Suicidal Thoughts and Self-injurious Behavior Associated With Glucagon-Like Peptide-1 Receptor Agonists - A Review

GLP-1 receptor agonists mimic the actions of GLP-1 and are used to manage type 2 diabetes and help with weight loss. In recent times, antidiabetic GLP-1 receptor agonists have been misused widely for weight loss. This review article focuses on some serious side effects of GLP-1 receptor agonists, notified by different regulatory agencies. We searched the literature in online databases such as Medline/Pubmed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of Science, Embase, and reference lists to identify publications relevant to the serious side effects associated with the use of GLP-1 receptor agonists. Various pharmacovigilance analyses and notifications from different regulatory agencies have documented the occurrence of suicidal thoughts and self-injurious behavior associated with the use of GLP-1 receptor agonists. Healthcare professionals should be aware of GLP-1 receptor agonistsassociated suicidal thoughts and self-injurious behavior. Patients should not misuse/abuse antidiabetic GLP-1 receptor agonists and should consult their physician before using any GLP-1 receptor agonists for weight loss.

An Overview of Conventional and Black Cumin Seeds (Nigella sativa) Therapy in the Management of Nipah Viral Infection

The recent outbreaks of Nipah viral infection were associated with severe respiratory illness, lethal encephalitis, and an extremely high mortality rate. As there are no approved antiviral medications, patients with NiV infections are currently treated with repurposed or investigational antivirals and supportive care. This review examines the potential health benefits of N. sativa in the treatment of NiV infection. To identify relevant studies, the literature was searched in online databases like Medline/PubMed, Google Scholar, Science Direct, and reference lists. Through its antiviral, anti-inflammatory, antioxidant, anticonvulsant, immunomodulatory, bronchodilatory, and other properties, a number of studies have demonstrated that N. sativa is effective against a variety of viral infections, inflammatory conditions, neurological and respiratory illnesses, and other conditions. As a result, in the treatment of NiV-infected patients, N. sativa could be added as an adjuvant treatment alongside repurposed or investigational antivirals and supportive care. The efficacy of N. sativa in the treatment of NiV infection will be determined by the results of upcoming randomized controlled clinical trials.

Paracetamol (Acetaminophen)-associated SJS, TEN, AGEP, and DRESS Syndromes - A Narrative Review

INTRODUCTION

Paracetamol (Acetaminophen) is a very common OTC drug that is found in more than 200 OTC products sold as pain, cough and cold remedies. Paracetamol is commonly used as an antipyretic to reduce fever and as an alternative to Non-steroidal anti-inflammatory drugs (NSAIDs) that are contraindicated in certain patients to relieve mild-moderate pain.

OBJECTIVE

This review article focuses on SJS, TEN, SJS/TEN overlap, AGEP, and DRESS syndromes associated with the use of paracetamol or paracetamol-containing products.

METHODS

To find published articles relevant to paracetamol-associated SJS, TEN, AGEP, and DRESS, we searched the online databases Medline/Pubmed/PMC, Google Scholar, Science Direct, Ebsco, Scopus, Web of Science, Embase, and reference lists using keywords like Stevens-Johnson Syndrome, Acetaminophen, Paracetamol, Toxic epidermal necrolysis, Acute generalized exanthematous pustulosis, Drug reaction with eosinophilia and systemic symptoms.

RESULTS

The paracetamol-associated SJS, TEN, SJS/TEN overlap, AGEP, and DRESS syndromes have been identified by a number of publications.

CONCLUSION

When evaluating drug-induced hypersensitivity skin reactions, healthcare professionals, including prescribers, pharmacists, and others, should be aware of this rare risk. Patients who exhibit signs and symptoms of paracetamol-associated hypersensitivity should be referred to physicians by pharmacists for further treatment. At the first sign of a skin rash or other hypersensitivity reaction while taking paracetamol, patients should be told to stop taking it and see a doctor right away.

Adverse Effects Associated with Long-Term Use of Proton Pump Inhibitors

Proton Pump Inhibitors are used widely to manage many gastric acid-related conditions such as gastroesophageal disease, gastritis, esophagitis, Barrett's esophagus, Zollinger-Ellison syndrome, peptic ulcer disease, nonsteroidal anti-inflammatory drug-associated ulcers, and Helicobacter pylori eradication, around the globe. This review article focuses on adverse effects associated with the long-term use of proton pump inhibitors. Various observational studies, clinical trials, and meta-analyses have established the adverse effects associated with the long-term use of proton pump inhibitors including renal disorders (acute interstitial nephritis, acute kidney injury, chronic kidney disease, and end-stage renal disease), cardiovascular risks (major adverse cardiovascular events, myocardial infarction, stent thrombosis, and stroke), fractures, infections (Clostridium difficile infection, community-acquired pneumonia, and Coronavirus disease 2019), micronutrient deficiencies (hypomagnesemia, anemia, vitamin B12 deficiency, hypocalcemia, hypokalemia), hypergastrinemia, cancers (gastric cancer, pancreatic cancer, colorectal cancer, hepatic cancer), hepatic encephalopathy, and dementia. Clinicians including prescribers and pharmacists should be aware of the adverse effects of taking proton pump inhibitors for an extended period of time. In addition, the patients taking proton pump inhibitors for long-term should be monitored for the listed adverse effects. The American Gastroenterological association recommends a few non-pharmacological measures and the use of histamine 2 blockers to lessen gastrointestinal symptoms of gastroesophageal reflex disease and the utilization of proton pump inhibitors treatment if there is a definitive indication. Additionally, the American Gastroenterological association's Best Practice Advice statements emphasize deprescribing when there is no clear indication for proton pump inhibitors therapy.

A Review of Clinical and Preclinical Studies on the Therapeutic Potential of Black Seeds (Nigella sativa) in the Management of Polycystic Ovarian Syndrome (PCOS)

Objectives

Polycystic ovary syndrome (PCOS) is a condition that occurs frequently among women of reproductive age and is a polygenic, multifactorial, endocrine, and metabolic disorder. PCOS is becoming more common as a result of risk factors such as current lifestyle, overnutrition, and stress. The use of traditional herbal medicine is higher among the global population. Hence, this review article focuses on the potential of Nigella sativa to manage women with PCOS.

Methods

A literature search was carried out using databases including Medline, Google Scholar, EBSCO, Embase, and Science Direct, as well as reference lists, to identify relevant publications that support the use of N. sativa in the management of women with PCOS.

Results

Several clinical and preclinical studies have demonstrated that the major bioactive constituent of black seed (N. sativa), thymoquinone, has potential for managing women with PCOS. Moreover, N. sativa may help to manage oligomenorrhea and amenorrhea in women with PCOS through its anti-inflammatory and antioxidant properties.

Conclusion

N. sativa has potential for use as a herbal medicine for managing women with PCOS as an integrative medicine along with traditional and modern medicine in conjunction with calorie restriction and regular exercise.

A Review of Pharmacotherapeutic Potentials of Black seeds (Nigella sativa) in the Management of Monkeypox Infection

Abstract:

Around 3500 laboratory-confirmed cases of monkeypox infection, from 42 non-endemic countries have been reported to World Health Organization (WHO), during the current multi-country monkeypox outbreak. As of now, patients with monkeypox infection are managed symptomatically with supportive care. Hence, our current review focuses on the analysis of the pharmacotherapeutic potentials of black seeds (N. sativa). The literature was searched in web-based databases including web of science, Medline/PMC/PubMed, Embase, EBSCO, Google Scholar, Science Direct, and reference lists to identify relevant publications. Several clinical, animal, in-vivo, in-vitro, and in-silico studies have confirmed the antiviral efficacy of N. sativa against various viruses. In addition, previous research have demonstrated the analgesic, anti-inflammatory, antibacterial, antioxidant, and immunomodulatory effects of Black seeds (N. sativa), which would help to alleviate the signs, symptoms, and complications associated with monkeypox infection. In consequence, black seeds (N. sativa) could be added as an adjuvant therapy along with repurposed/investigational antiviral drugs and supportive care in the management of patients with monkeypox infection in early stages to prevent inflammatory conditions and secondary bacterial infections. The safety and efficacy of Black seeds (N. sativa) in the management of monkeypox infection would further be established by future randomized controlled clinical trials.

Role of Supplements in the Management of COVID-19 - A Comprehensive Review

Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) and patients with COVID-19 may be treated primarily with SARS CoV-2-targeting drugs and the therapeutic agents assisting in the management of COVID-19 complications. This review focuses on the supplements like vitamins, minerals, herbal constituents, and others that help prevent or manage negative outcomes among COVID-19 patients. The literature was searched in databases such as Medline/PubMed Central/PubMed, Google Scholar, Science Direct, EBSCO, Scopus, EMBASE, the Directory of Open Access Journals (DOAJ), and reference lists to identify relevant articles. The vitamins, including vitamin C, and vitamin D, minerals such as zinc, selenium, and copper, herbal constituents like thymoquinone, curcumin, naringenin, quercetin, and glycyrrhizin, and other supplements, including N-acetylcysteine and melatonin. Melatonin have been identified as having the potential to manage patients with COVID-19 along with standard care. Some of the ongoing clinical trials are investigating the effectiveness of different supplements among COVID-19 patients.

Potential of Black Seeds (Nigella Sativa) in the Management of Long COVID or Post-acute Sequelae of COVID-19 (PASC) and Persistent COVID-19 Symptoms - An Insight

BACKGROUND

Some individuals may experience symptoms persisting for many months after the recovery from COVID-19 and patients with Long COVID are managed mainly with symptomatic treatment and supportive care.

OBJECTIVE

This review article focuses on the beneficial effects of black seeds (Nigella Sativa) in the management of long COVID and persistent COVID symptoms.

METHODS

The literature was searched in databases such as LitCOVID, Web of Science, Google Scholar, bioRxiv, medRxiv, Science Direct, EBSCO, Scopus, Embase, and reference lists to identify studies, which evaluated various effects of black seeds (N. sativa) related to signs and symptoms of Long COVID.

RESULTS

Black seeds (N. sativa) have shown potential anti-COVID, antiviral, anti-inflammatory, antioxidant, immunomodulatory, antihypertensive, anti-obesity, antidiabetic, antihyperlipidemic, and antiasthmatic properties in various clinical, animal, in-vitro, in-vivo, and in-silico studies, which would help the patients recovered from COVID to mitigate Long COVID complications.

CONCLUSION

Patients experiencing Long COVID may use black seeds (N. sativa) as adjunctive therapy in combination with symptomatic treatment and supportive care to prevent further deterioration and hospitalization. The safety and efficacy of N. sativa in patients with Long-COVID would further be established by future randomized controlled clinical trials.

A Comprehensive Review of the Pharmacologic Perspective on Loop Diuretic Drug Interactions with Therapeutically Used Drugs

Background:

Loop diuretics help to manage the patients with edema associated with congestive heart failure, liver cirrhosis, and renal disease and hypertension. The patients taking loop diuretics may receive other medications to treat comorbidities leading to drug interactions.

Methodology:

The literature was searched in databases such as Medline/PMC/PubMed, Google Scholar, Cochrane Library, Science Direct, EMBASE, Web of science, Ebsco, Directory of open access journals (DOAJ) and reference lists to spot relevant articles using the keywords Drug interactions, Pharmacodynamic interactions, Loop diuretics, Bumetanide, Ethacrynic acid, Furosemide, and Torsemide.

Results:

Loop diuretics are associated with hypokalemia, ototoxicity and other adverse effects. The drugs affected by hypokalemia, and having the potential of inducing ototoxicity could interact with loop diuretics pharmacodynamically. Loop diuretics can interact with drugs such as amphotericin B, digoxin, angiotensin-converting enzyme inhibitors (ACE inhibitors), antidiabetic drugs, antifungal agents, dobutamine, gossypoland sotalol due to diuretic associated hypokalemia. In addition, the risk of ototoxicity could be enhanced by the concomitant use of loop diuretics and cisplatin, aminoglycoside antibiotics or phosphodiesterase 5 (PDE 5) inhibitors. Loop diuretics may also interact pharmacodynamically with drugs like cephalosporins, ceritinib, levothyroxine, pixantrone, probenecid, lithium, non-steroidal anti-inflammatory drugs (NSAIDs), sulfonylureas and herbal drugs.

Conclusion:

Clinicians, pharmacists and other health care providers should take responsibility for the safe use of medications. In addition, they are required to be aware of the drugs interacting with loop diuretics, to prevent adverse drug interactions.

An Insight of Clinical Evidences of Ayurveda Interventions in the Management of COVID-19 Patients

BACKGROUND

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) caused Coronavirus disease 2019 (COVID-19) and the patients with COVID-19 might be managed with traditional medicine like Ayurveda alone or in combination with standard allopathic treatment as Ayurveda is one of the oldest traditional medicinal systems followed by millions around the globe.

METHODS

The literature was searched in databases such as LitCOVID, Google Scholar, Science Direct, EBSCO, Scopus, Web of science, EMBASE, and reference lists to identify articles relevant to the use of Ayurvedic medicines in the management of COVID-19.

RESULTS

Several clinical studies have determined the efficacy of Ayurvedic medicines and formulations in the management of patients with COVID-19.

CONCLUSION

The Ayurvedic medicines and formulations having antiviral, antioxidant, anti-inflammatory, and immunomodulatory properties could be used along with standard allopathic medicines to assist in the earlier clearance of virus, speedy recovery of patients with COVID-19, faster discharge from hospitals, and the prevention of further deterioration.

An Overview of Clinically Imperative and Pharmacodynamically Significant Drug Interactions of Renin-Angiotensin-Aldosterone System (RAAS) Blockers

INTRODUCTION

Hypertension is a leading cause of cardiovascular disease and chronic kidney disease, resulting in premature death and disability. The Renin-Angiotensin-Aldosterone System (RAAS) blockers, including Angiotensin-Converting Enzyme (ACE) inhibitors or Angiotensin Receptor Blockers (ARBs), are used as first-line antihypertensive therapy to treat hypertensive patients with comorbidities, including diabetes, ischemic heart disease, heart failure, and chronic kidney disease. The use of RAS blockers is associated with the risks, such as hyperkalemia, angioedema, etc. The drugs potentiating them interact pharmacodynamically, resulting in adverse consequences. This review article focuses on the clinically important drug interactions of RAAS blockers.

MATERIALS AND METHODS

The electronic databases, such as Medline/PubMed Central/PubMed, Google Scholar, ScienceDirect, Cochrane Library, Directory of Open Access Journals (DOAJ), Embase, and reference lists were searched to identify relevant articles.

RESULTS

The risk of hyperkalemia may be enhanced potentially in patients receiving a RAS blocker and potassium-sparing diuretics, potassium supplements, trimethoprim, adrenergic betablockers, antifungal agents, calcineurin inhibitors, pentamidine, heparins or an NSAID, concomitantly. The patients taking ACE inhibitors and mTOR inhibitors, DPP4 inhibitors, alteplase, or sacubitril/valsartan concurrently may be at increased risk of developing angioedema.

CONCLUSION

Clinicians, pharmacists, and other healthcare practitioners should be accountable for medication safety. To avoid adverse implications, prescribers and pharmacists must be aware of the drugs that interact with RAAS blockers.

Nigella Sativa (Black seeds) – Potential herb to help Weight Loss

:

Obesity is associated with many diseases, including diabetes, hypertension, dyslipidemia, coronary heart disease, stroke, fatty liver disease, cancer, osteoarthritis and many others. The prevalence of obesity is increasing every year among the global population. The persons being overweight or obese may consider traditional herbal medicines as a good strategy to manage chronic conditions due to various reasons. Nigella sativa (Black seeds) has been used to treat various conditions, including obesity, diabetes, hypertension, cancer, etc. Hence, the anti-obesity potential of N. sativa is analyzed in this review. The databases, including Medline/PMC/PubMed, Google Scholar, Science Direct, and reference lists, were searched to identify relevant randomized controlled clinical trials. Significant reduction of body weight, body mass index and waist circumference have been observed in many randomized controlled clinical trials (RCTs) by using N. sativa. Hence, the individuals willing to reduce their body weight can effectively use N. sativa along with lifestyle modifications.

Antidiabetic Activity of Nigella Sativa (Black Seeds) and Its Active Constituent (Thymoquinone): A Review of Human and Experimental Animal Studies

The use of herbal medicine to manage chronic conditions including diabetes has become a recent global trend. Diabetes mellitus (DM) is a group of metabolic disorders characterized by hyperglycemia. The present review is aimed to analyze the antidiabetic activity of N. sativa as many type 2 diabetic patients use it as a complementary therapy along with their modern allopathic medications or as an alternative therapy. The literature was reviewed in databases like Medline/PubMed Central/PubMed, Google Scholar, Science Direct, EBSCO, Scopus, Web of science, EMBASE, Directory of open access journals (DOAJ), and reference lists to identify relevant articles supporting the use of N. sativa in diabetes management. Numerous clinical and animal studies have demonstrated the antidiabetic efficacy of black seeds (N. sativa) and its major bioactive constituent thymoquinone. Based on these findings patients with diabetes may use N. sativa as an adjuvant therapy, which may help to reduce the dose and incidence of adverse effects of modern antidiabetic medicines.

A Review on Pharmacokinetic and Pharmacodynamic Drug Interactions of Adrenergic β-blockers with Clinically Relevant Drugs-An Overview

Adrenergic β-blockers are used to treat many conditions, including hypertension, cardiac arrhythmias, heart failure, angina pectoris, migraine, and tremors. The majority of the β-blockers, including propranolol, metoprolol, acebutolol, alprenolol, betaxolol, carvedilol, nebivolol, and oxprenolol are metabolised majorly by CYP2D6, and bisoprolol is primarily metabolised by CYP3A4 enzymes. The drugs inhibiting or inducing them may alter the pharmacokinetics of those β-blockers. The plasma concentrations of propranolol might be elevated by the concomitant use of drugs such as SSRIs (Fluoxetine, Paroxetine), SNRIs (Duloxetine), and cimetidine, while the plasma concentrations of metoprolol are increased by the concurrent use of SSRIs (Fluoxetine, Paroxetine), amiodarone, celecoxib, cimetidine, terbinafine, and diphenhydramine. β-blockers can also interact pharmacodynamically with drugs, including fluoroquinolones, antidiabetic agents, and NSAIDs. In addition, β-blockers may interact with herbs such as curcumin, Ginkgo biloba, Schisandra chinensis, green tea, guggul, hawthorn, St. John's wort, and Yohimbine . This article focuses on clinically relevant drug interactions of β-blockers with commonly prescribed medications. In addition to pharmacokinetics and pharmacodynamics of the drug interactions, recommendations for clinical practice are highlighted. The prescribers and the pharmacists are needed to be aware of the drugs interacting with β-blockers to prevent possible adverse drug interactions.

Drug interactions of dipeptidyl peptidase 4 inhibitors involving CYP enzymes and P-gp efflux pump

Dipeptidyl peptidase 4 (DPP4) inhibitors are oral antidiabetic drugs approved to manage type 2 diabetes mellitus. Saxagliptin is a substrate of CYP3A4/5 enzymes while other DPP4 inhibitors such as sitagliptin, linagliptin, gemigliptin and teneligliptin are weak substrates of CYP3A4. DPP4 inhibitors have also been identified as substrates of P-gp. Hence, the drugs inhibiting or inducing CYP3A4/5 enzymes and/or P-gp can alter the pharmacokinetics of DPP4 inhibitors. This review is aimed to identify the drugs interacting with DPP4 inhibitors. The plasma concentrations of saxagliptin have been reported to be increased significantly by the concomitant administration of ketoconazole or diltiazem while no significant interactions between various DPP4 inhibitors and drugs like warfarin, digoxin or cyclosporine have been identified.

Tobacco smoking and its drug interactions with comedications involving CYP and UGT enzymes and nicotine

Tobacco smoking is a global public health threat causing several illnesses including cardiovascular disease (Myocardial infarction), cerebrovascular disease (Stroke), peripheral vascular disease (Claudication), chronic obstructive pulmonary disease, asthma, reduced female infertility, sexual dysfunction in men, different types of cancer and many other diseases. It has been estimated in 2015 that approximately 1.3 billion people smoke, around the globe. Use of medications among smokers is more common, nowadays. This review is aimed to identify the medications affected by smoking, involving Cytochrome P450 (CYP) and uridine diphosphate-glucuronosyltransferases (UGTs) enzymes and Nicotine. Polycyclic aromatic hydrocarbons (PAHs) of tobacco smoke have been associated with the induction of CYP enzymes such as CYP1A1, CYP1A2 and possibly CYP2E1 and UGT enzymes. The drugs metabolized by CYP1A1, CYP1A2, CYP2E1 and UGT enzymes might be affected by tobacco smoking and the smokers taking medications metabolized by those enzymes, may need higher doses due to decreased plasma concentrations through enhanced induction by PAHs of tobacco smoke. The prescribers and the pharmacists are required to be aware of medications affected by tobacco smoking to prevent the toxicity-associated complications during smoking cessation.

Drug interactions of meglitinide antidiabetics involving CYP enzymes and OATP1B1 transporter

Meglitinides such as repaglinide and nateglinide are useful to treat type 2 diabetes patients who follow a flexible lifestyle. They are short-acting insulin secretagogues and are associated with less risk of hypoglycemia, weight gain and chronic hyperinsulinemia compared with sulfonylureas. Meglitinides are the substrates of cytochrome P450 (CYP) enzymes and organic anion transporting polypeptide 1B1 (OATP1B1 transporter) and the coadministration of the drugs affecting them will result in pharmacokinetic drug interactions. This article focuses on the drug interactions of meglitinides involving CYP enzymes and OATP1B1 transporter. To prevent the risk of hypoglycemic episodes, prescribers and pharmacists must be aware of the adverse drug interactions of meglitinides.

Drug Interactions of Metformin Involving Drug Transporter Proteins

Metformin is a most widely used medication all around the world to treat Type 2 diabetes mellitus. It is also found to be effective against various conditions including, Prediabetes, Gestational diabetes mellitus (GDM), Polycystic Ovarian Syndrome (PCOS), Obesity, Cancer, etc. It is a cationic drug and it depends Organic Cation Transporters (OCTs) and Multidrug and Toxin Extruders (MATEs) mostly for its pharmacokinetics movement. The probability of drug interaction increases with the number of concomitant medications. This article focuses the drug interactions of metformin and most of them are linked to the inhibition of OCTs and MATEs leading to increased plasma metformin concentrations and subsequent elevation of risk of Metformin Associated Lactic Acidosis (MALA). By identifying the drugs inhibiting OCTs and MATEs, the healthcare professionals can predict the drug interactions of metformin.

Protective Effect of Prosopis cineraria Against N-Nitrosodiethylamine Induced Liver Tumor by Modulating Membrane Bound Enzymes and Glycoproteins

PURPOSE

The objective of the present study was to evaluate the protective effect of methanol extract of Prosopis cineraria (MPC) against N-nitrosodiethylamine (DEN, 200mg/kg) induced Phenobarbital promoted experimental liver tumors in male Wistar rats.

METHODS

The rats were divided into four groups, each group consisting of six animals. Group 1 served as control animals. Liver tumor was induced in group 2, 3, and 4 and Group 3 animals received MPC 200mg/kg and Group 4 animals received MPC 400mg/kg.

RESULTS

Administration of DEN has brought down the levels of membrane bound enzymes like Na(+)/ K(+) ATPase, Mg(2+) ATPase and Ca(2+)ATPase which were later found to be increased by the administration of Prosopis cineraria (200 and 400mg/kg) in dose dependent manner. The MPC extract also suppressed the levels of glycoproteins like Hexose, Hexosamine and Sialic acid when compared to liver tumor bearing animals.

CONCLUSION

Our study suggests that MPC may extend its protective role by modulating the levels of membrane bound enzymes and suppressing glycoprotein levels.