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Zaremba SMM, Conduit-Turner K. Knowledge of vitamin D and practices of vitamin D supplementation in a Scottish adult population: A cross-sectional study. Nutr Health 2024:2601060241238824. [PMID: 38497198 DOI: 10.1177/02601060241238824] [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: 03/19/2024]
Abstract
Background: Vitamin D supplementation practices (dose and frequency) are relatively unknown in the Scottish population, with no recent up-to-date data available. Reassessing current knowledge, practices, and awareness of vitamin D supplementation following a national health campaign in 2020 by Food Standards Scotland on vitamin D is warranted. Aim: This article aims to present the knowledge and awareness of vitamin D, and current vitamin D supplementation practices in adults living in Scotland. Methods: A cross-sectional study was performed between June and July 2022 using an online survey adapted from previous work on assessing knowledge of vitamin D in adults. Participants aged 18+, living in Scotland for ≥6 months were eligible to participate. Scores for knowledge were calculated as a percentage. Univariate associations between demographic and supplement use were established by χ2-test and logistic regression performed to predict factors associated with daily vitamin D intake. Results: Four hundred and three participants (72.7% female), mean age 36.4 (±14.2 years), completed the study. Awareness of vitamin D was very high (99.5%) but the mean overall knowledge score was poor (31.4 ± 15.3%), with those with a university degree more likely to have knowledge scores at/above the mean compared with those with lower levels of education, χ2(1, N = 393) 10.7, p = 0.001, odds ratio (OR) = 2.1 (95% confidence interval (CI) 1.7-2.7). Finally, 64.3% took vitamin D supplements, of which 37.5% took them daily during winter months, with only 7.4% taking the recommended daily dose. Conclusion: The current study highlights the need to improve both knowledge of vitamin D and practices of vitamin D supplementation during the autumn and winter months in Scotland.
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Affiliation(s)
- Suzanne M M Zaremba
- Division of Population Health & Genomics, Ninewells Hospital & Medical School, University of Dundee, Dundee, UK
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Jung YS, Jin BH, Choi JE, Park MS, Kim YW, Kang HW, Cho S, Kim CO. Assessment of Pharmacokinetic Effects of Herbal Medicines on Escitalopram. Ther Clin Risk Manag 2024; 20:151-160. [PMID: 38434107 PMCID: PMC10906722 DOI: 10.2147/tcrm.s448090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/18/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose Herbal medicines are occasionally used in combination with conventional antidepressants to mitigate various depression-associated symptoms. However, there is limited information on herb-antidepressant interactions. In this study, we investigated the pharmacokinetic (PK) effects of four herbal medicines (Gami-soyosan, Banhasasim-tang, Ojeok-san, and Bojungikgi-tang) on escitalopram, a commonly used antidepressant. Patients and Methods In this open-label, fixed-sequence, three-period, crossover study, 18 participants were enrolled and divided into two groups. Each group received a 10 mg oral dose of escitalopram in period 1. Participants took escitalopram once daily and their assigned herbal medicines thrice a day for 7 d in periods 2 (group 1: Gami-soyosan, group 2: Ojeok-san) and 3 (group 1: Banhasasim-tang; group 2: Bojungikgi-tang). The primary endpoints were Cmax,ss and AUCtau,ss of escitalopram. Cmax,ss and AUCtau,ss in period 1 were obtained using nonparametric superposition from single-dose data. The PK endpoints were classified according to the CYP2C19 phenotype. Results Of 18 participants, 16 completed the study. Systemic exposure to escitalopram resulted in a minor increase in the presence of each herbal medicine. The geometric mean ratios (GMRs, combination with herbal medicines/escitalopram monotherapy) and their 90% confidence intervals (CIs) for Cmax,ss and AUCtau,ss were as follows: Gamisoyosan- 1.1454 (0.9201, 1.4258) and 1.0749 (0.8084, 1.4291), Banhasasim-tang-1.0470 (0.7779, 1.4092) and 1.0465 (0.7035, 1.5568), Ojeok-san-1.1204 (0.8744, 1.4357) and 1.1267 (0.8466, 1.4996), and Bojungikgi-tang-1.1264 (0.8594, 1.4762) and 1.1400 (0.8515, 1.5261), respectively. Furthermore, no significant differences in the GMRs of Cmax,ss and AUCtau,ss were observed across different CYP2C19 phenotypes in any of the groups. Conclusion The co-administration of escitalopram with Gami-soyosan, Banhasasim-tang, Ojeok-san, or Bojungikgi-tang did not exert significant PK effects on escitalopram. These findings provide valuable insights into the safe use of herbal medicines along with escitalopram.
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Affiliation(s)
- Yun Seob Jung
- Department of Pharmacology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hak Jin
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Ju Eun Choi
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Min Soo Park
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Young-Woo Kim
- School of Korean Medicine, Dongguk University, Gyeongju, Korea
| | - Hyung Won Kang
- College of Korean Medicine, Wonkwang University, Iksan, Korea
| | | | - Choon Ok Kim
- Department of Clinical Pharmacology, Severance Hospital, Yonsei University Health System, Seoul, Korea
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Winkler NE, Sebo P, Haller DM, Maisonneuve H. Non-pharmacological home remedies used by primary care patients. Eur J Intern Med 2024; 120:122-124. [PMID: 37925352 DOI: 10.1016/j.ejim.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/27/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Neria E Winkler
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Paul Sebo
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Primary Care, Geneva University Hospitals, Geneva, Switzerland
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland; University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France.
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Attia KA. Physiological, Anatomical and Physicochemical Characteristics of Children Affecting Food-Drug Interaction-Review. Pak J Biol Sci 2024; 27:1-7. [PMID: 38413392 DOI: 10.3923/pjbs.2024.1.7] [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: 02/29/2024]
Abstract
The drug-food interaction has a great interest in nutrition research to minimize unfavorable reactions to nutritional treatment. Failure to supply appropriate nutrition to the child can harm both body development and growth. This review aimed to examine available data on the impact of diet on medication absorption in pediatric populations. Mechanisms underlying food-drug interactions were investigated to explore possible distinctions between adult and pediatric populations and to gain insight into how this may impact the pharmacokinetic profile in a child. Several changes in physiology, anatomy and physicochemical properties among children are likely to result in food-drug interactions that cannot be anticipated based on adult studies. The influence of food on medications results in decreased bioavailability and altered drug elimination. Drugs, on the other hand, can affect dietary intake, digestion, absorption and excretion. Literature shows that differences in gastrointestinal physiology and anatomy between pediatric and adult populations can have a major impact on drug absorption and bioavailability. A higher splanchnic blood flow may result in decreased drug bioavailability due to increased loss in first-pass metabolism. To overcome the overall lack of knowledge on analyzing food-drug interactions among pediatric populations, comprehensive procedures and recommendations must be developed.
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Shalgouny M, Bertz-Lepel J, Fischer V Weikersthal L, Herbin J, Meier-Höfig M, Mücke R, Rohe U, Stauch T, Stoll C, Troeltzsch D, Wittmann S, Kurz O, Naumann R, Huebner J. Introducing a standardized assessment of patients' interest in and usage of CAM in routine cancer care: chances and risks from patients' and physicians' point of view. J Cancer Res Clin Oncol 2023; 149:16575-16587. [PMID: 37715831 PMCID: PMC10645655 DOI: 10.1007/s00432-023-05182-3] [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: 06/27/2023] [Accepted: 07/12/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Cancer patients often use complementary and alternative medicine (CAM), however, standardized assessment in clinical routine is missing. The aim of this study was to evaluate a screening questionnaire on CAM usage that was published in the S3 Guideline Complementary Medicine in the Treatment of Oncological Patients. METHODS We developed a survey questionnaire to assess the practicability of the guideline questionnaire and communication on CAM between health care providers (HCPs) and patients. We collected 258 guideline questionnaires and 116 survey questionnaires from ten clinics and held twelve semi-structured interviews with HCPs. RESULTS 85% used at least one of the listed CAM methods, 54 participants (N = 77) never disclosed usage to a physician. The most frequently used CAM methods were physical activity (76.4%) and vitamin D (46.4%). 25.2% used at least one method, that was labeled risky by the guideline. 53.4% did not know of CAM's risk of interactions and side effects. Introducing the guideline questionnaire in routine cancer care increased the rate of patients talking to an HCP regarding CAM significantly from 35.5 to 87.3%. The HCPs stated positive effects as an initiation of conversation, increased safety within CAM usage and patients feeling thankful and taken seriously. However, due to the limited amount of time available for discussions on CAM, generalized distribution to all patients was not feasible. CONCLUSION Institutions should focus on implementing standard procedures and resources that help HCPs discuss CAM on a regular basis. HCPs should meet the patient's demands for CAM counseling and make sure they are equipped professionally.
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Affiliation(s)
- M Shalgouny
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - J Bertz-Lepel
- Klinik für Hämatologie, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - L Fischer V Weikersthal
- Praxis für Hämatologie und Internistische Onkologie, Gesundheitszentrum St. Marien GmbH, Amberg, Germany
| | - J Herbin
- Onkologische Schwerpunktpraxis Berlin, Berlin, Germany
| | - M Meier-Höfig
- 3. Medizinische Klinik, Städtisches Krankenhaus Kiel, Kiel, Germany
| | - R Mücke
- MVZ Strahlentherapie RheinMainNahe GmbH, Mainz, Germany
| | - U Rohe
- St. Barbara Klinik Hamm, Hamm, Germany
| | - T Stauch
- Klinik für Onkologie, Median Adelsbergklinik Bad Berka, Bad Berka, Germany
| | - C Stoll
- Rehaklinik für Orthopädie, Klinik Herzoghöhe Bayreuth, Bayreuth, Germany
| | - D Troeltzsch
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Wittmann
- Klinik für Onkologie, Hämatologie und Palliativmedizin, Helios Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - O Kurz
- Medizinische Klinik III, Marien Kliniken Siegen, Siegen, Germany
| | - R Naumann
- Medizinische Klinik III, Marien Kliniken Siegen, Siegen, Germany
| | - J Huebner
- Klinik für Innere Medizin II, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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Ke J, Li MT, Xu S, Ma J, Liu MY, Han Y. Advances for pharmacological activities of Polygonum cuspidatum - A review. PHARMACEUTICAL BIOLOGY 2023; 61:177-188. [PMID: 36620922 PMCID: PMC9833411 DOI: 10.1080/13880209.2022.2158349] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 10/22/2022] [Accepted: 12/08/2022] [Indexed: 06/01/2023]
Abstract
CONTEXT Polygonum cuspidatum Sieb. et Zucc (Polygonaceae), the root of which is included in the Chinese Pharmcopoeia under the name 'Huzhang', has a long history as a medicinal plant and vegetable. Polygonum cuspidatum has been used in traditional Chinese medicine for the treatment of inflammation, hyperlipemia, etc. OBJECTIVE This article reviews the pharmacological action and the clinical applications of Polygonum cuspidatum and its extracts, whether in vivo or in vitro. We also summarized the main phytochemical constituents and pharmacokinetics of Polygonum cuspidatum and its extracts. METHODS The data were retrieved from major medical databases, such as CNKI, PubMed, and SinoMed, from 2014 to 2022. Polygonum cuspidatum, pharmacology, toxicity, clinical application, and pharmacokinetics were used as keywords. RESULTS The rhizomes, leaves, and flowers of Polygonum cuspidatum have different phytochemical constituents. The plant contains flavonoids, anthraquinones, and stilbenes. Polygonum cuspidatum and the extracts have anti-inflammatory, antioxidation, anticancer, heart protection, and other pharmacological effects. It is used in the clinics to treat dizziness, headaches, traumatic injuries, and water and fire burns. CONCLUSIONS Polygonum cuspidatum has the potential to treat many diseases, such as arthritis, ulcerative colitis, asthma, and cardiac hypertrophy. It has a broad range of medicinal applications, but mainly focused on root medication; its aerial parts should receive more attention. Pharmacokinetics also need to be further investigated.
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Affiliation(s)
- Jia Ke
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Meng-Ting Li
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuyang Xu
- Monteverde Academy Shanghai, Shanghai, China
| | - Jianpeng Ma
- Multiscale Research Institute of Complex Systems, Fudan University, Shanghai, China
| | - Ming-Yuan Liu
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yan Han
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Siwek M, Woroń J, Wrzosek A, Gupało J, Chrobak AA. Harder, better, faster, stronger? Retrospective chart review of adverse events of interactions between adaptogens and antidepressant drugs. Front Pharmacol 2023; 14:1271776. [PMID: 37829299 PMCID: PMC10565488 DOI: 10.3389/fphar.2023.1271776] [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: 08/02/2023] [Accepted: 09/07/2023] [Indexed: 10/14/2023] Open
Abstract
Aim: We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review. Methodology: A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Results: Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: Withania somnifera: reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); Eleutherococcus senticosus: duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); Schisandra chinensis: bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); Tribulus terrestris: citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); Coptis chinensis: mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); Cimicifuga racemosa: mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); Bacopa monnieri: agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); Gynostemma pentaphyllum: duloxetine (back pain); Cordyceps sinensis: sertraline (upper gastrointestinal bleeding); Lepidium meyenii: mianserin (restless legs syndrome); and Scutellaria baicalensis: bupropion (seizures). Conclusion: Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.
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Affiliation(s)
- Marcin Siwek
- Department of Affective Disorders, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
| | - Jarosław Woroń
- Department of Clinical Pharmacology, Chair of Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland
- Department of Anesthesiology and Intensive Care, University Hospital in Cracow, Kraków, Poland
- University Center for Monitoring and Research on Adverse Drug Effects in Krakow, Kraków, Poland
| | - Anna Wrzosek
- Department of Anesthesiology and Intensive Care, University Hospital in Cracow, Kraków, Poland
- Department of Interdisciplinary Intensive Care, Jagiellonian University, Krakow, Poland
| | - Jarosław Gupało
- Pharma Consult, Pharmacotherapy Safety Team, Zakopane, Poland
| | - Adrian Andrzej Chrobak
- Department of Adult Psychiatry, Chair of Psychiatry, Jagiellonian University Medical College, Kraków, Poland
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Sile I, Teterovska R, Onzevs O, Ardava E. Safety Concerns Related to the Simultaneous Use of Prescription or Over-the-Counter Medications and Herbal Medicinal Products: Survey Results among Latvian Citizens. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6551. [PMID: 37623137 PMCID: PMC10454617 DOI: 10.3390/ijerph20166551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
The use of herbal medicines is increasing worldwide. While the safety profile of many herbal medicines is promising, the data in the literature show important interactions with conventional drugs that can expose individual patients to high risk. The aim of this study was to investigate the experience of the use of herbal medicines and preparations and the risks of interactions between herbal and conventional medicines among Latvian citizens. Data were collected between 2019 and 2021 using a structured questionnaire designed for pharmacy customers in Latvia. Electronic databases such as Drugs.com, Medscape, and European Union herbal monographs were reviewed for the risk of drug interactions and potential side effects when herbal medicines were involved. The survey included 504 respondents. Of all the participants, 77.8% used herbal preparations. Most of the participants interviewed used herbal remedies based on the recommendation of the pharmacist or their own initiative. A total of 38.3% found the use of herbal remedies safe and harmless, while 57.3% of respondents regarded the combination of herbal and regular drugs as unsafe. The identified herbal medicines implicated in the potential risk of serious interactions were grapefruit, St. John's wort, and valerian. As the risks of herb-drug interactions were identified among the respondents, in the future, both pharmacy customers and healthcare specialists should pay more attention to possible herb-drug interactions of over-the-counter and prescription medications.
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Affiliation(s)
- Inga Sile
- Department of Applied Pharmacy, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia
- Latvian Institute of Organic Synthesis, 21 Aizkraukles Street, LV-1006 Riga, Latvia
| | - Renate Teterovska
- Department of Pharmaceutical Chemistry, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia;
- Department of Pharmacy, Riga Stradins University Red Cross Medical College, 5 J. Asara Street, LV-1009 Riga, Latvia;
| | - Oskars Onzevs
- Department of Commerce, Turība University, 68 Graudu Street, LV-1058 Riga, Latvia;
| | - Elita Ardava
- Department of Pharmacy, Riga Stradins University Red Cross Medical College, 5 J. Asara Street, LV-1009 Riga, Latvia;
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Fravel MA, Ernst ME, Gilmartin-Thomas J, Woods RL, Orchard SG, Owen AJ. Dietary supplement and complementary and alternative medicine use among older adults in Australia and the United States. J Am Geriatr Soc 2023; 71:2219-2228. [PMID: 36852896 PMCID: PMC10460828 DOI: 10.1111/jgs.18305] [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: 08/12/2022] [Revised: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023]
Abstract
BACKGROUND Dietary supplement and complementary and alternative medication (CAM) use can contribute to drug interactions, polypharmacy, nonadherence with prescription medications, and healthcare expenses, whereas evidence supporting benefits of using these products is sparse. There is a lack of current published literature describing the patterns or predictors of their use in community-dwelling older adults. MATERIALS AND METHODS We performed a cross-sectional analysis of community-dwelling adults from Australia and the US, aged 70 years and older (65 years for US minorities), enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) study. At study enrollment, eligible participants were required to be without concurrent 5-year life-limiting illness and free of documented evidence of cardiovascular disease, dementia, or significant physical disability. During the final study visit, a questionnaire was administered to collect information about supplement/CAM use. Data from 15,729 participants who completed this questionnaire between January 2017 and January 2018 were analyzed. Descriptive statistics were used to report the prevalence and types of products used. Factors associated with use were determined using multivariate regression. RESULTS Mean age of respondents was 79.6 years; 56.4% were female, 88.8% were from Australia, 56.5% reported 12 years of education or less, and 98.7% were living at home. Two-thirds (66.2%) of participants reported use of one or more supplement/CAM in the previous month. Products most commonly used included vitamin D (33.8% of participants), fish oil (22.7%), calcium (20.6%), glucosamine (14.8%), and multivitamin (12.9%). Female sex, US residency, higher education, polypharmacy (prescription medications), and frailty (in women) were significantly associated with higher use of supplements/CAMs. CONCLUSIONS Dietary supplement and CAM use is common among community-dwelling older adults in the United States and Australia. Given the high prevalence of use, collaboration between healthcare providers and older adult patients is important to insure safe and optimal use of these products.
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Affiliation(s)
- Michelle A. Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, USA
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Julia Gilmartin-Thomas
- College of Health and Biomedicine & Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), St Albans, Victoria, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice J. Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Chen Y, Li H, Wang K, Wang Y. Recent Advances in Synthetic Drugs and Natural Actives Interacting with OAT3. Molecules 2023; 28:4740. [PMID: 37375294 DOI: 10.3390/molecules28124740] [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: 05/18/2023] [Revised: 06/03/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Organic anion transporter 3 (OAT3) is predominantly expressed in the kidney and plays a vital role in drug clearance. Consequently, co-ingestion of two OAT3 substrates may alter the pharmacokinetics of the substrate. This review summarizes drug-drug interactions (DDIs) and herbal-drug interactions (HDIs) mediated by OAT3, and inhibitors of OAT3 in natural active compounds in the past decade. This provides a valuable reference for the combined use of substrate drugs/herbs for OAT3 in clinical practice in the future and for the screening of OAT3 inhibitors to avoid harmful interactions.
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Affiliation(s)
- Ying Chen
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China
- Rizhao Huawei Institute of Comprehensive Health Industries, Shandong Keepfit Biotech. Co., Ltd., Rizhao 276800, China
| | - Hongyan Li
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China
- Rizhao Huawei Institute of Comprehensive Health Industries, Shandong Keepfit Biotech. Co., Ltd., Rizhao 276800, China
| | - Ke Wang
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China
- Rizhao Huawei Institute of Comprehensive Health Industries, Shandong Keepfit Biotech. Co., Ltd., Rizhao 276800, China
| | - Yousheng Wang
- Key Laboratory of Geriatric Nutrition and Health, Ministry of Education, Beijing Technology and Business University, Beijing 100048, China
- Rizhao Huawei Institute of Comprehensive Health Industries, Shandong Keepfit Biotech. Co., Ltd., Rizhao 276800, China
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Sandoval KE. Changes in Reported Dietary Supplement Use in Cognitively Normal National Alzheimer's Coordinating Center Participants Aged 55 and Older From 2015 to 2019. J Nutr 2023; 153:1771-1782. [PMID: 37044210 PMCID: PMC10447883 DOI: 10.1016/j.tjnut.2023.04.004] [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: 11/29/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Although reported dietary supplement use is common in older adults, evaluations of dietary supplement use over the past 10 y are lacking. OBJECTIVE This analysis determined changes in reported dietary supplement use in cognitively normal older adults (aged ≥ 55 y) using the National Alzheimer's Coordinating Center data from 2015 to 2019 using a serial cross-sectional study design. METHODS The first available visit for cognitively normal participants aged ≥ 55 y from 2015 to 2019 with a complete medication form was used, resulting in 9357 participants. Associations between visit year categories and reported use of dietary supplement categories/individual supplements were tested using categorical statistics. To determine whether the probabilities of reported supplement use changed in 2019 compared with those of 2015, z-scores and two-sided P values were used. Weighted analyses were used to confirm analytical findings. RESULTS When comparing 2015 and 2019, the reported use of any dietary supplement decreased from 77.7% in 2015 to 71.0% in 2019 (P < 0.0001); any vitamin from 72.5% to 65.5% (P < 0.0001); any mineral from 39.2% to 30.4% (P < 0.0001); "other" nonvitamin/nonmineral supplements from 34.4% to 26.9% (P < 0.0001), calcium from 31.2% to 21.7% (P < 0.0001), multivitamins from 48.4% to 38.4% (P < 0.0001), potassium from 5.6% to 3.5% (P = 0.001), vitamin C from 13.0% to 9.2% (P = 0.0002), chondroitin from 6.0% to 4.1% (P = 0.006), glucosamine from 11.1% to 6.5% (P < 0.0001), and all omega fatty acids from 25.2% to 17.0% (P < 0.0001). Reported use increased for vitamin B7/biotin from 3.1% in 2015 to 5.8% in 2019 (P = 0.0003), melatonin from 3.1% to 5.8% (P = 0.0002), and turmeric from 1.2% to 4.7% (P < 0.0001). CONCLUSION Although the reported use of many major dietary supplement categories and individual supplements significantly decreased in older adults from 2015 to 2019, biotin, turmeric, and melatonin significantly increased. Because biotin may interfere with some laboratory tests, this may have important public health implications.
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Affiliation(s)
- Karin E Sandoval
- Pharmaceutical Sciences Southern Illinois University Edwardsville, 200 University Park Drive, Building 220, Edwardsville IL 62025.
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d'Arqom A, Nasution MZ, Kadir SZSA, Yusof J, Govindaraju K. Practice and knowledge of dietary supplement consumption among Indonesian adults post-delta wave of the COVID-19 pandemic. F1000Res 2023; 12:3. [PMID: 37469719 PMCID: PMC10352623 DOI: 10.12688/f1000research.129045.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/02/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Increasing dietary supplement (DS) consumption was observed during the COVID-19 pandemic, including during the post-Delta wave period. This study aimed to measure the practice of DS consumption and respondents' knowledge of DS. Methods: An internet-based survey was distributed from October-December 2021 and obtained 541 valid and completed responses. Descriptive analysis was performed to present the practice of DS consumption, including frequency, duration, aim, preferable dosage form etc. Level of knowledge on DS principles, side effects and regulation were also measured. Inferential analyses were conducted to determine the predictors of the respondents' DS practice and level of knowledge. Results: Data from 541 valid responses showed that 77.63% of respondents consumed DS in the last 3 months, with only 59.52% reporting also consuming DS before the COVID-19 pandemic. One half of the respondents had good knowledge about DS; however, some knowledge regarding side effects and possible drug-supplement interaction needed improvement. Their DS consumption practice was affected by their economic status and history of contracting COVID-19. Nevertheless, the level of knowledge was not affected by the sociodemographic factors and DS supplement experience. Conclusions: Taken together, the practice of self-consumption of DS in Indonesia is increasing; hence, knowledge of DS is necessary to avoid detrimental effects that might occur in the future. Increasing access to information on better labelling and educating consumers about DS are important actions to consider.
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Affiliation(s)
- Annette d'Arqom
- Translational Medicine and Therapeutics Research Group, Universitas Airlangga, Surabaya, 60131, Indonesia
- Department of Anatomy, Histology, and Pharmacology, Faculty of Medicine, Universitas Airlangga, Surabaya, East Java, 60131, Indonesia
| | - Mhd Zamal Nasution
- Postgraduate School, Universitas Airlangga, Surabaya, East Java, 60286, Indonesia
| | | | - Junaidah Yusof
- School of Human Resource Development & Psychology, Faculty of Social Sciences & Humanities, Universiti Teknologi Malaysia, Johor Bahru, 81310, Malaysia
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Masumoto S, Nakayama G, Haruta J, Maeno T. Association between experience of interprofessional care and self-medication among family caregivers: A cross-sectional study. Res Social Adm Pharm 2023; 19:773-777. [PMID: 36658019 DOI: 10.1016/j.sapharm.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although healthcare professionals pay attention to the drugs prescribed by physicians, few studies have assessed self-medication by family caregivers. Family caregivers' experience of interprofessional care in the care of patients can influence caregivers' health behaviors. OBJECTIVES This study aimed to describe self-medication among family caregivers of community-dwelling adult patients, and to assess association between family caregivers' experience of interprofessional care and their self-medication, adjusting for possible confounding factors. METHODS We conducted a cross-sectional survey from November to December 2020 in Ibaraki Prefecture, Japan. Family caregivers between 40 and 74 years old and caring for community-dwelling adult patients with chronic conditions were recruited. The use of any self-medication in the last 2 weeks by family caregivers was the outcome variable. The explanatory variable was family caregivers' experience of interprofessional care in the care of patients, using the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS). Adjusted covariates were age, gender, educational attainment, annual household income, self-rated health, and caregiving time of family caregivers. RESULTS Of 1091 recruited family caregivers, 750 were included in the analysis. A total of 258 (34.4%) family caregivers reported having used self-medication in the past 2 weeks. Logistic regression analysis showed that having a higher score on the J-IEXPAC CAREGIVERS (odds ratio 0.80 per 1 standard deviation increase) was associated with less use of self-medication by caregivers. CONCLUSIONS This study revealed that about one-third of family caregivers self-medicate, and this practice is associated with a less positive experience of interprofessional care. These results suggest that it is important for healthcare professionals to be aware of the health condition of family caregivers and to provide appropriate advice regarding self-medication.
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Affiliation(s)
- Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan; Department of General Medicine, Tsukuba Central Hospital, 1589-3 Kashiwadacho, Ushiku, Ibaraki, 300-1211, Japan.
| | - Gen Nakayama
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku ku, Tokyo, 160-8582, Japan.
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Shah H, Nagi J, Khare S, Hassan H, Siu A. Limiting Factors in Implementing Pharmacovigilance Principles in the Elderly. Cureus 2023; 15:e36899. [PMID: 37128538 PMCID: PMC10148568 DOI: 10.7759/cureus.36899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
The overarching aim of pharmacovigilance is to ensure the safe and effective usage of medication across the population and optimise medicines through holistic considerations. However, within the heterogeneous elderly population, several unique factors are at play, limiting the ability of clinicians to fulfil this aim. A matured physiology influencing the response and effects of drugs, increased polypharmacy enabling drug-drug interactions, and greater consumption of concurrent herbal medicines predispose patients to harmful drug events. This increasingly multimorbid subpopulation requires complex pharmaceutical regimens encouraging inappropriate prescribing and medicine non-adherence leading to suboptimal therapy. Furthermore, restrictive practices in clinical trials commonly exclude elderly patients creating disparities from expected findings within a real-world setting. These issues create an environment where elderly patients are at a heightened risk of adverse drug events and clinicians are forced to make significant decisions from limited information. With projections showing that this demographic will continue growing in size, the true burden of these limiting factors is yet to be realised.
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Bazrafshani MS, Pardakhty A, Kalantari Khandani B, Tajadini H, Ghazanfari Pour S, Hashemi S, Amiri S, Mehmandoost S, Beigzadeh A, Abbaszadeh S, Sharifi H. The prevalence and predictors of herb-drug interactions among Iranian cancer patients during chemotherapy courses. BMC Complement Med Ther 2023; 23:41. [PMID: 36750849 PMCID: PMC9903537 DOI: 10.1186/s12906-023-03869-1] [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: 07/30/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients. METHODS This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16. RESULTS Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 - 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43-2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00-4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients. CONCLUSION Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients.
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Affiliation(s)
- Maliheh Sadat Bazrafshani
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.
| | - Behjat Kalantari Khandani
- grid.412105.30000 0001 2092 9755Department of Internal Medicine, Hematology and Oncology Division, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Tajadini
- grid.412105.30000 0001 2092 9755Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadra Ghazanfari Pour
- grid.412105.30000 0001 2092 9755Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Hashemi
- grid.412105.30000 0001 2092 9755Departement of Medical Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Shiva Amiri
- grid.412105.30000 0001 2092 9755Pharmaceutics Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran ,grid.412105.30000 0001 2092 9755Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | | | - Samaneh Abbaszadeh
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111, Iran.
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Ma T, He L, Luo Y, Zhang G, Cheng X, Bai Y. Use of fish oil and mortality of patients with cardiometabolic multimorbidity: A prospective study of UK biobank. Nutr Metab Cardiovasc Dis 2022; 32:2751-2759. [PMID: 36319577 DOI: 10.1016/j.numecd.2022.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/30/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIMS Cardiometabolic multimorbidity (CMM) has risen as a global issue of public health, with an in-creasing prevalence and more severe clinical prognosis. This study aimed to estimate the association between use of fish oil and mortality among patients with CMM. METHODS AND RESULTS In this prospective study based on UK Biobank, participants with ≥2 of cardiometabolic diseases (CMDs, including coronary heart disease [CHD], diabetes, hypertension, and stroke in this study) at recruitment were included. Use of fish oil was derived from touchscreen questionnaires at baseline. All-cause and cardiovascular mortality were accessed via electronic health-related records. Kaplan-Meier curves and flexible parametric Royston-Parmar proportion-hazard models were fitted to assess the as-sociations of fish-oil use with all-cause, cardiovascular mortality, and related life expectancy alterations. Among 30 068 participants from UK Biobank (67.9% men; mean age 61.75 years), 5357 deaths were reported during 12.03 years of follow-up. For patients with CMM, use of fish oil was associated with a 17% lower risk of all-cause mortality (95% confidence interval [95% CI] 0.78-0.88, P < 0.001), and 19% lower risk of cardiovascular mortality (95% CI 0.72-0.90, P < 0.001) in multivariable-adjusted models. At 45 years old, using fish oil was associated with 1.66 years of life expectancy gained. CONCLUSION Among patients with CMM, use of fish oil was associated with a significantly reduced risk of all-cause, cardiovascular mortality, and prolonged life expectancy.
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Affiliation(s)
- Tianqi Ma
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Lingfang He
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Yi Luo
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Guogang Zhang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, 410008, China; Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Xunjie Cheng
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
| | - Yongping Bai
- Department of Geriatric Medicine, Center of Coronary Circulation, Xiangya Hospital, Central South University, Changsha, 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, 410008, China.
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Lüthold RV, Jungo KT, Weir KR, Geier AK, Scholtes B, Kurpas D, Wild DMG, Petrazzuoli F, Thulesius H, Lingner H, Assenova R, Poortvliet RKE, Lazic V, Rozsnyai Z, Streit S. Understanding older patients' willingness to have medications deprescribed in primary care: a protocol for a cross-sectional survey study in nine European countries. BMC Geriatr 2022; 22:920. [PMID: 36451180 PMCID: PMC9709365 DOI: 10.1186/s12877-022-03562-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION To reduce inappropriate polypharmacy, deprescribing should be part of patients' regular care. Yet deprescribing is difficult to implement, as shown in several studies. Understanding patients' attitudes towards deprescribing at the individual and country level may reveal effective ways to involve older adults in decisions about medications and help to implement deprescribing in primary care settings. In this study we aim to investigate older adults' perceptions and views on deprescribing in different European countries. Specific objectives are to investigate the patients' willingness to have medications deprescribed by medication type and to have herbal or dietary supplements reduced or stopped, the role of the Patient Typology (on medication perspectives), and the impact of the patient-GP relationship in these decisions. METHODS AND ANALYSIS This cross-sectional survey study has two parts: Part A and Part B. Data collection for Part A will take place in nine countries, in which per country 10 GPs will recruit 10 older patients (≥65 years old) each (n = 900). Part B will be conducted in Switzerland only, in which an additional 35 GPs will recruit five patients each and respond to a questionnaire themselves, with questions about the patients' medications, their willingness to deprescribe those, and their patient-provider relationship. For both Part A and part B, a questionnaire will be used to assess the willingness of older patients with polypharmacy to have medications deprescribed and other relevant information. For Part B, this same questionnaire will have additional questions on the use of herbal and dietary supplements. DISCUSSION The international study design will allow comparisons of patient perspectives on deprescribing from different countries. We will collect information about willingness to have medications deprescribed by medication type and regarding herbal and dietary supplements, which adds important information to the literature on patients' preferences. In addition, GPs in Switzerland will also be surveyed, allowing us to compare GPs' and patients' views and preferences on stopping or reducing specific medications. Our findings will help to understand patients' attitudes towards deprescribing, contributing to improvements in the design and implementation of deprescribing interventions that are better tailored to patients' preferences.
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Affiliation(s)
- Renata Vidonscky Lüthold
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.5734.50000 0001 0726 5157Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Katharina Tabea Jungo
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Kristie Rebecca Weir
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland ,grid.1013.30000 0004 1936 834XSydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Anne-Kathrin Geier
- grid.9647.c0000 0004 7669 9786Department of General Practice, Faculty of Medicine, Leipzig University, Leipzig, Germany
| | - Beatrice Scholtes
- grid.4861.b0000 0001 0805 7253Research Unit of Primary Care and Health, Department of General Medicine, Faculty of Medicine, University of Liège, Liège, Belgium
| | - Donata Kurpas
- grid.4495.c0000 0001 1090 049XFamily Medicine Department, Wrocław Medical University, Wrocław, Poland
| | - Dorothea M. G. Wild
- grid.10388.320000 0001 2240 3300Institute of Family Medicine and General Practice, University Hospital Bonn, Bonn University, Bonn, Germany
| | - Ferdinando Petrazzuoli
- Sezione SNaMID Caserta, Caserta, Italy ,grid.4514.40000 0001 0930 2361Center for Primary Health Care Research, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Hans Thulesius
- grid.8148.50000 0001 2174 3522Department of Medicine and Optometry, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden ,grid.4514.40000 0001 0930 2361Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Heidrun Lingner
- grid.10423.340000 0000 9529 9877Hannover Medical School, Center for Public Health and Healthcare, Hannover, Germany
| | - Radost Assenova
- grid.35371.330000 0001 0726 0380Department of Urology and General Practice, Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Rosalinde K. E. Poortvliet
- grid.10419.3d0000000089452978University Network for the Care sector Zuid-Holland, Leiden University Medical Center, Leiden, The Netherlands ,grid.10419.3d0000000089452978Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vanja Lazic
- Health center Zagreb – Centar, Zagreb, Croatia
| | - Zsofia Rozsnyai
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Sven Streit
- grid.5734.50000 0001 0726 5157Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
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Degefu N, Getachew M, Amare F. Knowledge of Drug–Food Interactions Among Healthcare Professionals Working in Public Hospitals in Ethiopia. J Multidiscip Healthc 2022; 15:2635-2645. [PMID: 36411827 PMCID: PMC9675322 DOI: 10.2147/jmdh.s389068] [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: 09/07/2022] [Accepted: 10/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Drug–food interactions can result in unfavorable outcomes during the treatment of patients. Healthcare professionals (HCPs) should advise patients on drug–food interactions. Knowledge of such interactions is crucial to avoid their occurrence. However, there is no information regarding the knowledge of HCPs about drug–food interactions in Harari Regional State. Objective To assess knowledge of drug–food interactions and associated factors among HCPs working in public hospitals in Harari Regional State, Eastern Ethiopia from April 15 to May 15, 2022. Methods A cross-sectional study was conducted in public hospitals in Harari Regional State, Eastern Ethiopia, among 251 HCPs. After stratification was done based on profession (pharmacists, nurses, and doctors), the sample size was proportionally allocated for the respective groups. Data were collected using a standardized self-administered questionnaire, entered into Epi-Data 3.1 and analyzed using Statistical Package for Social Sciences 26.0. Descriptive statistics were used to summarize variables. Multivariable logistic regression was done to determine factors associated with knowledge of drug–food interactions. P < 0.05 was used to declare significant association. Results Among the HCPs who completed the questionnaire, 56 (22.3%), 36 (14.3%), and 159 (63.3%) were doctors, pharmacists, and nurses, respectively. The majority of the HCPs were males (174 (69.3%)). The mean age of the HCPs was 27.6±3.8. The mean knowledge score±SD of the HCPs was 28.6±6.6 out of an overall score of 59. The HCPs poorly identified drug–food interactions and the correct administration time of drugs relative to meals. Being a pharmacist (AOR: 2.8, CI: 1.3–6.4, p-value=0.012), and working at a tertiary hospital (AOR: 3.9, CI: 2.1–7.3, p-value <0.001), were associated with higher knowledge of drug-food interactions. Conclusion The HCPs in this study had inadequate knowledge of drug–food interactions. Thus, additional educational courses and training should be provided in order to improve knowledge regarding drug-food interaction.
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Affiliation(s)
- Natanim Degefu
- Department of Pharmaceutics, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Melaku Getachew
- Department of Emergency Medicine and Critical Care, School of Medicine, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Firehiwot Amare, Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia, Tel +251 913183027, Email
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Associations of baseline use of fish oil with progression of cardiometabolic multimorbidity and mortality among patients with hypertension: a prospective study of UK Biobank. Eur J Nutr 2022; 61:3461-3470. [PMID: 35589868 PMCID: PMC9119234 DOI: 10.1007/s00394-022-02889-w] [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: 01/11/2022] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE The role of fish oil in the prognosis of hypertensive patients is unknown. This study investigated the associations of fish oil supplementation with the progression of cardiometabolic multimorbidity (CMM) and mortality among patients with hypertension. METHODS Based on UK Biobank, we enrolled participants with hypertension and free of other cardiometabolic diseases. The exposure was baseline use of fish oil derived from questionnaires at baseline. The primary outcomes were the incidence of CMM and all-cause mortality. Competing risk models and flexible parametric proportion-hazards models were fitted to assess the adjusted hazard ratios (HRs) for the risk of CMM and mortality outcomes, respectively. RESULTS Among 81,579 participants involved [50.37%, men; mean age, 59.38 years (standard deviation, 7.23 years)], 15,990 CMM events and 6456 all-cause deaths were reported (median follow-up, 12.23 years). In multivariable-adjusted models, baseline use of fish oil was associated with 8% lower risk of CMM [95% confidence interval (95% CI) 0.89-0.96, P < 0.001] and 10% lower risk of all-cause mortality (95% CI 0.85-0.95, P < 0.001). CONCLUSION In individuals with hypertension, baseline use of fish oil was associated with a reduced risk of CMM and all-cause mortality, and further clinical trials are needed to prove this hypothesis.
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Guo X, Li M, Du X, Jiang C, Li S, Tang R, Sang C, Yu R, Long D, Dong J, Ma C. Multimorbidity, polypharmacy and inappropriate prescribing in elderly patients with atrial fibrillation: A report from the China Atrial Fibrillation Registry Study. Front Cardiovasc Med 2022; 9:988799. [PMID: 36148073 PMCID: PMC9485537 DOI: 10.3389/fcvm.2022.988799] [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: 07/07/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMultimorbidity, polypharmacy and inappropriate prescribing is common in elderly patients worldwide. We aimed to explore the current status of multimorbidity, polypharmacy and the appropriateness of pharmacological therapy among elderly patients with atrial fibrillation (AF) in China.Materials and methodsWe randomly selected 500 patients aged 65 years or older from the China AF Registry study. Multimorbidity was defined as ≥2 comorbidities and polypharmacy was defined as ≥5 long-term prescribed drugs. Appropriateness of prescribing was evaluated using the Screening Tool of Older People’s Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) criteria version 2. Patients’ attitudes toward polypharmacy were evaluated by the Patients’ Attitudes Towards Deprescribing (PATD) questionnaire.ResultsAmong the 500 patients included (mean age 75.2 ± 6.7 years, 49.0% male), 98.0% had multimorbidity and 49.4% had polypharmacy. The prevalence of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was 43.6% (n = 218) and 71.6% (n = 358), respectively. Traditional Chinese medicine attributed largely to PIMs. Anticoagulants were the most common PPOs. Many clinical factors increased the risk of PIMs and PPOs. However, polypharmacy increased the risk of PIMs (OR 2.70, 95%CI 1.78–4.11; p < 0.0001), but not PPOs. In addition, 73.7% patients with polypharmacy were willing to have one or more of their medications prescribed if advised by their doctor.ConclusionMultimorbidity and polypharmacy were highly prevalent in elderly patients with AF in China. A high prevalence of inappropriate prescribing was also observed. Therefore, much more attention should be paid to the serious health problem in the elderly population.
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Affiliation(s)
- Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Mengmeng Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Ronghui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
- *Correspondence: Changsheng Ma,
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Longden-Naufal C, Rolfe V, Mackonochie M. Narratives of Herbal Medicine Utilisation in the United Kingdom: Scoping Literature Review. Front Pharmacol 2022; 13:886574. [PMID: 36091802 PMCID: PMC9452627 DOI: 10.3389/fphar.2022.886574] [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: 02/28/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Using thematic analysis of existing literature, this scoping review aims to explore the narratives of people using herbal medicine (HM) in the United Kingdom. Understanding who is using HM and why will enable better ways of facilitating the use of HM, as well as assist in designing future research. Ethnic groups were found to be primary users of HM in the United Kingdom. A sense of heritage continues to be important for these participants as it allows tradition and culture to stay alive within communities, as well as the ritualistic purposes of these plants. For women, another key demographic, concepts surrounding the naturalness of HMs are associated with the idea of femineity and self-healing. A reoccurring theme in the literature focusing on both ethnic groups and women’s perceptions is the judgement from healthcare practitioners/professionals (HCPs) when addressing the use of HM. However, studies that investigated the perceptions of HCPs on HM confirmed that they often were supportive of using HM where standard treatments had been unsuccessful, and if a patient had anecdotal evidence of a herb having been effective. Delving deeper into public narratives of HM usage will allow conventional healthcare systems to effectively integrate alternative approaches, as well as ensuring that future research into the benefits of HMs is relevant to how people use them.
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Affiliation(s)
| | | | - Marion Mackonochie
- Pukka Herbs Ltd., Keynsham, United Kingdom
- *Correspondence: Marion Mackonochie,
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22
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Le TT, McGrath SR, Fasinu PS. Herb-drug Interactions in Neuropsychiatric Pharmacotherapy - A Review of Clinically Relevant Findings. Curr Neuropharmacol 2022; 20:1736-1751. [PMID: 34370637 PMCID: PMC9881059 DOI: 10.2174/1570159x19666210809100357] [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: 06/14/2021] [Revised: 07/23/2021] [Accepted: 08/04/2021] [Indexed: 11/22/2022] Open
Abstract
The management of neuropsychiatric disorders relies heavily on pharmacotherapy. The use of herbal products as complimentary medicine, often concomitantly, is common among patients taking prescription neuropsychiatric drugs. Herb-drug interaction, a clinical consequence of this practice, may jeopardize the success of pharmacotherapy in neuropsychiatry. Besides the wellknown ability of phytochemicals to inhibit and/or induce drug-metabolizing enzymes and transport proteins, several phytoconstituents are capable of exerting pharmacological effects on the central nervous system. This study reviewed the relevant literature and identified 13 commonly used herbal products - celery, echinacea, ginkgo, ginseng, hydroxycut, kava, kratom, moringa, piperine, rhodiola, St. John's wort, terminalia/commiphora ayurvedic mixture and valerian - which have shown clinically relevant interactions with prescription drugs used in the management of neuropsychiatric disorders. The consequent pharmacokinetic and pharmacodynamic interactions with orthodox medications often result in deleterious clinical consequences. This underscores the importance of caution in herb-drug co-medication.
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Affiliation(s)
- Tram T. Le
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, 27501, USA;
| | - Sarah R. McGrath
- School of Pharmacy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC, 27501, USA;
| | - Pius S. Fasinu
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA,Address correspondence to this author at the Department of Pharmacology and Toxicology, University of Alabama at Birmingham, Birmingham, AL, 35294, USA; Tel/Fax: +1 205 934 4565; E-mail:
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23
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Harnett JE, Desselle S, Ung COL. Towards consensus: defining and supporting a professional role for pharmacists associated with traditional and complementary medicines - a protocol of implementing an international e-survey. BMJ Open 2022; 12:e061352. [PMID: 35902196 PMCID: PMC9341198 DOI: 10.1136/bmjopen-2022-061352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Traditional and complementary medicines (T&CM) are predominantly self-selected from retail outlets including pharmacies as part of self-care practices. Concerns about the appropriate and safe use of T&CM products raises questions about 'should' and 'how' pharmacists could adopt professional responsibilities. There lacks a consensus about the scope of these responsibilities, or the initiatives required to execute them. The aim of this study is to identify an international set of core responsibilities that support pharmacists' contribution to ensuring the quality and safe use of T&CMs to promote public health. METHODS AND ANALYSIS An international cross-sectional e-survey of pharmacists representing the six WHO regions will be conducted over a 12-month period. Pharmacists will be invited via representative organisations and professional networks within their respective country. Survey responses to statements about the relevance of T&CM to day-to-day practice; opinions about the bioethical and practice responsibilities; and support required to build their scope of practice associated with T&CM will be collected centrally via the online survey platform Survey Monkey and analysed using the Statistical Package for Social Sciences V.27 software for Windows. Bivariate statistical analysis will be conducted to examine the associations between agreement to statements within each section with key demographic variables, country of practice, pharmacy type, age, gender, qualification and years in practice. Cronbach's alpha will be used to test the internal consistency of items from certain sections of the survey and evince their clarity to respondents of the questionnaire. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Macau (approval number SSHRE21-APP068-ICMS-01). The results of this survey will be used to inform key discussion points in a consensus process and a step towards developing an agreed and defined professional role for pharmacists in T&CMs.
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Affiliation(s)
- Joanna E Harnett
- Faculty of Medicine and Health Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - Carolina Oi Lam Ung
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau
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24
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Kaźmierska A, Bolesławska I, Polańska A, Dańczak-Pazdrowska A, Jagielski P, Drzymała-Czyż S, Adamski Z, Przysławski J. Effect of Evening Primrose Oil Supplementation on Selected Parameters of Skin Condition in a Group of Patients Treated with Isotretinoin-A Randomized Double-Blind Trial. Nutrients 2022; 14:nu14142980. [PMID: 35889936 PMCID: PMC9317771 DOI: 10.3390/nu14142980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Retinoids, which include isotretinoin, reduce sebum levels, the degree of epidermal wetness (CORN) and cause an increase in transepidermal water loss (TEWL). Weight gain has also been observed in isotretinoin-treated patients. An agent that can reduce the severity of isotretinoin side effects is evening primrose oil (Oenothera paradoxa). The purpose of this study was to evaluate the effect of evening primrose oil supplementation in patients with acne vulgaris treated with isotretinoin on skin hydration status (CORN), transepidermal water loss (TEWL), skin oiliness (sebum) and changes in body weight and BMI. Methods: Patients diagnosed with acne were assigned to the isotretinoin-treated group (n = 25) or the isotretinoin and evening primrose oil-treated group (n = 25). The intervention lasted 9 months. CORN (with a corneometer), TEWL (with a tewameter) and sebum (with a sebumeter) were assessed twice, as well as body weight and BMI (Tanita MC-780). Results: The isotretinoin-treated group showed statistically significant reductions in CORN (p = 0.015), TEWL (p = 0.004) and sebum (p < 0.001) after the intervention. In the group treated with isotretinoin and evening primrose oil, TEWL and sebum levels also decreased significantly (p < 0.05), while CORN levels increased from 42.0 ± 9.70 to 50.9 ± 10.4 (p = 0.017). A significant decrease in body weight (p < 0.001) and BMI (p < 0.001) was observed in both groups after 9 months of intervention. Conclusions: During isotretinoin treatment, supplementation with evening primrose oil increased skin hydration. However, there were no differences between groups in transepidermal water loss, skin oiliness, weight loss and BMI.
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Affiliation(s)
- Agnieszka Kaźmierska
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
| | - Izabela Bolesławska
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
- Correspondence:
| | - Adriana Polańska
- Laboratory of Connective Tissue Diseases, Department of Dermatology and Venereology, Poznan University of Medical Sciences, 60-355 Poznan, Poland;
| | | | - Paweł Jagielski
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, 31-066 Krakow, Poland;
| | - Sławomira Drzymała-Czyż
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
| | - Zygmunt Adamski
- Department of Dermatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.D.-P.); (Z.A.)
| | - Juliusz Przysławski
- Department of Bromatology, Poznan University of Medical Sciences, 60-806 Poznan, Poland; (A.K.); (S.D.-C.); (J.P.)
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25
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Winkler NE, Sebo P, Haller DM, Maisonneuve H. Primary care patients' perspectives on the use of non-pharmacological home remedies in Geneva: a cross-sectional study. BMC Complement Med Ther 2022; 22:126. [PMID: 35513859 PMCID: PMC9074289 DOI: 10.1186/s12906-022-03564-7] [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: 06/25/2021] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background Home remedies are anchored in patients’ everyday life, but their use in Western cultures remains scarcely explored. Our objectives were to investigate primary care patients’ perspectives and use of non-pharmacological home remedies in Geneva (Switzerland). Methods In spring 2020, we conducted a cross-sectional survey among adult primary care patients in randomly selected general practices (N = 15). Patients were recruited in the waiting rooms and asked to complete a questionnaire about their sociodemographic characteristics, their home remedy use, and their expectations and reasons for using (or not using) home remedies. We employed descriptive statistics to summarise the data and logistic regression adjusted for clustering within practices to explore associations between home remedy use and participants’ sociodemographic characteristics. Results Three hundred fourteen of three hundred ninety patients agreed to participate in the study (participation rate 80.5%). Home remedies were used by 64.4% of patients. The main reasons given were for preventive purposes (55.3%), self-care (41.0%), as an alternative to conventional medicine (40.5%) and to avoid or delay a medical consultation (38.5%). One-third of patients considered that it was the GP’s role to spontaneously inform them about home remedies (36.4%), another third considered that it was the GP’s role to inform them, but only upon specific request (32.3%), and the last third of patients declared that it was not the GP’s role to provide information about home remedies (30.3%). Patients living in an urban zone (adjusted OR 2.1; 95%CI 1.0–4.4; p 0.05) and those with a tertiary education background (adjusted OR 1.9; 95%CI 1.0–3.6; p 0.05) believed that it was their GP’s role to inform them about home remedies. Conclusions Home remedies are used by a majority of primary care patients in Geneva. For a comprehensive and safe healthcare management in the context of patient-oriented medicine, more evidence-based research on efficacy and safety of home remedies as well as their place in primary care consultation is required.
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Affiliation(s)
- Neria E Winkler
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Paul Sebo
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Community, Primary Care and Emergency Medicine & Department of Paediatrics, Geneva University Hospitals, Geneva, Switzerland
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Healthcare Professionals' Knowledge and Behaviors Regarding Drug-Dietary Supplement and Drug-Herbal Product Interactions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074290. [PMID: 35409970 PMCID: PMC8998985 DOI: 10.3390/ijerph19074290] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 12/07/2022]
Abstract
Given the widespread use of dietary supplements (DS) and herbal products (HP), healthcare professionals (HCPs) will increasingly encounter patients who use these preparations with conventional drugs and who need their services to reduce the consequences of adverse therapeutic outcomes. The aim of our survey was to assess the knowledge and behaviors of HCPs regarding the risk of potential drug−dietary supplement (DDSIs) and drug−herbal product (DHPIs) interactions. This cross-sectional survey collected data via on paper-based questionnaire among general practitioners (GPs) (n = 105), specialty doctors (n = 87) and nurses (n = 154). The HCPs were mostly familiar with the interaction of doxycycline with magnesium (83%) and were least familiar with interaction of warfarin with glucosamine (14%). The results on DDSIs and DHPIs knowledge showed that GPs scored significantly higher than nurses (p < 0.001 and p = 0.003, respectively), while specialty doctors scored significantly higher than nurses only on DDSIs knowledge (p < 0.001). Only 28% of respondents reported that they often or always ask patients on drug therapy about the use of DS or HP, and 25% of respondents record such data in the medical documentation of patients. Our results showed that HCPs have sufficient knowledge about most major DDSIs and DHPIs, but insufficient knowledge about most moderate interactions. However, their overall knowledge and behavior regarding the risk of these interactions indicate the need for further continuing education and training.
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Lippert A, Renner B. Herb-Drug Interaction in Inflammatory Diseases: Review of Phytomedicine and Herbal Supplements. J Clin Med 2022; 11:1567. [PMID: 35329893 PMCID: PMC8951360 DOI: 10.3390/jcm11061567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 02/06/2023] Open
Abstract
Many people worldwide use plant preparations for medicinal purposes. Even in industrialized regions, such as Europe, where conventional therapies are accessible for the majority of patients, there is a growing interest in and usage of phytomedicine. Plant preparations are not only used as alternative treatment, but also combined with conventional drugs. These combinations deserve careful contemplation, as the complex mixtures of bioactive substances in plants show a potential for interactions. Induction of CYP enzymes and pGP by St John's wort may be the most famous example, but there is much more to consider. In this review, we shed light on what is known about the interactions between botanicals and drugs, in order to make practitioners aware of potential drug-related problems. The main focus of the article is the treatment of inflammatory diseases, accompanied by plant preparations used in Europe. Several of the drugs we discuss here, as basal medication in chronic inflammatory diseases (e.g., methotrexate, janus kinase inhibitors), are also used as oral tumor therapeutics.
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Affiliation(s)
- Annemarie Lippert
- Institute of Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, 01069 Dresden, Germany;
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28
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Cote B, Elbarbry F, Bui F, Su JW, Seo K, Nguyen A, Lee M, Rao DA. Mechanistic Basis for the Role of Phytochemicals in Inflammation-Associated Chronic Diseases. Molecules 2022; 27:molecules27030781. [PMID: 35164043 PMCID: PMC8838908 DOI: 10.3390/molecules27030781] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/15/2022] Open
Abstract
Chronic inflammatory diseases occur in a large portion of the population and are associated with a poor diet. Key natural products found in fruits and vegetables may assist in lowering inflammation associated with chronic diseases such as obesity, diabetes, cardiovascular diseases, and cancer. This review seeks to examine the roles of several natural products, resveratrol (RES), quercetin (QUE), curcumin (CUR), piperine (PIP), epigallocatechin gallate (EGCG), and gingerol (GIN), in their ability to attenuate inflammatory markers in specific diseases states. Additionally, we will discuss findings in past and ongoing clinical trials, detail possible phytochemical–drug interactions, and provide a brief resource for researchers and healthcare professionals on natural product and supplement regulation as well as names of databases with information on efficacy, indications, and natural product–drug interactions. As diet and over-the-counter supplement use are modifiable factors and patients are interested in using complementary and alternative therapies, understanding the mechanisms by which natural products have demonstrated efficacy and the types of drugs they interact with and knowing where to find information on herbs and supplements is important for practicing healthcare providers and researchers interested in this field.
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Affiliation(s)
- Brianna Cote
- College of Pharmacy, Oregon State University, Portland, OR 97201, USA;
| | - Fawzy Elbarbry
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
| | - Fiona Bui
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
| | - Joe W. Su
- School of Pharmacy, West Coast University, Los Angeles, CA 90004, USA;
| | - Karen Seo
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
| | - Arthur Nguyen
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
| | - Max Lee
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
| | - Deepa A. Rao
- School of Pharmacy, Pacific University, Hillsboro, OR 97123, USA; (F.E.); (F.B.); (K.S.); (A.N.); (M.L.)
- Correspondence:
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Modulatory effects of Benjakul extract on rat hepatic cytochrome P450 enzymes. Heliyon 2021; 7:e08498. [PMID: 34901514 PMCID: PMC8642608 DOI: 10.1016/j.heliyon.2021.e08498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 10/04/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Benjakul, a traditional Thai formulation, has been used as a carminative and adaptogenic drug. It consists of five plants, Piper chaba Hunter, Piper sarmentosum Roxb., Piper interruptum Opiz., Plumbago indica Linn., and Zingiber officinale Roscoe, in equal ratios. Some individual herbs present in Benjakul were reported to modulate cytochrome P450 (CYP) enzymes. This study aimed to investigate the effects of Benjakul extract on the activities and mRNA expression levels of hepatic CYP2C11 and CYP3A1 in rats. Adult male rats were orally administered 200, 400, or 600 mg/kg BW Benjakul extract for 28 days. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine levels were assayed. CYP2C11 and CYP3A1 activities were analyzed using cytochrome P450 assay kits. The mRNA expression of CYP2C11 and CYP3A1 was measured using a quantitative real-time PCR assay. Benjakul treatment significantly increased the serum ALT and BUN levels. At doses of 200, 400, and 600 mg/kg BW, Benjakul treatment increased hepatic CYP3A1 activity and CYP3A1 mRNA expression. CYP2C11 mRNA expression was unchanged by treatment with Benjakul extract; however, treatment with the high and middle doses of Benjakul extract increased CYP2C11 activity. Treament with Benjakul extract induced CYP2C11 and CYP3A1 activity in rats. Concurrent use of Benjakul with conventional drugs should be considered to potentially induce herb-drug interactions.
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Huang CY, Wu MY, Chang CL, Liao YC, Chen YY, Lin WC, Yen HR. Coprescription Trends in Western Medicine, Chinese Herbal Medicine and Dental Medicine among Older Adults in Taiwan from 1997 to 2013. Complement Ther Med 2021; 63:102782. [PMID: 34710559 DOI: 10.1016/j.ctim.2021.102782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/25/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Coprescription is a potential medical problem for older adults that could induce polypharmacy and subsequent complications. In Taiwan, Chinese herbal medicine (CHM) is popular among the older adults. Investigating the coprescription trends in Western medicine, CHM and dental medicine is important to avoid possible polypharmacy. METHODS We analyzed data from the Longitudinal Health Insurance Database 2000 (LHID 2000) in Taiwan. Patients ≥ 60 years old who received coprescription of Western medicine, CHM and drugs for dental care from 1997 to 2013 were included. The odds ratio (OR) and 95% confidence interval (95% CI) were estimated by a logistic regression model for evaluating the correlation between baseline characteristics and coprescription. RESULTS A total of 266,034 patients were included for the analysis. Most patients receiving coprescriptions lived in the northern Taiwan and with a monthly income lower than 20,000 new Taiwan dollars. The trends in older adults using Western medicine alone or CHM alone decreased over time, but the cohort using dental medicine alone had the opposite result. Decreased trends in coprescription with age were noted. The trends in the proportion of coprescription and the number of days of coprescription increased with the calendar year. Increased trends in the proportion of patients with coprescription were also found, except for the cohort of patients who used both Western medicine and CHM. Patients who were female, and aged 70-79 years were prone to receive coprescription. CONCLUSIONS Coprescription in older patients is not uncommon in Taiwan. Healthcare providers and policymakers should be aware of the complex coprescription pattern in the older adults.
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Affiliation(s)
- Chia-Yu Huang
- Department of Family Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan
| | - Mei-Yao Wu
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; School of Post-baccalaureate Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan
| | - Chia-Ling Chang
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan; College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Yuan-Ching Liao
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Ying-Yu Chen
- Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan
| | - Wu-Chou Lin
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung 404, Taiwan.
| | - Hung-Rong Yen
- Graduate Institute of Chinese Medicine, School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung 404, Taiwan; Department of Chinese Medicine, China Medical University Hospital, Taichung 404, Taiwan; Research Center for Traditional Chinese Medicine, Department of Medical Research, China Medical University Hospital, Taichung 404, Taiwan; Chinese Medicine Research Center, China Medical University, Taichung 404, Taiwan; Department of Medical Laboratory Science and Biotechnology, Asia University, Taichung 413, Taiwan.
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Ayala MP, Beaumont CDM, Ceremuga TE. Exploration of Predictive Modeling of Defense Health Agency & Department of Veterans Affairs Beneficiaries Dietary Supplements Use. J Perianesth Nurs 2021; 36:678-684. [PMID: 34686401 DOI: 10.1016/j.jopan.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/03/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to predict dietary supplements (DS) use among Defense Health Agency (DHA) and Veterans Affairs (VA) beneficiaries who were scheduled for surgical procedures. DESIGN This was a predictive descriptive multicenter study with a convenience sample of 2,623 adult subjects. After institutional review board exemption, data collection occurred preoperatively via electronic survey. Participation was voluntary and data unidentifiable. METHODS Data were collected in preoperative anesthesia clinics during preanesthetic evaluations, or in surgery holding areas immediately prior to surgery, using a validated data collection tool. The total convenience sample size was 2,623 subjects from 6 medical centers. Data were voluntarily, anonymously, and verbally obtained from subjects using electronic survey methodology. Collected data included: gender, age, rank, beneficiary status, race, body mass index, tobacco use, marital status, and knowledge of DS side effects and drug interactions. For predictive modeling of DS use, multiple logistic regression was performed for binary outcomes via SPSS. FINDINGS For binary logistic regression the predictors were significant for the following outcomes: taking DS (education, sex, age, and race; P < .05), knowledge of side effects (age, race, and rank; P < .05), and believe they are having side effects (age; P < .05). CONCLUSIONS Understanding DS use is central to predict and anticipate potential negative sequelae in patient outcomes in anesthesia. College education, females, Caucasians, and increasing age are indicators for greater DS use. These results provide opportunities for perianesthesia nurses to improve preoperative assessments, design patient specific perianesthesia care, and enhance patient education. Further research is recommended.
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Affiliation(s)
- Melissa P Ayala
- United States Army Graduate Program in Anesthesia Nursing, Fort Sam Houston, TX
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Taneri PE, Akis N, Karaalp A. Herbal product use patterns and possible herb-drug interactions among older adults in Turkey. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bidirectional Influences of Cranberry on the Pharmacokinetics and Pharmacodynamics of Warfarin with Mechanism Elucidation. Nutrients 2021; 13:nu13093219. [PMID: 34579096 PMCID: PMC8470483 DOI: 10.3390/nu13093219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 11/17/2022] Open
Abstract
Cranberry is a dietary supplement popularly used for the prophylaxis of urinary tract infection. Interestingly, cranberry–warfarin interactions in clinical reports have shown bidirectional outcomes. (±) Warfarin, a widely prescribed anticoagulant, but with a narrow therapeutic index, contains equal amounts of S- and R-warfarin, of which S-warfarin is more active. The aim of this study was to investigate the effects of different ingestion times of cranberry on the pharmacokinetics and pharmacodynamics of warfarin. Rats were orally administered (±) warfarin (0.2 mg/kg) with and without cranberry (5.0 g/kg) at 0.5 h prior to the warfarin, and at 10 h after the warfarin. The plasma concentrations of S- and R-warfarin were determined by LC/MS. The results indicate that cranberry ingested at 0.5 h before (±) warfarin significantly decreased the systemic exposures of S-warfarin and R-warfarin. Conversely, when cranberry was ingested at 10 h after (±) warfarin, the elimination of S-warfarin was significantly inhibited, and the anticoagulation effect of (±) warfarin was significantly enhanced. The results of the mechanism studies indicate that cranberry activated the breast cancer resistance protein (BCRP), which mediated the efflux transports of S-warfarin and R-warfarin. Moreover, the metabolites of cranberry inhibited cytochrome P450 (CYP) 2C9, the main metabolizing enzyme for S-warfarin. In conclusion, cranberry affected the pharmacokinetics of (±) warfarin in a bidirectional manner by activating the BCRP by CJ during absorption and inhibiting the BCRP and CYP2C9 by CMs during elimination, depending on the ingestion time of CJ. The combined use of cranberry with warfarin should be avoided.
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Leite PM, Martins MAP, Carvalho MDG, Castilho RO. Mechanisms and interactions in concomitant use of herbs and warfarin therapy: An updated review. Biomed Pharmacother 2021; 143:112103. [PMID: 34474338 DOI: 10.1016/j.biopha.2021.112103] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/19/2021] [Accepted: 08/23/2021] [Indexed: 12/19/2022] Open
Abstract
This review is an updated and expanded version published in this journal in 2016. Warfarin pharmacotherapy is extremely complex, since in addition to being a low therapeutic index drug, it does not follow the dose-response pattern and has characteristics that predispose the occurrence of interactions, such as high binding rate to plasma proteins, metabolization by cytochrome P450 enzymes, further to acting in the complex process of blood coagulation, platelet activation, and inflammation. For these reasons, warfarin has great potential for interaction with drugs, foods, and herbal medicines. Herb-warfarin interactions, however, are still not very well studied; thus, the objective of this update is to present new information on the subject aiming to provide a scientific basis to help health professionals in the clinical management of these interactions. A literature review was performed from May to June 2021 in multiple databases and articles published in 2016 to 2021 were included. A total of 59 articles describing 114 herbal medicines were reported to interact with warfarin. Of the plants mentioned, 84% had the potential to increase warfarin effect and the risk of bleeding. Targets possibly involved in these interactions include the processes of blood coagulation, platelet activation, and inflammation, in addition to the pharmacokinetics and pharmacodynamics of warfarin. Despite these alarming numbers, however, the clinical management of interactions is known to be effective. Thus, it is important that the use of these herbal medicines be done with caution in anticoagulated patients and that studies of herb-drug interactions be encouraged in order to generate information to support the clinical management of patients.
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Affiliation(s)
- Paula Mendonça Leite
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Auxiliadora Parreiras Martins
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil
| | - Maria das Graças Carvalho
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil
| | - Rachel Oliveira Castilho
- Department of Pharmaceutical Products, Faculty of Pharmacy, Universidade Federal de Minas Gerais, Av. Antônio Carlos 6627, Belo Horizonte, Minas Gerais, Brazil; Consórcio Acadêmico Brasileiro de Saúde Integrativa, CABSIN, Brazil.
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Barry HE, Hughes CM. An Update on Medication Use in Older Adults: a Narrative Review. CURR EPIDEMIOL REP 2021; 8:108-115. [PMID: 34306966 PMCID: PMC8294219 DOI: 10.1007/s40471-021-00274-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
Purpose of Review The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. Recent Findings A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. Summary Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.
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Affiliation(s)
- Heather E Barry
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
| | - Carmel M Hughes
- Primary Care Research Group, School of Pharmacy, Queen's University Belfast, Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL UK
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Graves JM, Dilley JA, Terpak L, Brooks-Russell A, Whitehill JM, Klein TA, Liebelt E. Kratom exposures among older adults reported to U.S. poison centers, 2014-2019. J Am Geriatr Soc 2021; 69:2176-2184. [PMID: 34143890 DOI: 10.1111/jgs.17326] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND In recent years, use of the herbal supplement kratom has increased in the United States. The reasons for use include pain relief, particularly as a substitute for opioids. OBJECTIVES To describe epidemiologic trends in kratom-related exposures among older adults reported to U.S. poison centers. DESIGN Retrospective analysis of American Association of Poison Control Center's National Poison Data System (NPDS). SETTING Data from all U.S. poison centers from 2014 to 2019 were examined. PARTICIPANTS Kratom exposure cases involving adults aged 18 and older. Kratom cases were identified by product and NPDS generic codes. Non-human and information-only calls were excluded. Data were examined for all calls for exposures among adults, with a focus on older adults aged 60-69 years and above 70 years. MEASUREMENTS Descriptive analyses were used to characterize individual demographic, exposure information, clinical effects, and medical outcomes associated with kratom exposures among older adults. Comparisons across age groups (18-59, 60-69, and 70+ years) were made using Fisher's exact tests. RESULTS Among 3484 kratom-related exposures reported between 2014 and 2019, 4.6% (n = 162) were among adults over 60 years. The number of kratom-related exposures increased over time. Most cases originated with calls from healthcare facilities (81.1%) and involved kratom as a single ingestant (63.0%). The reason for most ingestions was intentional (74.5%). One in five exposures among adults aged 70 and older involved an adverse reaction (e.g., drug interaction; 21.9%), compared with 12.3% among ages 60-69 and 9.6% among ages 18-59 years. Neurological and cardiovascular clinical effects were observed. Twenty-three deaths were observed among older adults. CONCLUSION Healthcare providers and older adult patients should be aware of the potential risks of kratom use, including medication interactions and falls. When reviewing medication lists, providers should query this population for all medications and substances being used, especially in people being treated for pain.
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Affiliation(s)
- Janessa M Graves
- College of Nursing, Washington State University, Spokane, Washington, USA
| | - Julia A Dilley
- Multnomah County Health Department and Oregon Public Health Division, Program Design and Evaluation Services, Portland, Oregon, USA
| | - Lucia Terpak
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ashley Brooks-Russell
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer M Whitehill
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Tracy A Klein
- College of Nursing, Washington State University, Vancouver, Washington, USA
| | - Erica Liebelt
- Department of Pediatrics, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Mehta RS, Kochar BD, Kennelty K, Ernst ME, Chan AT. Emerging approaches to polypharmacy among older adults. NATURE AGING 2021; 1:347-356. [PMID: 37117591 DOI: 10.1038/s43587-021-00045-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/10/2021] [Indexed: 12/22/2022]
Abstract
Polypharmacy is a major health issue for older adults. Entangled with several geriatric syndromes, including frailty, falls and cognitive decline, research focused on polypharmacy has been challenged by heterogeneity in its definition, confounding by comorbidities and limited prospective data. In this Review, we discuss varying definitions for polypharmacy and highlight the need for a uniform definition for future studies. We critically appraise strategies for reducing medication prescriptions and implementing deprescribing as a mechanism to reduce the potential harmful effects of polypharmacy. As we look to the future, we assess the role of novel analytics and high-throughput technology, including multiomics profiling, to advance research in polypharmacy and the development of new strategies for risk stratification in the age of precision medicine.
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Affiliation(s)
- Raaj S Mehta
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Bharati D Kochar
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Korey Kennelty
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA, USA
- Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Andrew T Chan
- Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Brodziak-Dopierała B, Fischer A, Ahnert B. Polish students’ knowledge of dietary supplements. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01481-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
The increasing intake of dietary supplements (DS) can be observed worldwide. These preparations are classified as a special category of foods and are subject to food law, not pharmaceutical regulations. As a result, the requirements for DS are much less restrictive than for medications.
Methodology
This research was conducted in a group of young Polish students of pharmacy at the Medical University of Silesia in Katowice (SUM) and of finance and accounting at the University of Economics in Katowice (UE). The survey contained questions concerning DS, such as difference to drugs, scope of use, and safety.
Results
The respondents answered questions about taking DS and the effects of their use. DS were used either currently or in the past by about 70% of the respondents, while about 30% of the surveyed population declared that they did not use these preparations. Women and UE students predominated among those not taking DS.
Conclusion
Multi-component products taken for a period of less than 3 months to supplement a deficit for a given component were used the most often. One product was taken at a time. The respondents read product information and followed the recommended doses. Over 50% of the studied population was aware of the negative effects of DS. Adverse symptoms of DS use were observed by 5% of the respondents.
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Burato S, Leonardi L, Antonazzo IC, Raschi E, Ajolfi C, Baraghini M, Chiarello A, Delmonte V, Di Castri L, Donati M, Fadda A, Fedele D, Ferretti A, Gabrielli L, Gobbi S, Lughi S, Mazzari M, Pieraccini F, Renzetti A, Russi E, Scanelli C, Zanetti B, Poluzzi E. Comparing the Prevalence of Polypharmacy and Potential Drug-Drug Interactions in Nursing Homes and in the Community Dwelling Elderly of Emilia Romagna Region. Front Pharmacol 2021; 11:624888. [PMID: 33628186 PMCID: PMC7898059 DOI: 10.3389/fphar.2020.624888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/21/2020] [Indexed: 12/03/2022] Open
Abstract
Backround: We aimed at assessing the prevalence of polypharmacy and potential drug-drug interactions (DDIs) with clinical relevance in elderly patient on Emilia Romagna area. Both outpatients and residents in nursing homes were assessed, with only partially overlapping strategies. Methods: We defined a list of 190 pairs of potentially interacting drugs, based on literature appraisal and availability of therapeutic alternatives. January-June 2018 data on drug use in patients over 65 years-old were collected from nine Local Health Authorities of Emilia Romagna: data on community-dwelling subjects were extracted from archives of reimbursed prescriptions, while drug use in a sample of nursing homes was recorded from clinical charts in one index day within the same semester. The frequency of polypharmacy (at least five or at least 10 concurrent drugs) and of each DDI was calculated. Results: In line with different rates of polypharmacy (80% vs 16%), the risk of exposure to at least one interaction was 53.7% in nursing homes and 26.4% in outpatients. Among DDIs, in nursing homes antidepressants—anxiolytics (11.9%) ranked first, followed by antidepressants—aspirin (7.4%). In outpatients, ACE-inhibitors—non-steroidal anti-inflammatory drugs (NSAIDs) reached 7.2% followed by the calcium channel blockers—α-blockers (2.4%). Discussion: Polypharmacy and risk of DDIs appeared very different in the two settings, due to both technical and clinical reasons. In order to reduce use of benzodiazepines, NSAIDs, antidepressants and relevant DDIs, 1) defining alternative options for pain relief in elderly outpatients, and 2) implementing non-pharmacological management of insomnia and anxiety in nursing homes should be prioritized.
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Affiliation(s)
- Sofia Burato
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luca Leonardi
- Post Graduate School of Hospital Pharmacy, Department of Pharmacy, University of Pisa, Pisa, Italy
| | | | - Emanuel Raschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | | | - Manuela Baraghini
- Local Health Authority of Romagna (Forlì and Cesena Units), Emilia-Romagna, Italy
| | - Antonella Chiarello
- Post Graduate School of Hospital Pharmacy, Department of Pharmacy, University of Pisa, Pisa, Italy.,Local Health Authority of Imola, Imola, Italy
| | | | | | - Monia Donati
- Local Health Authority of Bologna, Bologna, Italy
| | | | | | | | - Laura Gabrielli
- Local Health Authority of Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Gobbi
- Local Health Authority of Romagna (Forlì and Cesena Units), Emilia-Romagna, Italy
| | - Sereno Lughi
- Local Health Authority of Romagna (Forlì and Cesena Units), Emilia-Romagna, Italy
| | | | - Fabio Pieraccini
- Local Health Authority of Romagna (Forlì and Cesena Units), Emilia-Romagna, Italy
| | | | - Elsa Russi
- Local Health Authority of Parma, Parma, Italy
| | | | | | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Centre of Studies and Research on the Elderly, University of Bologna, Bologna, Italy
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Sarhene M, Ni JY, Duncan ES, Liu Z, Li S, Zhang J, Guo R, Gao S, Gao X, Fan G. Ginsenosides for cardiovascular diseases; update on pre-clinical and clinical evidence, pharmacological effects and the mechanisms of action. Pharmacol Res 2021; 166:105481. [PMID: 33549726 DOI: 10.1016/j.phrs.2021.105481] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 01/20/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
Cardiovascular disease (CVD) remains the major cause of death worldwide, accounting for almost 31% of the global mortality annually. Several preclinical studies have indicated that ginseng and the major bioactive ingredient (ginsenosides) can modulate several CVDs through diverse mechanisms. However, there is paucity in the translation of such experiments into clinical arena for cardiovascular ailments due to lack of conclusive specific pathways through which these activities are initiated and lack of larger, long-term well-structured clinical trials. Therefore, this review elaborates on current pharmacological effects of ginseng and ginsenosides in the cardiovascular system and provides some insights into the safety, toxicity, and synergistic effects in human trials. The review concludes that before ginseng, ginsenosides and their preparations could be utilized in the clinical treatment of CVDs, there should be more preclinical studies in larger animals (like the guinea pig, rabbit, dog, and monkey) to find the specific dosages, address the toxicity, safety and synergistic effects with other conventional drugs. This could lead to the initiation of large-scale, long-term well-structured randomized, and placebo-controlled clinical trials to test whether treatment is effective for a longer period and test the efficacy against other conventional therapies.
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Affiliation(s)
- Michael Sarhene
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Jing Yu Ni
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Esi Sophia Duncan
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Zhihao Liu
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Sheng Li
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Jing Zhang
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Rui Guo
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China
| | - Shan Gao
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiumei Gao
- State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Guanwei Fan
- First teaching hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China; State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China; Tianjin Laboratory of Translational Research of TCM Prescription and Syndrome, Tianjin 300193, China.
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Ananchaisarp T, Rungruang S, Theerakulpisut S, Kamsakul P, Nilbupha N, Chansawangphop N, Yiambunya J, Jarudamrongsak J, Prasertsri K. Usage of herbal medicines among the elderly in a primary care unit in Hat Yai, Songkhla province, Thailand. ASIAN BIOMED 2021; 15:35-42. [PMID: 37551299 PMCID: PMC10388782 DOI: 10.2478/abm-2020-0005] [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: 11/20/2022]
Abstract
Background The prevalence of chronic diseases in the elderly is high, and some use herbal medicines instead of, or together with, conventional medicine. Herbal medicine usage may cause adverse events. Objectives To determine the prevalence of herbal medicine usage among the elderly attending a primary care unit (PCU) of Songklanagarind Hospital, a tertiary teaching hospital in Hat Yai, Songkhla province, Thailand, and associated factors, reasons for use, principles considered before use, perceived effects, and history of consultation with medical professionals concerning their herbal medicine usage. Methods We conducted a cross-sectional survey of a convenience sample of elderly patients who visited the PCU. Questionnaires were used to obtain data. Results We included 204 patients who met the eligibility criteria. About two-thirds were women, with a median age of 69.0 years. Most had underlying diseases and were educated. The all time prevalence of herbal medicine usage was 60.8%. Being educated was significantly associated with herbal medicine usage. Among 124 users, 79% did not consider any principles for safe use of herbal medicine, 63% had no knowledge of possible interactions with conventional medicines, and 73% had never been asked about their use of herbal medicines by their health care professionals. Conclusions There is a high prevalence of herbal medicine usage among the elderly Thai patients attending the PCU, especially by the educated. The majority did not consider the principles for safe use of herbal medicine. Health care providers should be more aware of herbal medicine usage and should increase their role in initiating a discussion about herbal medicine usage with elderly patients.
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Affiliation(s)
- Thareerat Ananchaisarp
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Supeecha Rungruang
- Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Saralee Theerakulpisut
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Peerada Kamsakul
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Nichapat Nilbupha
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Napat Chansawangphop
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Jirameth Yiambunya
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Jirayu Jarudamrongsak
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
| | - Kanokwan Prasertsri
- Graduate School of Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla90110, Thailand
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Lepionka T, Białek M, Czauderna M, Białek A. Pomegranate seed oil and bitter melon extract supplemented in diet influence the lipid profile and intensity of peroxidation in livers of SPRD rats exposed to a chemical carcinogen. Prostaglandins Other Lipid Mediat 2021; 152:106495. [DOI: 10.1016/j.prostaglandins.2020.106495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 12/21/2022]
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Systematic Review: Guideline-Based Approach for the Management of Asthma and Subtypes via Chinese Medicine. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:4319657. [PMID: 33505494 PMCID: PMC7810530 DOI: 10.1155/2021/4319657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022]
Abstract
Background Asthma is a chronic condition that results in the inflammation and narrowing of airways, often clinically presenting as wheeze and shortness of breath. Little is known of the mechanisms of action (MOA) of herbs used to treat asthma. The aim of this study is to review existing data regarding known MOA of traditional Chinese medicine which will aid in the understanding of possible interactions between Western drugs and Chinese herbs as well as the standardization of management via a proposed guideline to improve patient safety and possible synergism in the long term. Methods We searched through 5 databases for commonly prescribed herbs and formulas for asthma and narrowed down the search to identify the underlying MOA of individual herbs that could specifically target asthma symptoms. We included studies that stated the MOA of individual herbs when used for treating symptoms of asthma, excluding them if they are described as part of a formula. Results A total of 26 herbs commonly prescribed for asthma with known mechanism of action were identified. Herbs used for asthma were found to have similar MOA as that for drugs. Based on existing GINA guidelines, a guideline is proposed which includes a total of 5 steps depending on the severity of asthma and the herbs' MOA. 16 formulas were subsequently identified for the management of asthma, which consist of 12 “stand-alone” and 4 “add-on” formulas. “Stand-alone” formulas used independently for asthma generally follow the GINA guidelines but do not proceed beyond step 3. These formulas consist mainly of beta-agonist and steroid-like effects. “Add-on” formulas added as adjunct to “stand-alone” formulas, however, mainly act on T helper cells or have steroid-like effects. Conclusion Through the understanding of MOA of herbs and their respective formulas, it will ensue greater patient safety and outcomes.
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McDaid B, Woodside JV, Neville CE, Nugent AP. Botanical ingredients: Intakes, regulations, risks and attitudes. NUTR BULL 2020. [DOI: 10.1111/nbu.12473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- B. McDaid
- Institute for Global Food Security School of Biological Sciences Queen’s University Belfast Belfast UK
| | - J. V. Woodside
- Institute for Global Food Security (Centre for Public Health) School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - C. E. Neville
- Institute for Global Food Security (Centre for Public Health) School of Medicine, Dentistry and Biomedical Sciences Queen’s University Belfast Belfast UK
| | - A. P. Nugent
- Institute for Global Food Security School of Biological Sciences Queen’s University Belfast Belfast UK
- Institute of Food and Health School of Agriculture and Food Science University College Dublin Dublin Ireland
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Chi D, Ding D, Zhao Q, Liang X, Wu W, Luo J, Wang B. Potential herb-drug interactions in community-dwelling older adults in China: the Shanghai Aging Study. Aging Clin Exp Res 2020; 32:2677-2685. [PMID: 32008224 DOI: 10.1007/s40520-020-01489-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 01/17/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Potential herb-drug interactions (pHDIs) often go unrecognized, and little is known about the prevalence of pHDIs in older adults. AIMS This study aimed to investigate the prevalence of pHDIs in community-dwelling older adults in Shanghai and identify patterns and factors associated with pHDIs. METHODS Baseline data from the Shanghai Aging Study, which was designed to establish a prospective community-based cohort of older adults in Shanghai, were analyzed regarding pHDIs with Lexi-Interact Online software. RESULTS Among 1227 participants who used any combination of drug-herb or herb-herb, 43.3% were exposed to at least one pHDI. A total of 1641 different pHDIs were identified among the study samples. Only seven (0.4%) pHDIs were rated as risk category X, indicating that the combinations were contraindicated and should be avoided. Worryingly, 876 (53.4%) pHDIs were rated as risk category D, indicating that significant interactions may occur and therapeutic modification should be considered. Of particular concern is that 99.8% of pHDIs in risk category D involve herbs with anticoagulant/antiplatelet properties. Individuals with stroke (odds ratio [OR] 2.02), hyperlipidemia (OR 1.51) or heart diseases (OR 1.42) and the number of herbs (2.66), number of drugs (OR 1.21), and age (OR 1.02) were significantly associated with the risk of pHDIs. CONCLUSION 43.3% of community-dwelling older adults who used any combination of drug-herb or herb-herb was exposed to pHDIs, and more than half of pHDIs were related to herbs with anticoagulant/antiplatelet properties. Awareness of the patterns and high-risk groups of these pHDIs may contribute to increased patient safety.
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Ahn JH, Kim J, Rehman NU, Kim HJ, Ahn MJ, Chung HJ. Effect of Rumex Acetosa Extract, a Herbal Drug, on the Absorption of Fexofenadine. Pharmaceutics 2020; 12:pharmaceutics12060547. [PMID: 32545588 PMCID: PMC7355497 DOI: 10.3390/pharmaceutics12060547] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/06/2020] [Accepted: 06/10/2020] [Indexed: 01/10/2023] Open
Abstract
Herbal drugs are widely used for the auxiliary treatment of diseases. The pharmacokinetics of a drug may be altered when it is coadministered with herbal drugs that can affect drug absorption. The effects of herbal drugs on absorption must be evaluated. In this study, we investigated the effects of Rumex acetosa (R. acetosa) extract on fexofenadine absorption. Fexofenadine was selected as a model drug that is a substrate of P-glycoprotein (P-gp) and organic anion transporting polypeptide 1A2 (OATP1A2). Emodine—the major component of R. acetosa extract—showed P-gp inhibition in vitro and in vivo. Uptake of fexofenadine via OATP1A2 was inhibited by R. acetosa extract in OATP1A2 transfected cells. A pharmacokinetic study showed that the area under the plasma concentration–time curve (AUC) of fexofenadine was smaller in the R. acetosa extract coadministered group than in the control group. R. acetosa extract also decreased aqueous solubility of fexofenadine HCl. The results of this study suggest that R. acetosa extract could inhibit the absorption of certain drugs via intervention in the aqueous solubility and the drug transporters. Therefore, R. acetosa extract may cause drug interactions when coadministered with substrates of drug transporters and poorly water-soluble drugs, although further clinical studies are needed.
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Ni Y, Duan Z, Zhou D, Liu S, Wan H, Gui C, Zhang H. Identification of Structural Features for the Inhibition of OAT3-Mediated Uptake of Enalaprilat by Selected Drugs and Flavonoids. Front Pharmacol 2020; 11:802. [PMID: 32547398 PMCID: PMC7271668 DOI: 10.3389/fphar.2020.00802] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/15/2020] [Indexed: 12/12/2022] Open
Abstract
Enalaprilat is the active metabolite of enalapril, a widely used antihypertension drug. The human organic anion transporter 3 (OAT3), which is highly expressed in the kidney, plays a critical role in the renal clearance of many drugs. While urinary excretion is the primary elimination route of enalaprilat, direct involvement of OAT3 has not been reported so far. In the present study, OAT3-mediated uptake of enalaprilat was first characterized, and the inhibition of OAT3 transport activity was then examined for a number of flavonoid and drug molecules with diverse structures. A varying degree of inhibition potency was demonstrated for flavonoids, with IC50 values ranging from 0.03 to 22.6 µM against OAT3 transport activity. In addition, commonly used drugs such as urate transporter 1 (URAT1) inhibitors also displayed potent inhibition on OAT3-mediated enalaprilat uptake. Pharmacophore and three-dimensional quantitative structure-activity relationship (3D-QSAR) analyses revealed the presence of a polar center and a hydrophobic region involved in OAT3-inhibitor binding. For the polar center, hydroxyl groups present in flavonoids could act as either hydrogen bond donors or acceptors and the number and position of hydroxyl groups were critical drivers for inhibition potency, while carboxyl groups present in some drugs could form ionic bridges with OAT3. The predicted inhibition potencies by comparative molecular field analysis (CoMFA) and comparative molecular similarity indices analysis (CoMSIA) were correlated well with experimental IC50 values. Taken together, the present study identified OAT3-mediated uptake of enalaprilat as an important mechanism for its renal clearance, which may be liable for drug-drug and herb-drug interactions. The established computational models revealed unique structural features for OAT3 inhibitors and could be used for structure-activity relationship (SAR) analysis of OAT3 inhibition. The clinical relevance of the inhibition of OAT3-mediated enalaprilat uptake warrants further investigation, particularly in populations where herbal remedies and drugs are used concomitantly.
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Affiliation(s)
- Yao Ni
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Zelin Duan
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Dandan Zhou
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Shuai Liu
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Huida Wan
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Chunshan Gui
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Hongjian Zhang
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
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Kondo T, Ishimi Y, Takebayashi J, Tousen Y. Assessment of safety and efficacy of pine bark extract in normal and ovariectomized mice. J Food Sci 2020; 85:1956-1962. [PMID: 32406939 DOI: 10.1111/1750-3841.15160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
We evaluated the influence of pine bark extract (PBE) on organs, the cytochrome-P450 (CYP) activities in liver and estrogenic effects in normal and ovariectomized (OVX) female mice. The PBE did not affect organ weights and liver-function indexes (activities of alkaline phosphatase, aspartate amino transferase, and alanine amino transferase) at doses; 0.04%, 0.4%, and 2.0% PBE in the diet, in normal and OVX female mice. In the OVX mice, CYP1A1 activity was significantly higher in the 0.4% and 2.0% PBE groups than in the OVX control group, and in the 0.4% and 2.0% PBE groups were significantly higher than in the 0.04% PBE group. CYP1A2 and 3A4 activities were significantly higher in the 2.0% PBE group than in all other groups. The PBE did not affect uterine weight and femoral bone mineral density at all PBE doses. These results showed that the dose of PBE at the recommended human intake, had no toxic and estrogenic effects in normal female and OVX mice, however, it may need attention to use the excess intake of PBE with some drugs in postmenopausal women.
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Affiliation(s)
- Takashi Kondo
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Yoshiko Ishimi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan.,NODAI Research Institute, Tokyo University of Agriculture, 1-1-1, Sakuragaoka, Setagaya-ku, Tokyo, 156-8502, Japan
| | - Jun Takebayashi
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
| | - Yuko Tousen
- National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo, 162-8636, Japan
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Williamson EM, Liu X, Izzo AA. Trends in use, pharmacology, and clinical applications of emerging herbal nutraceuticals. Br J Pharmacol 2020; 177:1227-1240. [PMID: 31799702 DOI: 10.1111/bph.14943] [Citation(s) in RCA: 174] [Impact Index Per Article: 43.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/06/2019] [Accepted: 10/09/2019] [Indexed: 12/15/2022] Open
Abstract
The nutraceuticals market is vast, encompassing many different products with inconsistent levels of evidence available to support their use. This overview represents a Western perspective of the nutraceuticals market, with a brief comparison with that in China, as an illustration of how individual health supplements increase and decrease in popularity in regional terms. Recent changes in sales patterns, mainly taken from the US market, are summarized and a selection of five newer products, which have not been subject to extensive recent review are profiled: astaxanthin, a carotenoid found in red algae, seafood, salmon and trout, as an antioxidant; cannabidiol, a non-euphoric marijuana ingredient used as mood enhancer and for painful/inflammatory conditions; modified extracts of ginseng used in new indications including dementia and space travel; monk fruit, a non-sugar high intensity sweetener and nigella seed, a popular food ingredient and Asian medicine, which has experienced an extraordinary rise in sales recently. LINKED ARTICLES: This article is part of a themed section on The Pharmacology of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v177.6/issuetoc.
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Affiliation(s)
| | - Xinmin Liu
- Research Centre for Pharmacology and Toxicology, Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Angelo A Izzo
- Department of Pharmacy, School of Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Deprescribing as a Clinical Improvement Focus. J Am Med Dir Assoc 2019; 21:355-360. [PMID: 31672564 DOI: 10.1016/j.jamda.2019.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/11/2019] [Accepted: 08/30/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Polypharmacy is a concern in the practice of geriatrics because of consequences such as adverse drug events and poorer quality of life. Deprescribing, a response to polypharmacy, refers to the systematic, programmed, and appropriate reduction in drug number and dose. Although now broadly recognized, challenges exist in practice for effective implementation. This study was conducted to determine the deprescribing success rate and relate it to drug classes and clinical settings, and to identify factors that influence the deprescribing process. DESIGN As a performance improvement (PI) project, fellows in geriatric medicine, under supervision of faculty geriatricians, attempted deprescribing during at least 1 encounter daily at 2 long-term care (LTC) facilities and an outpatient geriatrics clinic (C) in Bronx, New York, from August 2018 to January 2019. Deprescribing was initiated following discussion and consent from patient or caregiver. Following the data collection, involved fellows and faculty physicians participated in a survey to identify factors that influenced the process. RESULTS Out of 449 encounters, 383 encounters were included for analysis. Average patient age was 78.2 years (LTC: 77.9, C: 79.1). Average patient comorbidities was 6.5 (LTC: 6.7, C: 5.8). Deprescribing was successful in 90.1% of encounters (LTC: 96.9%, C: 67.4%). On average, 1.3 medications were deprescribed per encounter (LTC: 1.4, C: 1.0). Analgesics (32.2%), multivitamin-minerals supplements (29.7%), lipid-lowering agents (22.9%), antihistamines (46.7%), and acid blockers (26.2%) had highest success. CONCLUSIONS AND IMPLICATIONS Deprescribing is possible in practice in both LTC and community settings at each encounter, until it is no longer applicable. Factors that contribute to successful deprescribing primarily include meaningful and earnest provider effort, ideally in collaboration with interdisciplinary team members (nurses, pharmacists, social worker, and others), besides interactions with consultants for the patient. Certain medication classes such as vitamins, minerals, analgesics, and proton pump inhibitors can be deprescribed with high success, as noted in our study, whereas antipsychotic agents, antidepressants, and ophthalmic preparations, prescribed by specialists, proved harder to deprescribe. An understanding of barriers to deprescribing (outlined in the article) and addressing them are crucial in enabling success. The study demonstrates that as a performance improvement project in collaborative effort with multiple disciplines, deprescribing is possible in health care. Factors promoting success and barriers to deprescribing are detailed. Appropriate deprescribing has the potential to help lower adverse drug events, costs of care, and possibly improve quality of life.
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