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Telnova TY, Morgunova MM, Shashkina SS, Vlasova AA, Dmitrieva ME, Shelkovnikova VN, Malygina EV, Imidoeva NA, Belyshenko AY, Konovalov AS, Misharina EA, Axenov-Gribanov DV. Detection of Pharmaceutical Contamination in Amphipods of Lake Baikal by the HPLC-MS Method. Antibiotics (Basel) 2024; 13:738. [PMID: 39200038 PMCID: PMC11350909 DOI: 10.3390/antibiotics13080738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 09/01/2024] Open
Abstract
Pollution by active ingredients is one of the most significant and widespread forms of pollution on Earth. Medicines can have a negative impact on ecosystems, and contamination can have unpredictable consequences. An urgent and unexplored task is to study the Lake Baikal ecosystem and its organisms for the presence of trace concentrations of active pharmaceutical ingredients. Our study aimed to conduct a qualitative analysis of active pharmaceutical ingredients, and quantitative analysis of ibuprofen in endemic amphipods of Lake Baikal, using methods of high-performance liquid chromatography and mass spectrometry (HPLC-MS). Acetylsalicylic acid (aspirin), ibuprofen, acetaminophen, azithromycin, dimetridazole, metronidazole, amikacin, spiramycin, and some tetracycline antibiotics were detected in the studied littoral amphipods. We also detected different annual loads of active pharmaceutical ingredients on amphipods. Using the multiple reaction monitoring (MRM) mode mentioned in GOST International Technical Standards, we detected molecules, fragmented as amikacin, chlortetracycline, doxycycline, oxytetracycline, dimetridazole, metronidazole and spiramycin. Thus, we first revealed that invertebrates of Lake Baikal can uptake pharmaceutical contaminants in the environment.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Denis V. Axenov-Gribanov
- Research Department, Biological and Soil Faculty, Irkutsk State University, Irkutsk 664003, Russia; (T.Y.T.); (M.M.M.); (S.S.S.); (A.A.V.); (M.E.D.); (V.N.S.); (E.V.M.); (N.A.I.); (A.Y.B.); (A.S.K.); (E.A.M.)
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2
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Huang L, Zhang T, Wang K, Chang B, Fu D, Chen X. Postoperative Multimodal Analgesia Strategy for Enhanced Recovery After Surgery in Elderly Colorectal Cancer Patients. Pain Ther 2024; 13:745-766. [PMID: 38836984 PMCID: PMC11254899 DOI: 10.1007/s40122-024-00619-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/21/2024] [Indexed: 06/06/2024] Open
Abstract
Enhanced Recovery After Surgery (ERAS) protocols have substantially proven their merit in diminishing recuperation durations and mitigating postoperative adverse events in geriatric populations undergoing colorectal cancer procedures. Despite this, the pivotal aspect of postoperative pain control has not garnered the commensurate attention it deserves. Typically, employing a multimodal analgesia regimen that weaves together nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, and nerve blocks stands paramount in curtailing surgical complications and facilitating reduced convalescence within hospital confines. Nevertheless, this integrative pain strategy is not devoid of pitfalls; the specter of organ dysfunction looms over the geriatric cohort, rooted in the abuse of analgesics or the complex interplay of polypharmacy. Revolutionary research is delving into alternative delivery and release modalities, seeking to allay the inadvertent consequences of analgesia and thereby potentially elevating postoperative outcomes for the elderly post-colorectal cancer surgery populace. This review examines the dual aspects of multimodal analgesia regimens by comparing their established benefits with potential limitations and offers insight into the evolving strategies of drug administration and release.
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Affiliation(s)
- Li Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Kaixin Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China
| | - Bingcheng Chang
- The Second Affiliated Hospital of Guizhou, University of Traditional Chinese Medicine, Guiyang, 550003, China
| | - Daan Fu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, Hubei, China.
- Institute of Anesthesia and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
- Ministry of Education, Key Laboratory of Anesthesiology and Resuscitation (Huazhong University of Science and Technology), Wuhan, China.
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3
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Sharif S, Jazaib Ali MY, Kirazlı Y, Vlok I, Zygourakis C, Zileli M. Acute back pain: The role of medication, physical medicine and rehabilitation: WFNS spine committee recommendations. World Neurosurg X 2024; 23:100273. [PMID: 38807862 PMCID: PMC11130729 DOI: 10.1016/j.wnsx.2024.100273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/01/2024] [Indexed: 05/30/2024] Open
Abstract
Objectives To formulate the most current, evidence-based recommendations for the role of medication, physical medicine, and rehabilitation in the management of acute low back pain lasting <4 weeks. Methods A systematic literature search in PubMed and Google Scholar databases was performed from 2012 to 2022 using the search terms "acute low back pain," "drugs," "bed rest," "physical medicine," rehabilitation." Standardized screening criteria resulted in a total of 39 articles that were analyzed, including 16 RCTs, 8 prospective studies, 6 retrospective studies, and 9 systematic reviews. This up-to-date information was reviewed and presented at two separate meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. Two rounds of the Delphi method were utilized to vote on the statements and arrive at a positive or negative consensus. Results and conclusion The WFNS Spine Committee finalized twelve recommendation guidelines on the role of medication, physical medicine and rehabilitation in the management of acute LBP. We advocate for a uniform approach to the treatment of these patients, including proper patient education and utilizing drugs with proven efficacy and minimal side effects. First-line pharmacologic agents are acetaminophen and NSAIDs; muscle relaxants can be used for spasms and pain reduction, and opioids should be minimized. Continued activity, rather than bed rest, is recommended, and lumbar spine orthotics may be used to reduce pain and augment functional status. Thermotherapy, cryotherapy, TENs, spinal manipulative therapy, and acupuncture may all be used as adjuncts to improve acute LBP.
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Affiliation(s)
- Salman Sharif
- Department of Neurosurgery, Liaquat National Hospital & Medical College, Karachi, Pakistan
| | | | - Yeşim Kirazlı
- Department of Physical Medicine and Rehabilitation, Ege University, Izmir, Turkey
| | - Ian Vlok
- Department of Neurosurgery, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Corinna Zygourakis
- Department of Neurosurgery, Sanko University Faculty of Medicine, Gaziantep, Turkey
| | - Mehmet Zileli
- Department of Neurosurgery, Stanford University School of Medicine, California, USA
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Velikova T, Valkov H, Aleksandrova A, Peshevska-Sekulovska M, Sekulovski M, Shumnalieva R. Harnessing immunity: Immunomodulatory therapies in COVID-19. World J Virol 2024; 13:92521. [PMID: 38984079 PMCID: PMC11229839 DOI: 10.5501/wjv.v13.i2.92521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/02/2024] [Accepted: 04/11/2024] [Indexed: 06/24/2024] Open
Abstract
An overly exuberant immune response, characterized by a cytokine storm and uncontrolled inflammation, has been identified as a significant driver of severe coronavirus disease 2019 (COVID-19) cases. Consequently, deciphering the intricacies of immune dysregulation in COVID-19 is imperative to identify specific targets for intervention and modulation. With these delicate dynamics in mind, immunomodulatory therapies have emerged as a promising avenue for mitigating the challenges posed by COVID-19. Precision in manipulating immune pathways presents an opportunity to alter the host response, optimizing antiviral defenses while curbing deleterious inflammation. This review article comprehensively analyzes immunomodulatory interventions in managing COVID-19. We explore diverse approaches to mitigating the hyperactive immune response and its impact, from corticosteroids and non-steroidal drugs to targeted biologics, including anti-viral drugs, cytokine inhibitors, JAK inhibitors, convalescent plasma, monoclonal antibodies (mAbs) to severe acute respiratory syndrome coronavirus 2, cell-based therapies (i.e., CAR T, etc.). By summarizing the current evidence, we aim to provide a clear roadmap for clinicians and researchers navigating the complex landscape of immunomodulation in COVID-19 treatment.
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Affiliation(s)
- Tsvetelina Velikova
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
| | - Hristo Valkov
- Department of Gastroenterology, University Hospital “Tsaritsa Yoanna-ISUL”, Medical University of Sofia, Sofia 1527, Bulgaria
| | | | - Monika Peshevska-Sekulovska
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Gastroenterology, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Metodija Sekulovski
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Anesthesiology and Intensive Care, University Hospital Lozenetz, Sofia 1407, Bulgaria
| | - Russka Shumnalieva
- Medical Faculty, Sofia University St. Kliment Ohridski, Sofia 1407, Bulgaria
- Department of Rheumatology, Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia 1612, Bulgaria
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Montuori P, Shojaeian SZ, Pennino F, D’Angelo D, Sorrentino M, Di Sarno S, Nubi R, Nardo A, Triassi M. Consumer awareness and knowledge regarding use of non-steroidal anti-inflammatory drugs (NSAIDs) in a metropolitan area. Front Pharmacol 2024; 15:1362632. [PMID: 38966546 PMCID: PMC11222409 DOI: 10.3389/fphar.2024.1362632] [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: 03/01/2024] [Accepted: 05/16/2024] [Indexed: 07/06/2024] Open
Abstract
Background Non-steroidal anti-inflammatory drugs (NSAIDs) have well-known adverse effects, and numerous studies have shown inappropriate behaviors regarding their use. The primary aim of this study was to analyze the knowledge, attitudes, and behaviors regarding the use of NSAIDs simultaneously in one of the largest and most populated areas of Italy, Naples. Methods From 2021 December 14th to 2022 January 4th, a cross-sectional survey study was conducted among community centers, working places, and universities using a snowball sampling method. For inclusion in the study, the participants were required to be at least 18 years old and residents in the metropolitan area of Naples. Three multiple linear regression analysis (MLRA) models were developed by including variables that could potentially be associated with the following outcomes of interest: knowledge (Model I), attitudes (Model II), and behavior (Model III) regarding the use of NSAIDs. Results Data were acquired from 1,012 questionnaires administered to subjects evenly divided by gender with an average age of 36.8 years and revealed that only 7.9% of the participants self-admittedly did not take NSAIDs, while approximately half the participants (50%) admitted to occasionally using them. The results showed a statistically significant correlation between attitudes regarding the appropriate use of NSAIDs and less knowledge. The regression analyses indicated that behaviors regarding the appropriate use of NSAIDs were statistically significant in younger respondents, non-smokers, and those without children. These interesting results showed that behaviors regarding the appropriate use of NSAIDs were significantly higher among respondents with less knowledge and more positive attitudes. Conclusion According to the collected data and statistical analysis results, it is possible to identify factors that can greatly affect inappropriate behaviors regarding the use of NSAIDs and establish targeted prevention programs.
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Affiliation(s)
| | | | - Francesca Pennino
- Department of Public Health, “Federico II” University, Naples, Italy
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Collamore G, DiCorcia MJ, Nagpal Y, Fiedler L, Garone MA, DeMets DL, Maki DG, Hennekens CH. Guidance for Healthcare Providers on Newest Guidelines for Over-the-Counter Drug Treatment of Mild Symptoms of COVID-19. Am J Med 2024; 137:490-493. [PMID: 38490308 DOI: 10.1016/j.amjmed.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
On January 18, 2024, the US Centers for Disease Control and Prevention issued their most recent guidelines for over-the-counter drugs for coronavirus disease 2019 (COVID-19). Specifically, the organization stated that "Most people with COVID-19 have mild illness and can recover at home. You can treat symptoms with over-the-counter medicines, such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil), to help you feel better." In this review we consider the contributions of different types of evidence and conclude that healthcare providers should make individual clinical judgments for each of their patients in the selection of over-the-counter drugs to treat symptoms of COVID-19. This judgment should be based on the entire benefit to risk profile of the patient. It is our belief that the individual healthcare provider knows far more about each of his or her patients than anyone, including expert members of guideline committees. Their astute and judicious individual clinical decision-making for each individual patient based on all these considerations has the potential to do far more good than harm.
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Affiliation(s)
- Gage Collamore
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Mark J DiCorcia
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Yash Nagpal
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Lawrence Fiedler
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| | - Michael A Garone
- Inova Fair Oaks Hospital, Chantilly, Virginia; George Washington University Hospital, Washington, DC
| | - David L DeMets
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Dennis G Maki
- University of Wisconsin School of Medicine and Public Health, Madison
| | - Charles H Hennekens
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
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Barbanti P, Allais G, Cevoli S, Guerzoni S, Valeriani M, Vernieri F. The Role of the Combination Paracetamol/Caffeine in Treatment of Acute Migraine Pain: A Narrative Review. Pain Ther 2024; 13:319-346. [PMID: 38446344 PMCID: PMC11111640 DOI: 10.1007/s40122-024-00581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/05/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Thirty years ago, the first migraine-specific drugs (triptans) appeared. Today two new categories (gepants and ditans) are marketed for acute migraine treatment. That said, is there still a role for conventional therapy? The aim of the present narrative review is to provide an expert overview examining the possible role of the combination paracetamol/caffeine in treatment of acute migraine pain. METHODS To understand possible settings for more appropriate use of paracetamol/caffeine (1000 mg/130 mg) in treatment of acute migraine, a structured literature search was performed using the PubMed database by a panel of experts from major Italian headache centers; articles not referring to migraine pain were excluded from this review; review articles were prioritized. RESULTS Overall response, even to newer specific and selective trigeminal targeted drugs (TTTs), is not over 60%; thus, there is still room for conventional therapies in acute migraine treatment. The panel identified settings in which the use of paracetamol/caffeine combination to treat acute migraine attacks might offer benefit considering the consolidated use through years, despite the lack of studies directly addressing the efficacy of paracetamol/caffeine in the identified populations: subjects > 65 years of age; presence of cardiovascular (CV) comorbidities; TTTs non-responders; pregnancy and breastfeeding; subjects < 18 years of age; paracetamol/caffeine as add-on therapy. CONCLUSIONS Paracetamol is included in the World Health Organization (WHO) essential drug list and has a high level of popularity among patients. Caffeine enhances the analgesic effect of other drugs including paracetamol. In early treatment of acute migraine pain, prescribing physicians might consider using the paracetamol/caffeine combination among other options.
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Affiliation(s)
- Piero Barbanti
- Headache and Pain Unit-IRCCS San Raffaele, via della Pisana 235, 00163, Rome, Italy.
- University San Raffaele, Rome, Italy.
| | - Gianni Allais
- Department of Surgical Sciences, Women's Headache Center, University of Turin, Turin, Italy
| | - Sabina Cevoli
- Sabina Cevoli IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simona Guerzoni
- Digital and Predictive Medicine, Pharmacology and Clinical Metabolic Toxicology-Headache Center and Drug Abuse-Laboratory of Clinical Pharmacology and Pharmacogenomics, Department of Specialist Medicines, AOU Policlinico di Modena, Modena, Italy
| | - Massimiliano Valeriani
- Developmental Neurology Unit, IRCSS Ospedale Pediatrico Bambino Gesù, Rome, Italy
- Center for Sensory-Motor Interaction, Aalborg University, Aalborg, Denmark
| | - Fabrizio Vernieri
- Headache Unit, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Neurology, Università Campus Bio-Medico di Roma, Rome, Italy
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Suciu M, Vlaia L, Boujneh E, Suciu L, Buda VO, Jianu N, Vlaia V, Cristescu C. Prevalence and Determinants of Self-Medication Practices among Cardiovascular Patients from Béja, North West Tunisia: A Community-Pharmacy-Based Survey. PHARMACY 2024; 12:68. [PMID: 38668094 PMCID: PMC11054241 DOI: 10.3390/pharmacy12020068] [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: 02/20/2024] [Revised: 03/30/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
In Tunisia, self-medication is a common practice, and there is a continual rise in the prevalence of cardiovascular disease. Given the lack of data on the self-medication practices (SMPs) among cardiovascular patients in this area, the present study aimed to identify the prevalence and determinants of SMPs among cardiovascular patients in the city of Béja. A community-pharmacy-based survey was conducted among selected cardiovascular patients in Béja, Tunisia, from May 2021 to June 2021. Data were collected using a self-administered questionnaire provided by pharmacists during in-person surveys with patients. Descriptive statistics were used to summarize the data, while Fisher's exact test was used for categorical variables, with the significance level set at p < 0.05. The frequency of self-medication among the 150 respondents was 96%; 70.14% of participants reported that the primary reason why people engage in self-medication is the existence of an old prescription. The most prevalent conditions leading patients to self-medicate were headaches (100%), fever (83.33%), toothache (65.97%), and dry cough (47.92%). The most frequently self-administered drugs were paracetamol (100%), antibiotics (56.94%), and antitussives (47.92%). The results of our study indicate that SMPs among Tunisian cardiovascular patients have a high prevalence. With this in mind, healthcare practitioners should ask their patients about their self-medication practices and advise cardiovascular patients about the risks and benefits associated with this practice.
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Affiliation(s)
- Maria Suciu
- Department II—Pharmacology-Pharmacotherapy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (M.S.); (L.S.); (C.C.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Lavinia Vlaia
- Department II—Pharmaceutical Technology, Formulation and Technology of Drugs Research Center, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Eya Boujneh
- Tunisian Pharmacist, Abdellatif Boujnah Pharmacy, Avenue Mongi Slim, Béja 9000, Tunisia;
| | - Liana Suciu
- Department II—Pharmacology-Pharmacotherapy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (M.S.); (L.S.); (C.C.)
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Valentina Oana Buda
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
- Department I—Clinical Pharmacy, Communication in Pharmacy, Pharmaceutical Care, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Narcisa Jianu
- Research Center for Pharmaco-Toxicological Evaluation, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
- Department I—Clinical Pharmacy, Communication in Pharmacy, Pharmaceutical Care, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania
| | - Vicențiu Vlaia
- Organic Chemistry, Formulation and Technology of Drugs Research Center, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania;
| | - Carmen Cristescu
- Department II—Pharmacology-Pharmacotherapy, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. No. 2, 300041 Timișoara, Romania; (M.S.); (L.S.); (C.C.)
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Wanyo P, So-In C. The protective effect of Thai rice bran on N-acetyl-ρ-aminophen-induced hepatotoxicity in mice. Res Pharm Sci 2024; 19:188-202. [PMID: 39035586 PMCID: PMC11257212 DOI: 10.4103/rps.rps_210_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 07/23/2024] Open
Abstract
Background and purpose N-acetyl-ρ-aminophen (APAP) is a widely used medication with analgesic and antipyretic characteristics. High paracetamol doses can damage the liver. Thai-pigmented rice may treat numerous liver disorders due to its antioxidant, anti-inflammatory, and glutathione-restoring capabilities. This study aimed to evaluate the phenolic components in three Thai rice bran extracts and their antioxidant and hepatoprotective activities in an animal model. Experimental approach Fifty male mice were randomly assigned to the control and APAP studies. Each study was divided into 5 groups (n = 5) treated with distilled water, Hom Mali, Hang-Ngok, and Hom Nil (HN) rice compared with N-acetylcysteine with/without 60 mg/kg/day of APAP orally once a day for two weeks. Blood and liver sampling were collected for analysis. Findings/Results HN rice bran exhibited higher contents of total phenolic, total flavonoid, total anthocyanin, ferric-reducing antioxidant, and 1,1-diphenyl-2-picrylhydrazyl radical scavenging activities than Hom Mali and Hang-Ngok. Anthocyanin was merely detected in HN. Following APAP administration, mice exhibited significant increases in hepatic enzymes including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), pro-inflammatory cytokines (tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6)), and malondialdehyde (MDA), but lower levels of antioxidant enzymes and glutathione profiles. Amongst the three cultivars, HN rice was the only compound that decreased MDA, ALT, AST, TNF-α, and IL-6 while increasing antioxidant enzyme activity such as superoxide dismutase, catalase, and glutathione peroxidase that was very close to that of N-acetylcysteine groups. Conclusion and implications Given the hepatoprotective and antioxidant properties, HN has the potential to be used as a health supplement.
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Affiliation(s)
- Pitchaporn Wanyo
- Department of Food Technology, Faculty of Agricultural Technology, Kalasin University, Kalasin 46000, Thailand
| | - Charinya So-In
- Department of Veterinary Technology, Faculty of Agricultural Technology, Kalasin University, Kalasin 46000, Thailand
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Kouznetsov VV. Exploring acetaminophen prodrugs and hybrids: a review. RSC Adv 2024; 14:9691-9715. [PMID: 38525062 PMCID: PMC10958773 DOI: 10.1039/d4ra00365a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 03/17/2024] [Indexed: 03/26/2024] Open
Abstract
This critical review highlights the advances in developing new molecules for treating pain syndrome, an important issue for human health. Acetaminophen (APAP, known as paracetamol) and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in clinical practice despite their adverse effects. Research is being conducted to develop innovative drugs with improved pharmaceutical properties to mitigate these effects. A more practical way to achieve that is to study well-known and time-tested drugs in their molecular combinations. Accordingly, the present work explores APAP and their combined chemical entities, i.e., prodrugs (soft drugs), codrugs (mutual prodrugs), and hybrids. Due to their molecular structure, APAP prodrugs or codrugs could be considered merged or conjugated hybrids; all these names are very fluid terms. This article proposed a structural classification of these entities to better analyze their advances. So, the following: carrier-linked O-modified APAP, -linked N-modified APAP derivatives (prodrugs), and direct- and spacer-N,O-linked APAP hybrids (codrugs) are the central parts of this review and are examined, especially ester and amide NSAID-APAP molecules. The C-linked APAP and nitric oxide (NO)-releasing APAP hybrids were also briefly discussed. Prime examples of APAP-based drugs such as propacetamol, benorylate, acetaminosalol, nitroparacetamol, and agent JNJ-10450232 weave well into this classification. The proposed classification is the first and original, giving a better understanding of the SAR studies for new pain relievers research and the design development for the analgesic APAP-(or NSAID)-based compounds.
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Affiliation(s)
- Vladimir V Kouznetsov
- Laboratorio de Química Orgánica y Biomolecular, Escuela de Química, Universidad Industrial de Santander Cl. 9 # Cra 27 A.A. 680006 Bucaramanga Colombia
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Sethi V, Qin L, Trocóniz IF, Van der Laan L, Cox E, Della Pasqua O. Model-Based Assessment of the Liver Safety Profile of Acetaminophen to Support its Combination Use with Topical Diclofenac in Mild-to-Moderate Osteoarthritis Pain. Pain Ther 2024; 13:127-143. [PMID: 38183572 PMCID: PMC10796898 DOI: 10.1007/s40122-023-00566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/15/2023] [Indexed: 01/08/2024] Open
Abstract
INTRODUCTION The use of combination therapy of oral acetaminophen and topical diclofenac, having complementary mechanisms of action, is an attractive strategy to enhance the analgesic response in osteoarthritis (OA) pain. While topical diclofenac is considered as well tolerated due to its low systemic exposure, concerns of liver toxicity with acetaminophen at standard analgesic doses remain. Thus, this study aimed to assess the liver safety profile of acetaminophen, particularly in OA management, using a model-based meta-analysis (MBMA). METHODS A literature review was conducted using the MEDLINE database to identify randomized clinical trials (RCTs) reporting liver toxicity on acetaminophen use. An MBMA was implemented to assess the deviation from the upper limit of normal (ULN) of alanine aminotransferase or aspartate aminotransferase, namely > 0-1 × ULN, > 1.5-2 × ULN, and > 3 × ULN representing mild, moderate, and severe risk of liver abnormality, respectively. RESULTS A total of 15 RCTs were included in the MBMA, encompassing over 4800 subjects and exposure to acetaminophen ranging from 2 to 26 weeks. Of the 15 included studies, eight involved patients with OA pain, four involved healthy subjects and three were in patients with conditions such as asthma, glaucoma, chronic pain, and cardiovascular disease. Acetaminophen 1500-4000 mg/day was found to exhibit 23% (95% confidence interval (CI): 17.74-29.20), 1.35% (95% CI: 0.17-2.51) and 0.01% (95% CI: 0.00-0.32) increased risk for mild, moderate, and severe liver injury, respectively, versus placebo. Moreover, at therapeutic doses, no correlation was identified between acetaminophen intake and liver abnormality risk. CONCLUSIONS Overall, our analysis shows that short-term (~ 8-16 weeks) acetaminophen use at therapeutically recommended doses is associated with a low risk of clinically relevant changes in liver enzymes. Given the good tolerability of topical diclofenac, the findings support the safety of the combination of acetaminophen and topical diclofenac, at least over the short term, as treatment for mild-to-moderate OA pain.
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Affiliation(s)
- Vidhu Sethi
- Medical Affairs, Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, 139234, Singapore.
| | - Li Qin
- Quantitative Science, Certara, Princeton, USA
| | - Iñaki F Trocóniz
- Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain
| | | | - Eugène Cox
- Quantitative Science, Certara, Princeton, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology and Therapeutics Group, University College London, London, UK
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
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12
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Stasiowski MJ, Lyssek-Boroń A, Zmarzły N, Marczak K, Grabarek BO. The Adequacy of Anesthesia Guidance for Vitreoretinal Surgeries with Preemptive Paracetamol/Metamizole. Pharmaceuticals (Basel) 2024; 17:129. [PMID: 38256962 PMCID: PMC10819548 DOI: 10.3390/ph17010129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/09/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024] Open
Abstract
Despite the possibility of postoperative pain occurrence, in some patients, vitreoretinal surgeries (VRSs) require performance of general anesthesia (GA). The administration of intraoperative intravenous rescue opioid analgesics (IROA) during GA constitutes a risk of perioperative adverse events. The Adequacy of Anesthesia (AoA) concept consists of an entropy electroencephalogram to guide the depth of GA and surgical pleth index (SPI) to optimize the titration of IROA. Preemptive analgesia (PA) using cyclooxygenase-3 (COX-3) inhibitors is added to GA to minimize the demand for IROA and reduce postoperative pain. The current analysis evaluated the advantage of PA using COX-3 inhibitors added to GA with AoA-guided administration of IROA on the rate of postoperative pain and hemodynamic stability in patients undergoing VRS. A total of 165 patients undergoing VRS were randomly allocated to receive either GA with AoA-guided IROA administration with intravenous paracetamol/metamizole or with preemptive paracetamol or metamizole. Preemptive paracetamol resulted in a reduction in the IROA requirement; both preemptive metamizole/paracetamol resulted in a reduced rate of postoperative pain as compared to metamizole alone. We recommend using intraoperative AOA-guided IROA administration during VRS to ensure hemodynamic stability alongside PA using both paracetamol/metamizole to reduce postoperative pain.
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Affiliation(s)
- Michał Jan Stasiowski
- Chair and Department of Emergency Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
| | - Anita Lyssek-Boroń
- Department of Ophthalmology with Paediatric Unit, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-055 Katowice, Poland
| | - Nikola Zmarzły
- Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland; (N.Z.); (B.O.G.)
| | - Kaja Marczak
- Department of Anaesthesiology and Intensive Care, 5th Regional Hospital, Trauma Centre, 41-200 Sosnowiec, Poland;
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13
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Castanho NRCM, de Marco N, Caetano ÉLA, Alves PLM, Pickler TB, Ibanez NLDA, Jozala AF, Grotto D. Exploring Bacterial Cellulose and a Biosurfactant as Eco-Friendly Strategies for Addressing Pharmaceutical Contaminants. Molecules 2024; 29:448. [PMID: 38257361 PMCID: PMC10818349 DOI: 10.3390/molecules29020448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/18/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Aquatic environments face contamination by pharmaceuticals, prompting concerns due to their toxicity even at low concentrations. To combat this, we developed an ecologically sustainable biosurfactant derived from a microorganism and integrated it into bacterial cellulose (BC). This study aimed to evaluate BC's efficacy, with and without the biosurfactant, as a sorbent for paracetamol and 17α-ethinylestradiol (EE2) in water. We cultivated BC membranes using Gluconacetobacter xylinus ATCC 53582 and synthesized the biosurfactant through pre-inoculation of Bacillus subtilis in a synthetic medium. Subsequently, BC membranes were immersed in the biosurfactant solution for incorporation. Experiments were conducted using contaminated water, analyzing paracetamol concentrations via spectrophotometry and EE2 levels through high-performance liquid chromatography. Results indicated BC's superior adsorption for EE2 over paracetamol. Incorporating the biosurfactant reduced hormone adsorption but enhanced paracetamol sorption. Notably, original and freeze-dried BC exhibited better adsorption efficacy than biosurfactant-infused BC. In conclusion, BC showed promise in mitigating EE2 contamination, suggesting its potential for environmental remediation. Future research could focus on optimizing biosurfactant concentrations to enhance sorption capabilities without compromising BC's inherent effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Angela Faustino Jozala
- Department of Pharmacy, University of Sorocaba (UNISO), Sorocaba 18023-000, Brazil; (N.R.C.M.C.); (N.d.M.); (É.L.A.C.); (P.L.M.A.); (T.B.P.); (N.L.d.A.I.)
| | - Denise Grotto
- Department of Pharmacy, University of Sorocaba (UNISO), Sorocaba 18023-000, Brazil; (N.R.C.M.C.); (N.d.M.); (É.L.A.C.); (P.L.M.A.); (T.B.P.); (N.L.d.A.I.)
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14
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Ghrayeb A, Finney AC, Agranovich B, Peled D, Anand SK, McKinney MP, Sarji M, Yang D, Weissman N, Drucker S, Fernandes SI, Fernández-García J, Mahan K, Abassi Z, Tan L, Lorenzi PL, Traylor J, Zhang J, Abramovich I, Chen YE, Rom O, Mor I, Gottlieb E. Serine synthesis via reversed SHMT2 activity drives glycine depletion and acetaminophen hepatotoxicity in MASLD. Cell Metab 2024; 36:116-129.e7. [PMID: 38171331 PMCID: PMC10777734 DOI: 10.1016/j.cmet.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 10/27/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024]
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) affects one-third of the global population. Understanding the metabolic pathways involved can provide insights into disease progression and treatment. Untargeted metabolomics of livers from mice with early-stage steatosis uncovered decreased methylated metabolites, suggesting altered one-carbon metabolism. The levels of glycine, a central component of one-carbon metabolism, were lower in mice with hepatic steatosis, consistent with clinical evidence. Stable-isotope tracing demonstrated that increased serine synthesis from glycine via reverse serine hydroxymethyltransferase (SHMT) is the underlying cause for decreased glycine in steatotic livers. Consequently, limited glycine availability in steatotic livers impaired glutathione synthesis under acetaminophen-induced oxidative stress, enhancing acute hepatotoxicity. Glycine supplementation or hepatocyte-specific ablation of the mitochondrial SHMT2 isoform in mice with hepatic steatosis mitigated acetaminophen-induced hepatotoxicity by supporting de novo glutathione synthesis. Thus, early metabolic changes in MASLD that limit glycine availability sensitize mice to xenobiotics even at the reversible stage of this disease.
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Affiliation(s)
- Alia Ghrayeb
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Alexandra C Finney
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA
| | - Bella Agranovich
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Daniel Peled
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Sumit Kumar Anand
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA
| | - M Peyton McKinney
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA
| | - Mahasen Sarji
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Dongshan Yang
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Natan Weissman
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Shani Drucker
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Sara Isabel Fernandes
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Jonatan Fernández-García
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Kyle Mahan
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Zaid Abassi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Lin Tan
- Metabolomics Core Facility, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Philip L Lorenzi
- Metabolomics Core Facility, Department of Bioinformatics and Computational Biology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - James Traylor
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA
| | - Jifeng Zhang
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ifat Abramovich
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel
| | - Y Eugene Chen
- Center for Advanced Models for Translational Sciences and Therapeutics, University of Michigan Medical Center, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Oren Rom
- Department of Pathology and Translational Pathobiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA; Department of Internal Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI 48109, USA; Department of Molecular and Cellular Physiology, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA; Center for Cardiovascular Diseases and Sciences, Louisiana State University Health Sciences Center-Shreveport, Shreveport, LA 71103, USA.
| | - Inbal Mor
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel.
| | - Eyal Gottlieb
- Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel; Department of Cancer Biology, University of Texas MD Anderson Cancer Center, Houston, TX 77054, USA.
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15
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Sufiawati I, Siregar FD, Wahyuni IS, Syamsudin E. Evaluation of diode laser efficacy in treating benign oral soft tissue masses: A case series. Int J Surg Case Rep 2024; 114:109075. [PMID: 38029573 PMCID: PMC10711152 DOI: 10.1016/j.ijscr.2023.109075] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The diode laser, with a wavelength ranging from 810 to 980 nm, is a modern treatment modality that offers significant advantages in the management of benign oral soft tissue masses. Therefore, this report aimed to assess the efficacy of diode laser application for excisional biopsy of such masses. CASE PRESENTATION Three female patients, aged 9, 39, and 45 years, visited the Oral Medicine Clinic with complaints of painless masses in the oral cavity persisting for two to three months. Their intraoral examination showed the presence of pedunculated or sessile exophytic lesions with a smooth surface. The lesions appeared as single, pink to red protrusions located in various sites, including the left buccal mucosa, right lateral border of the tongue, and lower gingiva. CLINICAL DISCUSSION Excisional biopsy of the masses was carried out in the patients using the diode laser. The surgical procedures ranged from 10 to 20 min, with minimal intraoperative bleeding and precise cutting, while no pain was reported. Postoperatively, at two weeks and four months follow-up, the intraoral wounds exhibited excellent healing without complications such as pain, bleeding, swelling, scarring, infection, or mass recurrence. The clinical diagnosis of irritational fibroma (two cases) and fibrous epulis were confirmed by histopathological examination. CONCLUSION Diode laser emerges as a highly efficacious method for the excisional biopsy of benign oral soft tissue masses, providing intraoperative and postoperative advantages over scalpel surgery.
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Affiliation(s)
- Irna Sufiawati
- Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia.
| | - Fitri Dona Siregar
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Indah Suasani Wahyuni
- Oral Medicine Residency Program, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Endang Syamsudin
- Department of Oral and Maxilofacial Surgery, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
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16
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Nili-Ahmadabadi A, Abdpour S, Omidifar N, Hashemi SA, Mousavi SM, Ahmadabadi MN. Therapeutic potentials of N-acetylcysteine immobilized polyrhodanine nanoparticles toward acetaminophen-induced acute hepatotoxicity in rat. Chem Biol Drug Des 2024; 103:e14430. [PMID: 38230777 DOI: 10.1111/cbdd.14430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 01/18/2024]
Abstract
N-acetylcysteine (NAC) is a recommended drug for treating acetaminophen (APAP) intoxication. Due to NAC's low bioavailability, this study aimed to use polyrhodanine (PR) nanoparticles (NPs) as a drug carrier to improve the effectiveness of NAC. After preparation and characterization of NAC loaded on PR, 30 rats were randomly divided into five groups of six. The first group (control) received normal saline. Groups 2-5 were treated with normal saline, PR, NAC, and NAC loaded on PR, respectively. The treatments were started 4 h after oral administration of APAP (2000 mg kg-1 ). After 48 h, the animals were anesthetized, and liver function indices and oxidative stress were measured in tissue and serum samples. The APAP administration can increase aminotransferases and alkaline phosphatase enzymes in serum, decreasing the total antioxidant capacity and thiol groups and increasing lipid peroxidation in liver tissue. Administration of PR-NAC could effectively improve the level of serum-hepatic enzymes, total antioxidant capacity and thiol groups, lipid peroxidation, and pathological changes in liver tissue in animals poisoned with APAP. PR-NAC has a significant therapeutic effect on preventing acute hepatotoxicity caused by APAP, and its effectiveness can be associated with an improvement in the oxidant/antioxidant balance of liver tissue.
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Affiliation(s)
- Amir Nili-Ahmadabadi
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeb Abdpour
- Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Department of Pharmacology and Toxicology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Navid Omidifar
- Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Alireza Hashemi
- Health Policy Research Center, Health Institute, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyyed Mojtaba Mousavi
- Department of Chemical Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Maryam Nili Ahmadabadi
- Department of Pharmaceutical Chemistry, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Parker W, Anderson LG, Jones JP, Anderson R, Williamson L, Bono-Lunn D, Konsoula Z. The Dangers of Acetaminophen for Neurodevelopment Outweigh Scant Evidence for Long-Term Benefits. CHILDREN (BASEL, SWITZERLAND) 2023; 11:44. [PMID: 38255358 PMCID: PMC10814214 DOI: 10.3390/children11010044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Based on available data that include approximately 20 lines of evidence from studies in laboratory animal models, observations in humans, correlations in time, and pharmacological/toxicological considerations, it has been concluded without reasonable doubt and with no evidence to the contrary that exposure of susceptible babies and children to acetaminophen (paracetamol) induces many, if not most, cases of autism spectrum disorder (ASD). However, the relative number of cases of ASD that might be induced by acetaminophen has not yet been estimated. Here, we examine a variety of evidence, including the acetaminophen-induced reduction of social awareness in adults, the prevalence of ASD through time, and crude estimates of the relative number of ASD cases induced by acetaminophen during various periods of neurodevelopment. We conclude that the very early postpartum period poses the greatest risk for acetaminophen-induced ASD, and that nearly ubiquitous use of acetaminophen during early development could conceivably be responsible for the induction in the vast majority, perhaps 90% or more, of all cases of ASD. Despite over a decade of accumulating evidence that acetaminophen is harmful for neurodevelopment, numerous studies demonstrate that acetaminophen is frequently administered to children in excess of currently approved amounts and under conditions in which it provides no benefit. Further, studies have failed to demonstrate long-term benefits of acetaminophen for the pediatric population, leaving no valid rationale for continued use of the drug in that population given its risks to neurodevelopment.
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Affiliation(s)
- William Parker
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599, USA
- WPLab, Inc., Durham, NC 27707, USA
- Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | - Lauren Williamson
- Department of Biological Sciences, Northern Kentucky University, Highland Heights, KY 41099, USA;
| | - Dillan Bono-Lunn
- Department of Public Policy, University of North Carolina, Chapel Hill, NC 27599, USA;
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18
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Moreira NS, Pinheiro KMP, Sousa LR, Garcia GDS, Figueredo F, Coltro WKT. Distance-based detection of paracetamol in microfluidic paper-based analytical devices for forensic application. ANALYTICAL METHODS : ADVANCING METHODS AND APPLICATIONS 2023; 16:33-39. [PMID: 38010169 DOI: 10.1039/d3ay01739g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Whisky adulteration is a prevalent practice driven by the high cost of these beverages. Counterfeiters commonly dilute whisky with less expensive alcoholic beverages, water, food additives, drugs or pharmaceuticals. Paracetamol (PAR), an analgesic drug that mitigates hangovers and headaches, is commonly used to adulterate whisky. Currently, the primary method for quantifying PAR levels is high-performance liquid chromatography, but this technique is both time consuming and usually generates more residues. In this context, the utilization of miniaturized and portable analytical devices becomes imperative for conducting point-of-care/need analyses. These devices offer several advantages, including portability, user-friendliness, low cost, and minimal material wastage. This study proposes the selective distance-based PAR quantification on whisky samples using a paper-based microfluidic analytical device (μPAD). Colorimetric detection on paper-based platforms offers great benefits such as affordability, portability, and the ability to detect PAR without complicated instrumentation. The optimal detection conditions were achieved by introducing 5 μL of a mixture containing 7.5 mmol L-1 of Fe(III) and K3[Fe(CN)6] into the detection zone, along with 12 μL of whisky samples into the sample zone. The method exhibited linear behavior within the concentration range from 15 to 120 mg L-1, with a determination coefficient of 0.998. PAR was quantified in adulterated samples. The results obtained with the paper-based devices were compared with a referenced method, and no significant differences were observed at a confidence level of 95%. The μPAD allowed to determine ca. 1 drop of pharmaceutical medicine PAR of 200 mg mL-1 in 1 L of solution, demonstrating excellent sensitivity. This method offers cost-effective and rapid analysis, reducing the consumption of samples, reagents, and wastes. Consequently, it could be considered a viable and portable alternative for analyzing beverages at criminal scenes, customs, and police operations, thereby enhancing the field of forensics.
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Affiliation(s)
- Nikaele S Moreira
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Kemilly M P Pinheiro
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Lucas R Sousa
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
- Laboratorio de Biosensores y Bioanálisis (LABB), Departamento de Química Biológica e IQUIBICEN - CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), Pabellón 2, Ciudad Universitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Gabriel D S Garcia
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
| | - Federico Figueredo
- Laboratorio de Biosensores y Bioanálisis (LABB), Departamento de Química Biológica e IQUIBICEN - CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), Pabellón 2, Ciudad Universitaria, Ciudad Autónoma de Buenos Aires, Argentina
| | - Wendell K T Coltro
- Instituto de Química, Universidade Federal de Goiás, 74690-900, Goiânia, GO, Brazil.
- Laboratorio de Biosensores y Bioanálisis (LABB), Departamento de Química Biológica e IQUIBICEN - CONICET, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires (UBA), Pabellón 2, Ciudad Universitaria, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Ciência e Tecnologia de Bioanalítica, 13084-971, Campinas, SP, Brazil
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19
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Stangeland H, Handal M, Skurtveit SO, Aakvaag HF, Dyb G, Wentzel-Larsen T, Baumann-Larsen M, Zwart JA, Storheim K, Stensland SØ. Killing pain?: a population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among all children, adolescents and young adults in Norway from 2004 to 2019. Eur Child Adolesc Psychiatry 2023; 32:2259-2270. [PMID: 36030342 PMCID: PMC9419914 DOI: 10.1007/s00787-022-02066-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
The ongoing opioid epidemic has been a global concern for years, increasingly due to its heavy toll on young people's lives and prospects. Few studies have investigated trends in use of the wider range of drugs prescribed to alleviate pain, psychological distress and insomnia in children, adolescents and young adults. Our aim was to study dispensation as a proxy for use of prescription analgesics, anxiolytics and hypnotics across age groups (0-29 years) and sex over the last 15 years in a large, representative general population. The study used data from a nationwide prescription database, which included information on all drugs dispensed from any pharmacy in Norway from 2004 through 2019. Age-specific trends revealed that the prevalence of use among children and adolescents up to age 14 was consistently low, with the exception of a substantial increase in use of melatonin from age 5. From age 15-29, adolescents and young adults used more prescription drugs with increasing age at all time points, especially analgesics and drugs with higher potential for misuse. Time trends also revealed that children from age 5 were increasingly dispensed melatonin over time, while adolescents from age 15 were increasingly dispensed analgesics, including opioids, gabapentinoids and paracetamol. In contrast, use of benzodiazepines and z-hypnotics slightly declined in young adults over time. Although trends were similar for both sexes, females used more prescription drugs than their male peers overall. The upsurge in use of prescription analgesics, anxiolytics and hypnotics among young people is alarming.Trial registration The study is part of the overarching Killing Pain project. The rationale behind the Killing Pain research was pre-registered through ClinicalTrials.gov on April 7, 2020. Registration number NCT04336605; https://clinicaltrials.gov/ct2/show/record/NCT04336605 .
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Affiliation(s)
- Helle Stangeland
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway.
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway.
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Marte Handal
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Svetlana Ondrasova Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Helene Flood Aakvaag
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Monica Baumann-Larsen
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Anker Zwart
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Storheim
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
| | - Synne Øien Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Gullhaugveien 1, 0484, Oslo, Norway
- Division of Clinical Neuroscience, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
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Sinuraya RK, Wulandari C, Amalia R, Puspitasari IM. Public Knowledge, Attitudes, and Practices Regarding the Use of Over-The-Counter (OTC) Analgesics in Indonesia: A Cross-Sectional Study. Patient Prefer Adherence 2023; 17:2569-2578. [PMID: 37869729 PMCID: PMC10590111 DOI: 10.2147/ppa.s426290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/05/2023] [Indexed: 10/24/2023] Open
Abstract
Background Over-the-counter analgesics like paracetamol and nonsteroidal antiinflammatory drugs (NSAIDs) are widely accessible to the general population. However, ensuring their safe and effective usage is crucial by considering individuals' knowledge, attitudes, and practices toward these medications. Objective This study aimed to assess the general population's knowledge, attitudes, and practices regarding the use of over-the-counter analgesics. Methods This cross-sectional study took place in Indonesia from December 2019 to June 2020. A validated questionnaire was used to survey a total of 582 respondents. A comparative analysis examined the variations in mean scores for respondents' characteristics concerning their knowledge, attitude, and practice. A regression analysis was also employed to explore the factors associated with adopting good analgesia practices. Results The findings of the study revealed significant differences in average knowledge scores related to gender, educational attainment, and employment status for the use of both paracetamol and NSAIDs. Regarding knowledge, the respondents demonstrated a higher average score for analgesics (4.56 ± 1.84) than NSAIDs (2.881 ± 2.40), out of a maximum score of 6 points. The results indicate that the respondents obtained a low score for attitude (6.80 ± 3.74) out of 16 points and a positive score for practice (2.71 ± 0.48) out of 3 points regarding using analgesics. Moreover, the regression analysis revealed that gender, residing near primary health care facilities, and having sound knowledge of NSAID use were significant predictors of good analgesic practice (p < 0.05). Conclusion The respondents demonstrated a greater understanding of analgesics compared with NSAIDs. However, despite this higher knowledge level, they had relatively low attitude scores but positive practice scores, indicating a discrepancy between attitudes and actual behavior in using analgesics.
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Affiliation(s)
- Rano Kurnia Sinuraya
- Unit of Global Health, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Chalisma Wulandari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Riezki Amalia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Irma M Puspitasari
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Center of Excellence for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, West Java, Indonesia
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21
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Striebel J, Ruppen W, Schneider T. Simultaneous application of lidocaine and ketamine during ambulatory infusion therapy: a retrospective analysis. Pain Manag 2023; 13:539-553. [PMID: 37850330 DOI: 10.2217/pmt-2023-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023] Open
Abstract
Background: Infusions with lidocaine or ketamine have been separately established in the treatment of chronic pain. This study aims to retrospectively evaluate the effect of combined infusions of lidocaine and ketamine. Materials & methods: Patient records were screened for receipt of combined ambulatory infusions of lidocaine and ketamine from 2012 through 2021. A scoring system was designed to assess pain response retrospectively. Results: A total of 319 patients were included. Median pain reduction in days was 10.00 (interquartile range: 13.25). Side effects were limited to the acute phase of infusions. A total of 41.4% of patients who received concomitant pain medication reported a dose reduction. Conclusion: Our data support combined infusions as a safe therapy option, with good short-, medium- and long-term reductions in pain and great heterogeneity in treatment response. Clinical trial registration: ClinicalTrials.gov (NCT05103319).
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Affiliation(s)
- Julia Striebel
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Wilhelm Ruppen
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
| | - Tobias Schneider
- Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine & Pain Therapy, University Hospital Basel, Basel, 4031, Switzerland
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22
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Baud F, Ladjouzi N, Ben Hassen J, El Omeiri N, Raveloson H, Brondin L, Ben Rahal C, Ould Ouali C, Zouloumis G, Schlatter J. Paracetamol prescriptions in older people hospitalized in a French geriatric hospital. Health Sci Rep 2023; 6:e1565. [PMID: 37732103 PMCID: PMC10507803 DOI: 10.1002/hsr2.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- Frederic Baud
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Nadia Ladjouzi
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Jihène Ben Hassen
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Nesrine El Omeiri
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Hendriniainia Raveloson
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Lucile Brondin
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Camille Ben Rahal
- Médecine gériatrique aigue, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Cid Ould Ouali
- Service de soins et réadaptation, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Georges Zouloumis
- Service de long séjour, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
| | - Joël Schlatter
- Pharmacie, Hôpital Paul DoumerAssistance Publique des Hôpitaux de ParisLabruyèreFrance
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Sridharan K, Mulubwa M, Qader AM. Population Pharmacokinetic Modeling and Dose Optimization of Acetaminophen and its Metabolites Following Intravenous Infusion in Critically ill Adults. Eur J Drug Metab Pharmacokinet 2023; 48:531-540. [PMID: 37389726 DOI: 10.1007/s13318-023-00841-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Acetaminophen (paracetamol) is a ubiquitously administered drug in critically ill patients. Considering the dearth of literature, we evaluated the population pharmacokinetics of intravenous acetaminophen and its principal metabolites (sulfate and glucuronide) in this population. METHODS Critically ill adults receiving intravenous acetaminophen were included in the study. One to three blood samples were withdrawn per patient for the estimation of acetaminophen, and its metabolites (acetaminophen glucuronide and acetaminophen sulfate). High-performance liquid chromatography was used for measuring serum concentrations. We used nonlinear mixed-effect modeling for estimating the primary pharmacokinetic parameters of acetaminophen and its metabolites. The effect of covariates was evaluated followed by dose optimization using Monte Carlo simulation. Patient factors such as demographic information, liver and renal function tests were used as covariates in population pharmacokinetic analysis. The therapeutic range for serum acetaminophen concentration was considered to be 66-132 μM, while 990 μM was considered as the threshold for toxic concentration. RESULTS Eighty-seven participants were recruited. A joint two-compartment acetaminophen pharmacokinetic model linked to glucuronide and sulfate metabolite compartments was used. The central and peripheral volume distributions were 7.87 and 8.87 L/70 kg, respectively. Estimated clearance (CL) was 0.58 L/h/70 kg, while intercompartmental clearance was 44.2 L/h/70 kg. The glucuronide and sulfate metabolite CL were 22 and 94.7 L/h/70 kg, respectively. Monte Carlo simulation showed that twice-daily administration of acetaminophen would result in a relatively higher proportion of patient population achieving and retaining serum concentrations in the therapeutic range, with reduced risk of concentrations remaining in the toxic range. CONCLUSION A joint pharmacokinetic model for intravenous acetaminophen and its principal metabolites in a critically ill patient population has been developed. Acetaminophen CL in this patient population is reduced. We propose a reduction in the frequency of administration to reduce the risk of supra-therapeutic concentrations in this population.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
| | - Mwila Mulubwa
- Drug Discovery and Development Centre (H3D), University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Ali Mohamed Qader
- Salmaniya medical complex, Manama, Kingdom of Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
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Alameri FM, Alkhalaileh K, Alkhafaji Y, Jaiganesh T, Nair SC. Challenges in Assessing Blood Pressure in Adults Following Intravenous Paracetamol Infusion in the Emergency Room. Cureus 2023; 15:e43355. [PMID: 37700973 PMCID: PMC10493514 DOI: 10.7759/cureus.43355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/14/2023] Open
Abstract
Background and objective The negligible side effects of paracetamol along with its ease of availability have catapulted paracetamol to be a widely used medication in emergency room management to reduce pain and subsequent elevations in blood pressure (BP). Our study aimed to address the challenges in informed clinical decision-making in the emergency room following paracetamol intravenous infusion. Methods This was a retrospective cross-sectional study involving the extraction of data from electronic medical records of patients who received intravenous paracetamol infusion between January 2022 and May 2022. Demographic information and BP-related data were collected for analysis. Results We initially considered a total of 162 patient records, with 132 of them eventually meeting the inclusion criteria. Among patients receiving paracetamol infusion for 15 minutes or less, 34% showed a drop of 1-5 mmHg in systolic BP (SBP), while 26% experienced a drop of 6-10 mmHg. However, infusion time longer than 16 minutes did not significantly reduce SBP. Diastolic BP (DBP) was not significantly affected by the duration of the paracetamol infusion. Analysis of the drop in SBP revealed no significant associations with age, gender, or ethnicity. Mean arterial pressure (MAP) was not significantly affected by the duration of paracetamol infusion. Conclusion Our findings suggest that intravenous paracetamol infusion does not significantly lower BP in adults in the emergency room, except for infusions of shorter durations. However, various factors, including infusion rate, patient characteristics, and concomitant medications, may influence BP measurements. The study emphasizes the need for establishing standardized criteria and conducting further research to assess intravenous paracetamol's hemodynamic effects accurately.
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Adhikary S, Al Hoque A, Ray M, Paul S, Hossain A, Goswami S, Dey R. Investigation of Paracetamol Entrapped Nanoporous Silica Nanoparticles in Transdermal Drug Delivery System. Appl Biochem Biotechnol 2023; 195:4712-4727. [PMID: 37273095 DOI: 10.1007/s12010-023-04576-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/06/2023]
Abstract
An effort was made to administer paracetamol drug through transdermal patch, as no such formulation of this drug has been developed yet. The primary cause for the lack of such formulations is paracetamol's poor aqueous solubility. As a result, the current research concentrated on preparing nanomedicines, or drug-loaded nanoparticles, for delivery via transdermal formulations. Nanoparticles can improve the solubility of weakly aqueous soluble or even aqueous insoluble drugs by changing the crystalline structure of loaded medicines to an amorphous state and serving as drug permeation boosters. Silica nanoparticles (SNPs) were synthesized through sol-gel technique to achieve the aforementioned goal. DLS data revealed that the average particle size was around 100-200 nm, which was sufficient to penetrate the skin barrier. XRD analysis showed that the SNPs were amorphous, and the drug molecules lost their crystallinity after encapsulation into the nanoparticles, causing the enhancement of dissolution of drug molecules in physiological pH (pH-7.4). Different kinetic models were employed for the ex vivo dissolution data to evaluate the suitable kinetic model followed by the drug release in both burst and sustained phase. In vivo analgesic study was executed on mice applying each of the transdermal formulations to examine the performances of the patches.
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Affiliation(s)
- Sourav Adhikary
- School of Materials Science and Nanotechnology, Jadavpur University, Kolkata, India.
| | - Ashique Al Hoque
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
- Department of Coatings and Polymeric Materials, North Dakota State University, Fargo, ND, 58108, USA
| | - Manisheeta Ray
- Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Swastik Paul
- Department of Chemical Engineering, University of Calcutta, Kolkata, India
| | - Akbar Hossain
- Department of Chemistry, Jadavpur University, Kolkata, India
| | - Subrata Goswami
- Department of Labour, ESI Institute of Pain Management, Kolkata, India
| | - Rajib Dey
- Metallurgical and Material Engineering Department, Jadavpur University, Kolkata, India
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26
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Silva F, Costa G, Veiga F, Cardoso C, Paiva-Santos AC. Parenteral Ready-to-Use Fixed-Dose Combinations Including NSAIDs with Paracetamol or Metamizole for Multimodal Analgesia-Approved Products and Challenges. Pharmaceuticals (Basel) 2023; 16:1084. [PMID: 37630999 PMCID: PMC10459253 DOI: 10.3390/ph16081084] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/11/2023] [Accepted: 07/25/2023] [Indexed: 08/27/2023] Open
Abstract
The combination of non-steroidal anti-inflammatory drugs (NSAIDs) with non-opioid analgesics is common in clinical practice for the treatment of acute painful conditions like post-operative and post-traumatic pain. Despite the satisfactory results achieved by oral analgesics, parenteral analgesia remains a key tool in the treatment of painful conditions when the enteral routes of administration are inconvenient. Parenteral ready-to-use fixed-dose combinations of non-opioid analgesics combinations, including NSAIDs and paracetamol or metamizole, could play a central role in the treatment of painful conditions by combining the advantages of multimodal and parenteral analgesia in a single formulation. Surprisingly, only in 2020, a parenteral ready-to-use fixed-dose combination of ibuprofen/paracetamol was launched to the market. This review aims to investigate the current availability of combinations of NSAIDs with paracetamol or metamizole in both European and American markets, and how the combination of such drugs could play a central role in a multimodal analgesia strategy. Also, we explored how the parenteral formulations of NSAIDs, paracetamol, and metamizole could serve as starting elements for the development of new parenteral ready-to-use fixed-dose combinations. We concluded that, despite the well-recognized utility of combining NSAIDs with paracetamol or metamizole, several randomized clinical trial studies demonstrate no clear advantages concerning their efficacy and safety. Future clinical trials specifically designed to assess the efficacy and safety of pre-formulated fixed-dose combinations are required to generate solid evidence about their clinical advantages.
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Affiliation(s)
- Fernando Silva
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Gustavo Costa
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Laboratory of Pharmacognosy, Faculty of Pharmacy, University of Coimbra, Azinhaga de Santa Comba, Pólo das Ciências da Saúde, 3000-548 Coimbra, Portugal
| | - Francisco Veiga
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Catarina Cardoso
- Laboratórios Basi, Parque Industrial Manuel Lourenço Ferreira, Lote 15, 3450-232 Mortágua, Portugal
| | - Ana Cláudia Paiva-Santos
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
- REQUIMTE/LAQV, Group of Pharmaceutical Technology, Faculty of Pharmacy, University of Coimbra, 3000-548 Coimbra, Portugal
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27
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Dowd LA, Cross AJ, Liau SJ, Jadczak AD, Visvanathan R, Veal FC, Bell JS. Identifying Residents Who May Benefit from an Analgesic Review: Applying Analgesic Indicators in Residential Aged Care Services. Drugs Aging 2023; 40:449-459. [PMID: 37147416 DOI: 10.1007/s40266-023-01025-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. METHODS Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted. Indicators included the proportion of residents who received > 3000 mg/day of acetaminophen (paracetamol), regular opioids without a documented clinical rationale, opioid doses > 60 mg morphine equivalents (MME)/day, more than one long-acting opioid concurrently, and a pro re nata (PRN) opioid on more than two occasions in the previous 7 days. Logistic regression was performed to investigate factors associated with residents who may benefit from analgesic review. RESULTS Of 381 (69.3%) residents charted regular acetaminophen, 176 (46.2%) were charted > 3000 mg/day. Of 165 (30%) residents charted regular opioids, only 2 (1.2%) had no prespecified potentially painful conditions in their medical record and 31 (18.8%) received > 60 MME/day. Of 153 (27.8%) residents charted long-acting opioids, 8 (5.2%) received more than one long-acting opioid concurrently. Of 212 (38.5%) residents charted PRN opioids, 10 (4.7%) received more than two administrations in the previous 7 days. Overall, 196 (35.6%) of 550 residents were identified as potentially benefiting from analgesic review. Females (odds ratio [OR] 1.87, 95% confidence interval [CI] 1.20-2.91) and residents with prior fracture (OR 1.62, 95% CI 1.12-2.33) were more likely to be identified. Observed pain (OR 0.50, 95% CI 0.29-0.88) was associated with a lower likelihood of being identified compared with residents with no observed pain. Overall, 43 (7.8%) residents were identified based on opioid-related indicators. CONCLUSIONS Up to one in three residents may benefit from a review of their analgesic regimen, including 1 in 13 who may benefit from a specific review of their opioid regimen. Analgesic indicators represent a new approach to target analgesic stewardship interventions.
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Affiliation(s)
- Laura A Dowd
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
| | - Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Shin J Liau
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
| | - Agathe D Jadczak
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Renuka Visvanathan
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
- Aged and Extended Care Services, The Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Felicity C Veal
- Unit for Medication Outcomes Research and Education (UMORE), School of Pharmacy and Pharmacology, University of Tasmania, Hobart, TAS, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Adelaide, SA, Australia
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Mercado SAS, Galvis DGV. Paracetamol ecotoxicological bioassay using the bioindicators Lens culinaris Med. and Pisum sativum L. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:61965-61976. [PMID: 36934188 PMCID: PMC10024602 DOI: 10.1007/s11356-023-26475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/11/2023] [Indexed: 05/10/2023]
Abstract
Paracetamol is one of the most widely used drugs worldwide, yet its environmental presence and hazardous impact on non-target organisms could rapidly increase. In this study, the possible cytotoxic effects of paracetamol were evaluated using two bioindicator plants Lens culinaris and Pisum sativum. Concentrations of 500, 400, 300, 200, 100, 50, 25, 5, 1 mg L-1, and a control (distilled water) were used for a total of 10 treatments, which were subsequently applied on seeds of Lens culinaris Med. and Pisum sativum L.; after 72 h of exposure, root growth, mitotic index, percentage of chromosomal abnormalities, and the presence of micronucleus were evaluated. The cytotoxic effect of paracetamol on L. culinaris and P. sativum was demonstrated, reporting the inhibition of root growth, the presence of abnormalities, and a significant micronucleus index at all concentrations used, which shows that this drug has a high degree of toxicity.
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Ezugwu AL, Anaduaka EG, Chibuogwu CC, Ezeorba TPC. Meat tenderization using acetaminophen (paracetamol/APAP): A review on deductive biochemical mechanisms, toxicological implications and strategies for mitigation. Heliyon 2023; 9:e15628. [PMID: 37159697 PMCID: PMC10163616 DOI: 10.1016/j.heliyon.2023.e15628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 05/11/2023] Open
Abstract
Meats consist of edible portions originating from domestic and wild animals. Meat's palatability and sensory accessibility largely depend on its tenderness to consumers. Although many factors influence meat tenderness, the cooking method cannot be neglected. Different chemical, mechanical, and natural means of meat tenderization have been considered healthy and safe for consumers. However, many households, food vendors, and bars in developing countries engage in the unhealthy use of acetaminophen (paracetamol/APAP) in meat tenderization due to the cost reduction it offers in the overall cooking process. Acetaminophen (paracetamol/APAP) is one of the most popular, relatively cheap, and ubiquitous over-the-counter drugs that induce serious toxicity challenges when misused. It is important to note that acetaminophen during cooking is hydrolyses into a toxic compound known as 4-aminophenol, which damages the liver and kidney and results in organ failure. Despite the reports on the increase in the use of acetaminophen for meat tenderizing in many web reports, there have not been any serious scientific publications on this subject. This study adopted classical/traditional methodology to review relevant literature retrieved from Scopus, PubMed, and ScienceDirect using relevant key terms (Acetaminophen, Toxicity, Meat tenderization, APAP, paracetamol, mechanisms) and Boolean operators (AND and OR). This paper provides in-depth information on the hazard and health implications of consuming acetaminophen tenderized meat via genetic and metabolic pathways deductions. Understanding these unsafe practices will promote awareness and mitigation strategies.
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Affiliation(s)
- Arinze Linus Ezugwu
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
- Department of Genetics and Biotechnology, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
| | - Emeka Godwin Anaduaka
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
- Department of Genetics and Biotechnology, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
| | - Christian Chiazor Chibuogwu
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
| | - Timothy Prince Chidike Ezeorba
- Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
- Department of Genetics and Biotechnology, Faculty of Biological Sciences, University of Nigeria, Enugu State, 410001, Nigeria
- Corresponding author. Department of Biochemistry, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, 410001, Nigeria.
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Sohail R, Mathew M, Patel KK, Reddy SA, Haider Z, Naria M, Habib A, Abdin ZU, Razzaq Chaudhry W, Akbar A. Effects of Non-steroidal Anti-inflammatory Drugs (NSAIDs) and Gastroprotective NSAIDs on the Gastrointestinal Tract: A Narrative Review. Cureus 2023; 15:e37080. [PMID: 37153279 PMCID: PMC10156439 DOI: 10.7759/cureus.37080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/05/2023] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used for their anti-inflammatory, antipyretic, and analgesic properties. However, their use is often associated with gastrointestinal tract (GIT) side effects due to the inhibition of both cyclooxygenase (COX)-1 and COX-2 enzymes, leading to a decrease in gastroprotective prostaglandins (PG). To minimize these adverse effects, various approaches have been explored, including selective COX-2 inhibitors, NO-NSAIDs (nitric oxide-releasing NSAIDs), and dual COX/LOX (lipoxygenase) NSAIDs. However, the effects of these gastroprotective NSAIDs on the GIT and their efficacy remains uncertain. This review aims to provide an overview of the current understanding of the effects of traditional NSAIDs and gastroprotective NSAIDs on GIT. We discuss the underlying mechanisms of GIT damage caused by NSAIDs, including mucosal injury, ulceration, and bleeding, and the potential of gastroprotective NSAIDs to mitigate these effects. We also summarize recent studies on the efficacy and safety of various gastroprotective NSAIDs and highlight the limitations and challenges of these approaches. The review concludes with recommendations for future research in this field.
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Affiliation(s)
- Rohab Sohail
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Midhun Mathew
- Department of Internal Medicine, Pennsylvania Hospital, Philadelphia, USA
| | - Khushbu K Patel
- Internal Medicine, Index Medical College Hospital & Research Center, Indore, IND
| | - Srija A Reddy
- Internal Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, IND
| | - Zaroon Haider
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Mansi Naria
- Internal Medicine, American University of Barbados, Bridgetown, BRB
| | - Ayesha Habib
- Internal Medicine, Punjab Medical College, Faisalabad, PAK
| | - Zain U Abdin
- Medicine, District Head Quarter Hospital, Faisalabad, PAK
| | | | - Anum Akbar
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, USA
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Mallet C, Desmeules J, Pegahi R, Eschalier A. An Updated Review on the Metabolite (AM404)-Mediated Central Mechanism of Action of Paracetamol (Acetaminophen): Experimental Evidence and Potential Clinical Impact. J Pain Res 2023; 16:1081-1094. [PMID: 37016715 PMCID: PMC10066900 DOI: 10.2147/jpr.s393809] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Paracetamol remains the recommended first-line option for mild-to-moderate acute pain in general population and particularly in vulnerable populations. Despite its wide use, debate exists regarding the analgesic mechanism of action (MoA) of paracetamol. A growing body of evidence challenged the notion that paracetamol exerts its analgesic effect through cyclooxygenase (COX)-dependent inhibitory effect. It is now more evident that paracetamol analgesia has multiple pathways and is mediated by the formation of the bioactive AM404 metabolite in the central nervous system (CNS). AM404 is a potent activator of TRPV1, a major contributor to neuronal response to pain in the brain and dorsal horn. In the periaqueductal grey, the bioactive metabolite AM404 activated the TRPV1 channel-mGlu5 receptor-PLC-DAGL-CB1 receptor signaling cascade. The present article provides a comprehensive literature review of the centrally located, COX-independent, analgesic MoA of paracetamol and relates how the current experimental evidence can be translated into clinical practice. The evidence discussed in this review established paracetamol as a central, COX-independent, antinociceptive medication that has a distinct MoA from non-steroidal anti-inflammatory drugs (NSAIDs) and a more tolerable safety profile. With the establishment of the central MoA of paracetamol, we believe that paracetamol remains the preferred first-line option for mild-to-moderate acute pain for healthy adults, children, and patients with health concerns. However, safety concerns remain with the high dose of paracetamol due to the NAPQI-mediated liver necrosis. Centrally acting paracetamol/p-aminophenol derivatives could potentiate the analgesic effect of paracetamol without increasing the risk of hepatoxicity. Moreover, the specific central MoA of paracetamol allows its combination with other analgesics, including NSAIDs, with a different MoA. Future experiments to better explain the central actions of paracetamol could pave the way for discovering new central analgesics with a better benefit-to-risk ratio.
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Affiliation(s)
- Christophe Mallet
- Université Clermont Auvergne, INSERM, NEURO-DOL Basics & Clinical Pharmacology of Pain, Clermont-Ferrand, France
| | - Jules Desmeules
- Faculty of Medicine and The School of Pharmaceutical Sciences, Faculty of Sciences, Geneva University, Geneva, Switzerland
| | | | - Alain Eschalier
- Université Clermont Auvergne, INSERM, NEURO-DOL Basics & Clinical Pharmacology of Pain, Clermont-Ferrand, France
- Correspondence: Alain Eschalier, Faculté de Médecine, UMR Neuro-Dol, 49 Bd François Mitterrand, Clermont-Ferrand, 63000, France, Email
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Bello AM, Dye C. Current perceptions and use of paracetamol in dogs among veterinary surgeons working in the United Kingdom. Vet Med Sci 2023; 9:679-686. [PMID: 36798030 PMCID: PMC10029871 DOI: 10.1002/vms3.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Paracetamol (acetaminophen) is recommended as a first-line drug in the management of pain and pyrexia in humans due to its minor gastrointestinal, renal and vascular side effects. OBJECTIVES To explore the perceptions and use of paracetamol in dogs by UK veterinarians. METHODS Veterinarians were invited to complete an online survey. Questions addressed career history, previous use, and personal perceptions of the use of paracetamol in dogs. RESULTS A total of 450 veterinarians were included in the survey; 96% (n = 431) of whom worked in small animal practice only. The majority reported a frequency of use of 1-3 times a week (n = 197), with oral dosing being the most common route of administration (n = 440). Only 8 had never prescribed paracetamol. Paracetamol was more commonly used to provide analgesia (n = 431) than for the treatment of pyrexia (n = 292) and was predominantly used as an alternative to NSAIDs (n = 408) or as part of multimodal analgesia (n = 406). Hepatotoxic (n = 311) and gastrointestinal (n = 120) side effects were a common concern, although the majority perceived a low risk of side effects and felt they were likely to be mild if they did occur (n = 279). Only 5% (n = 24) of respondents reported having experienced side effects, with gastrointestinal signs (n = 14) and hepatotoxicity (n = 6) being the most common. CONCLUSIONS Paracetamol is widely used by veterinarians working in the UK. Most veterinarians have changed their perception on the use of paracetamol over the last decade and consider it to be associated with fewer side effects and with more effective analgesic and antipyretic effects than they had previously believed.
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Affiliation(s)
- Alba M Bello
- Department of Small Animal Medicine, Pride Veterinary Centre, IVC Evidensia, Derby, UK
| | - Charlotte Dye
- Department of Small Animal Medicine, Pride Veterinary Centre, IVC Evidensia, Derby, UK
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Pergolizzi JV, Breve F, Magnusson P, LeQuang JK, Varassi G. Current and emerging COX inhibitors for treating postoperative pain following oral surgery. Expert Opin Pharmacother 2023; 24:347-358. [PMID: 36562415 DOI: 10.1080/14656566.2022.2161364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The numerous drugs in the NSAID class are often used to treat acute postoperative pain associated with oral surgery such as impacted third-molar extractions. These drugs are effective in this setting and dental pain studies often serve as models for acute pain relief and for registration of analgesics. With numerous cyclooxygenase (COX) inhibitors available as monotherapy, for use in combination with analgesic regimens, and in different doses and formulations, it was our aim to determine if there were clear-cut distinctions among these products and dosing regimens. AREAS COVERED This is a literature review of recent randomized controlled clinical trials evaluating NSAIDs for use in postoperative pain management following oral surgery. Of particular interest were head-to-head studies, which might offer some insight into comparative effectiveness. EXPERT OPINION Postoperative oral surgery pain is largely managed in real-world clinical practice using NSAIDs, either alone or in combination, and there is good evidence supporting their use especially in multimodal therapy. Head-to-head and comparative studies do not show a clear-cut 'optimal NSAID' in this setting, although ibuprofen, ketoprofen, dexketoprofen, and naproxen have gained most acceptance. Combination therapy with other analgesics or adjuvants is largely accepted.
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Affiliation(s)
| | - Franklin Breve
- Department of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Peter Magnusson
- School of Medicine, Orebro University, Örebro, SWE
- Cardiology, Center of Research and Development Region Gävleborg /Uppsala University, Gävle, SWE
- Medicine, Cardiology Research Unit, Karolinska Institutet, SWE, Sweden
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Muacevic A, Adler JR. Frequency and Knowledge of Analgesics Self-Use and Their Adverse Effects in the Eastern Province of Saudi Arabia. Cureus 2023; 15:e33344. [PMID: 36756032 PMCID: PMC9904425 DOI: 10.7759/cureus.33344] [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] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used over-the-counter (OTC) medications, both locally in Saudi Arabia (SA) and globally. They are widely available and can be easily obtained; however, the potential health risks of these drugs are well-documented. This study aimed to measure the frequency of analgesics' self-use and assess the general population's knowledge of their adverse effects. Methodology This is a descriptive, cross-sectional study that was conducted through an online self-administered questionnaire. It targeted adults who are non-healthcare professionals living in the eastern province of SA. Results The sample consisted of 345 participants, of which 196 (56.8%) were male and 149 (43.2%) were female. The most self-used medication was paracetamol at 91%, followed by ibuprofen at 38.8%. Although the prevalence of self-use was high, a low frequency of repeated use was evident, as 49.3% of the participants rarely used them and 19.4% used them only every few months. There was a significant association between the female gender, lower levels of education, and a higher frequency of repeated use of analgesics. About 54.5% of the participants recognized three side effects or fewer, while 90 (26.1%) of them showed knowledge about four to six side effects. Conclusions Considering that paracetamol and NSAIDs are easily procurable OTC, the knowledge of the general population about their harmful adverse effects needs to be enhanced, specifically that of the most vulnerable patient groups.
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Ventriglia G, Gervasoni F, Franco M, Magni A, Panico G, Iolascon G. Musculoskeletal Pain Management and Thermotherapy: An Exploratory Analysis of Italian Physicians' Attitude, Beliefs, and Prescribing Habits. J Pain Res 2023; 16:1547-1557. [PMID: 37197390 PMCID: PMC10184851 DOI: 10.2147/jpr.s401550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 03/28/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose In Italy, musculoskeletal (MSK) disorders are pervasive with one-third of adults seeking medical consultation for a MSK issue in the past year. MSK pain is often treated with local heat applications (LHAs) which can be integrated into MSK care by different specialists and in different settings. Compared to analgesia and physical exercise, LHAs have been less evaluated, and the quality of randomized clinical trials is generally low. The aim of the survey is to assess the knowledge, attitude, perception/practices of general practitioners (GPs), physiatrists and sports medicine doctors towards thermotherapy as delivered by superficial heat pads or wraps. Patients and Methods The survey was conducted between June and September 2022 in Italy. An online questionnaire with 22 multiple-choice questions was administered to explore the demographics and prescribing habits of the participants; the clinical profile of MSK patients; and physicians' attitude and beliefs about the use of thermotherapy/superficial heat applications in MSK pain management. Results GPs are at the forefront of the MSK patient journey and preferentially select NSAIDs as first-line option in arthrosis, muscle stiffness, and strain while prescribing heat wraps as preferred choice in presence of muscle spasm/contracture. Similar pattern of prescribing habits was found among specialists who, in contrast to GPs, adopted more frequently ice/cold therapy to relieve pain due to muscle strain and limited paracetamol use. Generally, survey participants agreed on the benefits of thermotherapy in MSK care management, namely increased blood flow and local tissue metabolism as well as connective tissue elasticity and pain relief which all may be of help in attaining pain control and improvement of function. Conclusion Our findings provided the basis for further investigations aimed at optimizing the MSK patient journey while building up additional evidence supporting the benefit of using superficial heat applications to effectively manage patients with MSK disorders.
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Affiliation(s)
- Giuseppe Ventriglia
- SIMG (Italian College of General Practitioners and Primary Care), Florence, Italy
| | - Fabrizio Gervasoni
- Rehabilitation Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Correspondence: Fabrizio Gervasoni, Rehabilitation Unit, Ospedale L. Sacco, ASST Fatebenefratelli-Sacco, Via G.B. Grassi 74, Milan, 20157, Italy, Tel +39 02 39041, Email
| | - Massimiliano Franco
- SIMG (Italian College of General Practitioners and Primary Care), Florence, Italy
| | - Alberto Magni
- SIMG (Italian College of General Practitioners and Primary Care), Florence, Italy
| | - Giorgio Panico
- Rehabilitation Unit, Luigi Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Cysewski P, Jeliński T, Przybyłek M, Nowak W, Olczak M. Solubility Characteristics of Acetaminophen and Phenacetin in Binary Mixtures of Aqueous Organic Solvents: Experimental and Deep Machine Learning Screening of Green Dissolution Media. Pharmaceutics 2022; 14:pharmaceutics14122828. [PMID: 36559321 PMCID: PMC9781932 DOI: 10.3390/pharmaceutics14122828] [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: 11/26/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
The solubility of active pharmaceutical ingredients is a mandatory physicochemical characteristic in pharmaceutical practice. However, the number of potential solvents and their mixtures prevents direct measurements of all possible combinations for finding environmentally friendly, operational and cost-effective solubilizers. That is why support from theoretical screening seems to be valuable. Here, a collection of acetaminophen and phenacetin solubility data in neat and binary solvent mixtures was used for the development of a nonlinear deep machine learning model using new intuitive molecular descriptors derived from COSMO-RS computations. The literature dataset was augmented with results of new measurements in aqueous binary mixtures of 4-formylmorpholine, DMSO and DMF. The solubility values back-computed with the developed ensemble of neural networks are in perfect agreement with the experimental data, which enables the extensive screening of many combinations of solvents not studied experimentally within the applicability domain of the trained model. The final predictions were presented not only in the form of the set of optimal hyperparameters but also in a more intuitive way by the set of parameters of the Jouyban-Acree equation often used in the co-solvency domain. This new and effective approach is easily extendible to other systems, enabling the fast and reliable selection of candidates for new solvents and directing the experimental solubility screening of active pharmaceutical ingredients.
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New Perspectives on the Adverse Effects of NSAIDs in Cancer Pain: An Italian Delphi Study from the Rational Use of Analgesics (RUA) Group. J Clin Med 2022; 11:jcm11247451. [PMID: 36556066 PMCID: PMC9781542 DOI: 10.3390/jcm11247451] [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: 11/29/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently prescribed drugs for cancer pain. We used the Delphi methodology to evaluate the opinions of clinicians on NSAIDs and paracetamol, with a specific focus on their safety profile. Consensus was reached on seven statements. A high level of consensus was reached regarding the use of NSAIDs and gastrointestinal, cardiovascular, and renal risk in patients taking low-dose aspirin and assessment of liver function during long-term treatment with paracetamol. Consensus was also reached that assessment and monitoring of eGFR are important in the elderly being administered NSAIDs. It was further agreed that NSAIDs can often play a key role in association with opioids in the treatment of cancer pain and that paracetamol is the analgesic of first choice for patients with mild chronic pain. When NSAIDs are administered in combination with steroids, it was agreed that the risk of gastrointestinal damage is increased since steroids delay the healing of ulcers and that paracetamol can be used during pregnancy and does not affect the health of the fetus. This Delphi study highlights that there is poor agreement on how these drugs are routinely prescribed. However, a consensus was reached for seven key statements and may represent a valid contribution to daily practice.
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Sridharan K, Qader AM, Hammad M, Jassim A, Diab DE, Abraham B, Hasan HMSN, Pasha SAA, Shah S. Evaluation of the Association between Single Nucleotide Polymorphisms of Metabolizing Enzymes with the Serum Concentration of Paracetamol and Its Metabolites. Metabolites 2022; 12:metabo12121235. [PMID: 36557273 PMCID: PMC9785892 DOI: 10.3390/metabo12121235] [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: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
Intravenous paracetamol is a commonly administered analgesic and antipyretic in inpatient settings. Paracetamol is metabolized by cytochrome P450 (CYP) enzymes followed by conjugating enzymes to mainly glucuronide but to a lesser extent, sulphate metabolites, and oxidative metabolites. Single nucleotide polymorphisms (SNPs) in the CYP enzymes result in modified enzymatic activity. The present study was carried out to evaluate the prevalence of SNPs related to paracetamol metabolism and principal metabolites in critically ill patients, and those with chronic kidney disease. The present study is a cross-sectional study carried out in adults (>21 years) requiring intravenous paracetamol as part of their standard of care. Details regarding their demographics, and renal and liver function tests were collected. Blood was withdrawn for the analysis of paracetamol and their metabolites, and the SNPs of key CYP enzymes. Paracetamol/paracetamol glucuronide (P/PG), paracetamol/paracetamol sulphate (P/PS) and PG/PS were estimated. Acute liver injury (ALI) and renal dysfunction were defined using standard definitions. We observed a significant prevalence of SNPs in CYP1A2*1C, CYP3A4*3, CYP1A2*1K, CYP1A2*6, CYP2D6*10, and CYP2E1*2 amongst the 150 study participants. Those with CYP1A2*6 (CC genotype) were observed with significantly lower PG and PS concentrations, and a higher P/PS ratio; CYP2D6*10 (1/1 genotype) with a significantly lower PG concentration and a higher P/PG ratio; and CYP1A2*1K (CC genotype) was observed with a significantly higher PG/PS ratio. Good predictive accuracies were observed for determining the SNPs with the cut-off concentration of 0.29 μM for PS in determining CYP1A2*1K, 0.39 μM for PG and 0.32 μM for PS in determining CYP1A2*6 genotype, and 0.29 μM for PG in determining the CYP2D6*10 genotype. Patients with renal dysfunction were observed with significantly greater concentrations of paracetamol, PG and P/PS, and PG/PS ratios, with a lower concentration of PS. No significant differences were observed in any of the metabolites or metabolite ratios in patients with ALI. We have elucidated the prevalence of key CYP enzymes involved in acetaminophen metabolism in our population. Alterations in the metabolite concentrations and metabolic ratios were observed with SNPs, and in patients with renal dysfunction. Population toxicokinetic studies elucidating the dose-response relationship are essential to understand the optimized dose in this sub-population.
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Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine and Medical Sciences, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
- Correspondence: ; Tel.: +973-17239794
| | | | - Mustafa Hammad
- Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
| | - Anfal Jassim
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Al-Jawhara Center, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
| | - Diab Eltayeb Diab
- Department of Molecular Medicine, College of Medicine and Medical Sciences, Al-Jawhara Center, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
| | - Betsy Abraham
- Intensive Care Unit, Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
| | | | | | - Shamik Shah
- Department of Nephrology, Salmaniya Medical Complex, Manama P.O. Box 26671, Bahrain
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Cecilia Farfan Ruiz A, Sriperumbuduri S, Shaw JLV, Clark EG. High-Anion-Gap Metabolic Acidosis During a Prolonged Hospitalization Following Perforated Diverticulitis: An Educational Case Report. Can J Kidney Health Dis 2022; 9:20543581221129753. [PMID: 36325264 PMCID: PMC9619282 DOI: 10.1177/20543581221129753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022] Open
Abstract
Rationale: The metabolic acidoses are generally separated into 2 categories on the basis of an anion gap calculation: high-anion-gap and normal anion-gap metabolic acidosis. When a high-anion-gap metabolic acidosis (HAGMA) is not clearly explained by common etiologies and routine confirmatory testing, specialized testing can definitively establish rare diagnoses such as 5-oxoproline, d-lactate accumulation, or diethylene glycol toxicity. Presenting Concerns of the Patient: A 56-year-old woman had a prolonged hospital admission following perforated diverticulitis requiring sigmoid resection. Her hospitalization was complicated by feculent peritonitis and surgical wound dehiscence needing prolonged broad-spectrum antibiotics and wound debridements. She developed acute kidney injury and HAGMA in the hospital. Diagnoses: Chart review showed that she received a large cumulative dose of acetaminophen during her hospital stay. Laboratory studies showed markedly increased serum 5-oxoproline causing HAGMA. Interventions (Including Prevention and Lifestyle): Patient was admitted to the intensive care unit and treated with N-acetylcysteine and renal replacement therapy. Outcomes: After admission to the intensive care unit, the patient continued to require vasopressor and ventilatory support for septic shock and a ventilator-associated pneumonia. After an initial recovery and resolution of her HAGMA, she subsequently suffered recurrent aspirations which were fatal. Teaching points:
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Affiliation(s)
- Ana Cecilia Farfan Ruiz
- Division of Nephrology, Department of Medicine, The University of Ottawa and Ottawa Hospital Research Institute, ON, Canada
| | - Sriram Sriperumbuduri
- Division of Nephrology, Department of Medicine, The University of Ottawa and Ottawa Hospital Research Institute, ON, Canada
| | - Julie L V Shaw
- Division of Biochemistry, Department of Pathology and Laboratory Medicine, The University of Ottawa and The Ottawa Hospital, ON, Canada
| | - Edward G. Clark
- Division of Nephrology, Department of Medicine, The University of Ottawa and Ottawa Hospital Research Institute, ON, Canada,Edward G. Clark, Associate Professor, Division of Nephrology, Department of Medicine, The University of Ottawa and Ottawa Hospital Research Institute, 1967 Riverside Drive, Ottawa, ON K1H 7W9, Canada.
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Perrot S, Eschalier A, Desmeules J, Lanteri-Minet M, Attal N. Practice guidelines for the treatment of acute migraine and chronic knee osteoarthritis with paracetamol: an expert appraisal on evolution over time between scientific societies. Curr Med Res Opin 2022; 38:1579-1585. [PMID: 35549792 DOI: 10.1080/03007995.2022.2076475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Paracetamol is the commonest analgesic worldwide in primary care. Despite evidence-based recommendations for management of acute and chronic pain with paracetamol, practices seem to vary considerably in its modalities of use, with or without restrictions, between renowned scientific societies and over time. OBJECTIVE Qualitative assessment of similarities, differences, and changes over time in guidelines for paracetamol use in acute and chronic pain. METHODS We focused on two common pain conditions for which paracetamol is widely used: acute migraine and chronic knee osteoarthritis (OA). In 19 guidelines (10 for acute migraine, 9 for chronic knee OA) from 10 scientific societies (AAN/AHS, ACR/AF, CHS, EFNS, EHF/LTB, ESCEO, EULAR, SFEMC, SRF, OARSI) published between 1997 and 2021, methods, results and conclusions were compared, between guidelines and over time. RESULTS In acute migraine, there was a shift from no recommendation for paracetamol or recommendation only for mild attacks to recommendation for mild to moderate attacks in updated guidelines, without restriction for use for four of the five scientific societies. In knee OA, although updated guidelines generally used the GRADE system, recommendations remained heterogeneous between scientific societies: recommendation without or with restrictions, or not recommended. Consensus is lacking regarding long-course safety and efficacy in acute pain and pain at mobilization. CONCLUSIONS Most migraine guidelines now recommend paracetamol for mild to moderate pain. Knee OA guidelines vary on the use of paracetamol: a more holistic approach is needed for this condition, considering patient profile, disease stage, and pain management during physical activity to clarify its appropriate use.
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Affiliation(s)
- Serge Perrot
- Centre d'Evaluation et Traitement de la Douleur, INSERM U987, Hôpital Cochin, Université de Paris, Paris, France
| | - Alain Eschalier
- INSERM U1107, NEURO-DOL, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Jules Desmeules
- Service de pharmacologie et toxicologie cliniques, Centre multidisciplinaire de la douleur, Département d'anesthésiologie de pharmacologie de médecine intensive et de médecine d'urgence, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Michel Lanteri-Minet
- Département d'Evaluation et Traitement de la Douleur et FHU InovPain, CHU Nice - Université Côte d'Azur, Nice, France
- INSERM U1107 Douleur Trigéminale et Migraine, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Nadine Attal
- CETD et INSERM U987, Hôpital Ambroise Paré, APHP, Boulogne Billancourt, France
- Université de Versailles Saint Quentin en Yvelines (UVSQ, Paris Saclay, Versailles Cedex, France)
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Sethi V, Van der Laan L, Gupta S, Piros KC. Perspectives of Healthcare Professionals Towards Combination Use of Oral Paracetamol and Topical Non-Steroidal Inflammatory Drugs in Managing Mild-to-Moderate Pain for Osteoarthritis in a Clinical Setting: An Exploratory Study. J Pain Res 2022; 15:2263-2272. [PMID: 35967469 PMCID: PMC9365014 DOI: 10.2147/jpr.s373382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To seek indicative evidence on clinical prescription practice and perspectives regarding combined oral paracetamol (APAP) and/or topical non-steroidal anti-inflammatory drugs (NSAIDs) therapy for managing mild-to-moderate osteoarthritis (OA) pain. Participants and Methods An exploratory qualitative study to investigate the perspectives towards using APAP and/or topical NSAIDs for OA pain management and whether current clinical practices are aligned with OA guidelines was conducted using a two-round modified Delphi methodology among three general practitioners, three orthopedists, and two pharmacists from Australia, Malaysia, and Sweden during January–June 2021. In the first round, 60-minute virtual in-depth interviews were conducted individually; in the second round, summary of the key findings was shared with the panel to seek clarity on the level of consensus (≥70% unanimity) and disagreement. Results The healthcare professionals (HCPs) agreed that APAP was considered as a universally accepted pharmacologic for most OA patients except those with contraindications or allergies. Consensus was achieved towards APAP combination with topical NSAIDs being a safer alternative than with oral NSAIDs. However, prescription uptake of combined therapy APAP with topical NSAIDs was low among the panel due to lack of strong scientific evidence on efficacy and awareness. Differences in clinical practice across and within countries could be due to different reference sources for OA pain – clinical practice experience or local/international guidelines/medical products handbooks. Conclusion The study suggests an opportunity to raise awareness of the suitability and potential benefits for adjuvant topical NSAIDs to APAP for effective OA pain management as well as a need for universal OA guidelines.
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Affiliation(s)
- Vidhu Sethi
- GlaxoSmithKline Consumer Healthcare, Singapore
- Correspondence: Vidhu Sethi, GlaxoSmithKline Consumer Healthcare, Singapore, GSK Asia House, 23 Rochester Park, 139234, Singapore, Tel +65 96447203, Email
| | - Luke Van der Laan
- Faculty of Business, Education, Law & Arts, University of Southern Queensland, Queensland, Australia
| | - Sanjeev Gupta
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
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Dewanjee S, Dua TK, Paul P, Dey A, Vallamkondu J, Samanta S, Kandimalla R, De Feo V. Probiotics: Evolving as a Potential Therapeutic Option against Acetaminophen-Induced Hepatotoxicity. Biomedicines 2022; 10:1498. [PMID: 35884803 PMCID: PMC9312935 DOI: 10.3390/biomedicines10071498] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 12/03/2022] Open
Abstract
Acetaminophen (APAP) is the most common prescription medicine around the world for the treatment of pain and fever and is considered to be a safe drug at its therapeutic dose. However, a single overdose or frequent use of APAP can cause severe acute liver injury. APAP hepatotoxicity is a prevalent cause of acute liver disease around the world and the lack of suitable treatment makes it a serious problem. In recent years, there has been a surge in interest in using probiotics and probiotic-derived products, known as postbiotics, as health and disease negotiators. A growing body of evidence revealed that they can be equally effective against APAP hepatotoxicity. Different probiotic bacteria were found to be pre-clinically effective against APAP hepatotoxicity. Different postbiotics have also shown exciting results in preclinical models of APAP hepatotoxicity. This review summarized the protective roles and mechanisms of the different probiotic bacteria and postbiotics against APAP hepatotoxicity, with critical discussion. A brief discussion on potential novel probiotics and postbiotics for oxidative liver injury was also included. This review was written in an attempt to pique the interest of researchers in developing a safe therapeutic option against oxidative liver damage using probiotics and/or postbiotics as dietary supplements.
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Affiliation(s)
- Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata 700032, India
| | - Tarun K. Dua
- Department of Pharmaceutical Technology, University of North Bengal, Raja Rammohunpur 734013, India; (T.K.D.); (P.P.)
| | - Paramita Paul
- Department of Pharmaceutical Technology, University of North Bengal, Raja Rammohunpur 734013, India; (T.K.D.); (P.P.)
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India;
| | | | - Sonalinandini Samanta
- Department of Dermatology (Skin & Venereology), Employee’s State Insurance Corporation Medical College & Hospital, Patna 801103, India;
| | - Ramesh Kandimalla
- Department of Biochemistry, Kakatiya Medical College, Warangal 506007, India;
- Applied Biology, Council of Scientific and Industrial Research-Indian Institute of Chemical Technology, Tarnaka 500007, India
| | - Vincenzo De Feo
- Department of Pharmacy, University of Salerno, 84084 Fisciano, Italy
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Mitchell KB, Johnson HM, Rodríguez JM, Eglash A, Scherzinger C, Zakarija-Grkovic I, Cash KW, Berens P, Miller B. Academy of Breastfeeding Medicine Clinical Protocol #36: The Mastitis Spectrum, Revised 2022. Breastfeed Med 2022; 17:360-376. [PMID: 35576513 DOI: 10.1089/bfm.2022.29207.kbm] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.
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Affiliation(s)
- Katrina B Mitchell
- Department of Breast Surgery, Ridley-Tree Cancer Center, Sansum Clinic, Santa Barbara, California, USA
| | - Helen M Johnson
- Department of Surgery, East Carolina University Brody School of Medicine, Greenville, North Carolina, USA
| | - Juan Miguel Rodríguez
- Department of Nutrition and Food Science, Complutense University of Madrid, Madrid, Spain
| | - Anne Eglash
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | | | - Kyle Widmer Cash
- Department of Medicine, Tulane University School of Medicine, Southeast, Louisiana Veterans Health Care System, New Orleans, Louisiana, USA
| | - Pamela Berens
- Department of Obstetrics and Gynecology, University of Texas, Houston, Texas, USA
| | - Brooke Miller
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
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Cerezo-Arias MDLO, Gómez-Tabales J, Martí M, García-Martín E, Agúndez JAG. Common UGT1A6 Variant Alleles Determine Acetaminophen Pharmacokinetics in Man. J Pers Med 2022; 12:jpm12050720. [PMID: 35629143 PMCID: PMC9143054 DOI: 10.3390/jpm12050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022] Open
Abstract
Acetaminophen (paracetamol) is a widely used drug that causes adverse drug events that are often dose-dependent and related to plasma drug concentrations. Acetaminophen metabolism strongly depends on UGT1A enzymes. We aimed to investigate putative factors influencing acetaminophen pharmacokinetics. We analyzed acetaminophen pharmacokinetics after intravenous administration in 186 individuals, and we determined the effect of sex; body mass index (BMI); previous and concomitant therapy with UGT1A substrates, inhibitors, and inducers; as well as common variations in the genes coding for UGT1A1, UGT1A6, and UGT1A9. We identified sex and UGT1A6 genetic variants as major factors influencing acetaminophen pharmacokinetics, with women showing lower clearance (p < 0.001) and higher area under the plasma drug concentration-time curve (AUC) values than men (p < 0.001). UGT1A6 genetic variants were related to decreased acetaminophen biodisposition. Individuals who were homozygous or double-heterozygous for variant UGT1A6 alleles showed a 22.5% increase in t1/2 values and a 22.8 increase in drug exposure (p < 0.001, and 0.006, respectively) after correction by sex. The effect is related to the UGT1A6*2 and UGT1A6*4 variant alleles, whereas no effect of UGT1A6*3 and UGT1A9*3 alleles, BMI, or drug−drug interaction was identified in this study. We conclude that sex and UGT1A6 variants determine acetaminophen pharmacokinetics, thus providing evidence to eventually developing pharmacogenomics procedures and recommendations for acetaminophen use.
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Affiliation(s)
- María de las Olas Cerezo-Arias
- Intensive Care Medicine Department, University Hospital, Badajoz, University of Extremadura (UEX), 06006 Badajoz, Spain;
| | - Javier Gómez-Tabales
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, 10071 Caceres, Spain; (J.G.-T.); (M.M.)
| | - Manuel Martí
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, 10071 Caceres, Spain; (J.G.-T.); (M.M.)
| | - Elena García-Martín
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, 10071 Caceres, Spain; (J.G.-T.); (M.M.)
- Correspondence: (E.G.-M.); (J.A.G.A.); Tel.: +34-927251514 (E.G.-M.); +34-927251323 (J.A.G.A)
| | - José A. G. Agúndez
- Universidad de Extremadura, University Institute of Molecular Pathology Biomarkers, ARADyAL Instituto de Salud Carlos III, 10071 Caceres, Spain; (J.G.-T.); (M.M.)
- Correspondence: (E.G.-M.); (J.A.G.A.); Tel.: +34-927251514 (E.G.-M.); +34-927251323 (J.A.G.A)
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Abstract
Pain and related disability remain a major social and therapeutic problem. Comorbidities and therapies increase drug interactions and side effects making pain management more compounded especially in the elderly who are the fastest-growing pain population. Multimodal analgesia consists of using two or more drugs and/or techniques that target different sites of pain, increasing the level of analgesia and decreasing adverse events from treatment. Paracetamol enhances multimodal analgesia in experimental and clinical pain states. Strong preclinical evidence supports that paracetamol has additive and synergistic interactions with anti-inflammatory, opioid and anti-neuropathic drugs in rodent models of nociceptive and neuropathic pain. Clinical studies in young and adult elderly patients confirm the utility of paracetamol in multimodal, non-opioid or opioid-sparing, therapies for the treatment of acute and chronic pain.
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Affiliation(s)
- Ulderico Freo
- Anesthesiology & Intensive Medicine, Department of Medicine - DIMED, University of Padua, Via Giustiniani, 2, 35128, Padua, Italy
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Acetaminophen and pregabalin attenuate central sensitization in rodent models of nociplastic widespread pain. Neuropharmacology 2022; 210:109029. [DOI: 10.1016/j.neuropharm.2022.109029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/11/2022] [Accepted: 03/12/2022] [Indexed: 12/21/2022]
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Kašiković Lečić S, Javorac J, Živanović D, Lovrenski A, Tegeltija D, Zvekić Svorcan J, Maksimović J. Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review. Ups J Med Sci 2022; 127:8739. [PMID: 35910492 PMCID: PMC9287761 DOI: 10.48101/ujms.v127.8739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/18/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrotic, and fatal interstitial lung disease (ILD) of unknown etiology that primarily affects the elderly. Patients with IPF suffer from a heavy symptom burden and usually have a poor quality of life. Dyspnea and dry cough are predominant symptoms of IPF. Although pain is not considered one of the main symptoms of IPF, it can occur for a variety of reasons, such as hypoxia, coughing, muscle and nerve damage, deconditioning, and steroid use. The prevalence of pain in IPF patients varies greatly, ranging from around 30 to 80%, with the prevalence being estimated mostly among patients in the end-of-life period. It manifests itself in the form of muscle pain, joint discomfort, or back and chest pain. Approaches to the treatment of chronic musculoskeletal pain in patients with IPF include pharmacological and non-pharmacological measures that are also important to optimize the treatment of other symptoms (dyspnea and cough) and the optimal treatment of comorbidities. Given the scarcity of data on this symptom in the literature, this article summarizes what is currently known about the etiology and treatment of musculoskeletal pain in IPF.
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Affiliation(s)
- Svetlana Kašiković Lečić
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
| | - Jovan Javorac
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Internal Medicine, Novi Sad, Serbia
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Dejan Živanović
- College of Vocational Studies for the Education of Preschool Teachers and Sports Trainers, Department of Biomedical Sciences, Subotica, Serbia
| | - Aleksandra Lovrenski
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Dragana Tegeltija
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Pathology, Novi Sad, Serbia
| | - Jelena Zvekić Svorcan
- Special Hospital for Rheumatic Diseases, Novi Sad, Serbia
- University of Novi Sad, Faculty of Medicine, Department of Medical Rehabilitation, Novi Sad, Serbia
| | - Jadranka Maksimović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Jasat H, Thompson J, Sonneborn O, Dayment J, Miller C. Prolonged use of paracetamol and the prescribing patterns on rehabilitation facilities. J Clin Nurs 2021; 31:3605-3616. [PMID: 34957612 DOI: 10.1111/jocn.16188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES The study investigated: (a) the usage patterns of paracetamol, and (b) the association between paracetamol use and patient outcomes such as liver and kidney functions among older people. BACKGROUND Paracetamol is a well-known analgesic and antipyretic drug, with an excellent safety profile when used within its recommended dose. It is a commonly used drug by people aged over 65 years to treat chronic pain. Prolonged use of paracetamol in the elderly is poorly understood. As such, there is a genuine risk among older people of unintentional overdose. METHODS A retrospective analysis of medical records in rehabilitation wards was undertaken from 1 July 2016 to 30 June 2017. Patients' paracetamol use, prescribing patterns and biochemical results were analysed to assess for differences in admission and discharge biochemistry results. The TREND Statement was utilised to guide study reporting (Enhancing the QUAlity and Transparency Of health Research, 2021). RESULTS A total of 1119 patients were admitted for seven or more days in a metropolitan tertiary hospital in Melbourne. Almost three-quarters (74%) of patients were administered paracetamol; 76.1% received Immediate-Release Paracetamol (IRP), and 23.9% were given Sustained-release paracetamol (SRP). A proportion (4.5%) of patients in both the IRP and SRP groups received more than the daily recommended dose. There were limited statistically significant differences between patients' admission and discharge biochemistry results; group or time differences were observed, which were indicative of improvements within the paracetamol group. CONCLUSION Paracetamol was a commonly used medication among long-stay elderly patients. Precaution to ensure paracetamol use does not exceed recommended daily doses is required. This study suggests that paracetamol used at a therapeutic level in older patients had limited, negative associations with liver and kidney function. RELEVANCE TO CLINICAL PRACTICE The clinical practice regarding prolonged use of paracetamol is ambitious. The increased risk of paracetamol toxicity among the frail elderly is a concern. Optimising the dose adjustment in the elderly is important to avoid adverse outcomes.
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Affiliation(s)
- Homairah Jasat
- La Trobe University, Bundoora, Victoria, Australia.,Austin Health, Heidelberg, Victoria, Australia
| | - John Thompson
- Department of Nursing, The University of Melbourne, Carlton, Victoria, Australia.,Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Olivia Sonneborn
- La Trobe University, Bundoora, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | | | - Charne Miller
- La Trobe University, Bundoora, Victoria, Australia.,Department of Nursing, The University of Melbourne, Carlton, Victoria, Australia
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