not therapeutic treatment, during vaccination has a negative influence on the antibody concentration after hepatitis B vaccination in adults. These findings prompt to consider therapeutic instead of prophylactic treatment to ensure maximal vaccination efficacy and retain the possibility to treat pain and fever after vaccination. Trial Registration Controlled-Trials.com ISRCTN03576945
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Aritomi K, Ishitsuka Y, Tomishima Y, Shimizu D, Abe N, Shuto T, Irikura M, Kai H, Irie T. Evaluation of Three-Dimensional Cultured HepG2 Cells in a Nano Culture Plate System: an In Vitro Human Model of Acetaminophen Hepatotoxicity. J Pharmacol Sci 2014; 124:218-29. [DOI: 10.1254/jphs.13135fp] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Koteswara CM, D S. A Study on Pre-Emptive Analgesic Effect of Intravenous Paracetamol in Functional Endoscopic Sinus Surgeries (FESSs): A Randomized, Double-Blinded Clinical Study. J Clin Diagn Res 2014; 8:108-11. [PMID: 24596738 DOI: 10.7860/jcdr/2014/7016.3922] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 12/15/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Functional Endoscopic Sinus Surgery (FESS) is associated with significant post-operative pain. Intravenous (iv) paracetamol provides pain relief in most patients who have undergone FESS. In some studies, it was found to be inadequate. It has been observed from previous studies conducted on patients undergoing other surgeries like abdominal surgeries that the analgesic efficacy of iv paracetamol improves when used Pre-emptively. There are no studies done previously on use of iv paracetamol Pre-emptively in FESS. OBJECTIVE The purpose of the study was to determine the post-operative analgesic effects of Pre-emptive intravenous (iv) paracetamol in FESS. MATERIALS AND METHODS Following institutional ethics committee approval, thirty nine American Society of Anesthesiology (ASA) physical status I-II patients were assigned in a randomized manner into two groups: Group I received iv paracetamol 1g, in 100mL, 15 minutes before induction and Group II received iv paracetamol 1g, in 100 mL, at the end of the surgery. The time to first analgesic use and the total analgesic consumed in 24 hours was recorded. Visual Analog Scale (VAS) pain scores were obtained from all patients at 0, 30 minutes, 1, 2, 6, 12 and 24 hours after the end of the Surgery. RESULTS Time to first analgesic requirement was significantly longer in Group I compared to Group II (p = 0.0329). Rescue analgesic consumption and post-operative VAS pain scores recorded were significantly lower in Group I compared to Group II (p < 0.05) until 24 after surgery. CONCLUSION Pre-emptive iv paracetamol in comparison to intra-operative paracetamol, provided effective and reliable post-operative analgesia after FESS.
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Affiliation(s)
- Chethan M Koteswara
- Assistant Professor, Department of Anaesthesiology, AJ Institute of Medical Sciences , Kuntikana, Mangalore-575008, Karnataka, India
| | - Sheetal D
- Associate Professor, Department of ENT, AJ Institute of Medical Sciences , Kuntikana, Mangalore-575008, Karnataka, India
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Ingawale DK, Mandlik SK, Naik SR. Models of hepatotoxicity and the underlying cellular, biochemical and immunological mechanism(s): a critical discussion. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2014; 37:118-133. [PMID: 24322620 DOI: 10.1016/j.etap.2013.08.015] [Citation(s) in RCA: 160] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/27/2013] [Accepted: 08/31/2013] [Indexed: 06/03/2023]
Abstract
Liver is a primary organ involved in biotransformation of food and drugs. Hepatic diseases are a major worldwide problem. Hepatic disorders are mainly caused by toxic chemicals (alcohol), xenobiotics (carbon tetrachloride, chlorinated hydrocarbons and gases CO₂ and O₂) anticancer (azathioprine, doxorubicin, cisplatin), immunosuppressant (cyclosporine), analgesic anti-inflammatory (paracetamol, thioacetamide), anti-tubercular (isoniazid, rifampicin) drugs, biologicals (Bacillus-Calmette-Guerin vaccine), radiations (gamma radiations), heavy metals (cadmium, arsenic), mycotoxin (aflatoxin), galactosamine, lipopolysaccharides, etc. Various risk factors for hepatic injury include concomitant hepatic diseases, age, gender, alcoholism, nutrition and genetic polymorphisms of cytochrome P450 enzymes have also been emphasized. The present review enumerates various in vivo animal models and in vitro methods of hepatic injury using diverse toxicants, their probable metabolic pathways, and numerous biochemical changes viz. serum biomarkers enzymes, liver function, oxidative stress associated events like free radicals formation, lipid peroxidation, enzyme antioxidants and participation of cytokines (tumour necrosis factor-α, transforming growth factor-β, tumour necrosis factor-related apoptosis inducing ligand), and other biomolecules (Fas and C-jun N-terminal kinase) are also discussed. The underlying cellular, molecular, immunological, and biochemical mechanism(s) of action responsible for liver damage (toxicity) are also been discussed. This review should be immensely useful for researchers especially for phytochemists, pharmacologists and toxicologists working on hepatotoxicity, hepatotoxic chemicals and drugs, hepatoprotective agents and drug research organizations involved especially in phytopharmaceuticals and other natural products.
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Affiliation(s)
- Deepa K Ingawale
- Sinhgad Technical Education Society's, Sinhgad Institute of Pharmaceutical Sciences, S. No. 309/310, Off Mumbai-Pune Expressway, Kusgaon (Bk.), Lonavala, Pune 410 401, Maharashtra, India
| | - Satish K Mandlik
- Sinhgad College of Pharmacy, S. No. 44/1, Vadgaon (Bk.), Off Sinhgad Road, Pune 411 041, Maharashtra, India
| | - Suresh R Naik
- Sinhgad Technical Education Society's, Sinhgad Institute of Pharmaceutical Sciences, S. No. 309/310, Off Mumbai-Pune Expressway, Kusgaon (Bk.), Lonavala, Pune 410 401, Maharashtra, India.
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