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Rasheed H, Ahmed S, Sharma A. Changing Trends Towards Herbal Supplements: An Insight into Safety and Herb-drug Interaction. Curr Pharm Biotechnol 2024; 25:285-300. [PMID: 37464829 DOI: 10.2174/1389201024666230718114606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/20/2023]
Abstract
Herbs have been used as sustenance and medicine for a very long time, often in conjunction with other prescribed medications. Even though they are thought to be natural and secure, many of these herbs can interact with other medications and cause potentially dangerous adverse effects or decrease the benefits of the medication. The complex and diverse pharmacological functions carried out by the active ingredients in herbs unavoidably alter the pharmacokinetics of chemical drugs when administered in vivo. Drug transporter expression has a direct impact on how medications are absorbed, distributed, metabolized, and excreted in living organisms. Changes in substrate pharmacokinetics can affect the effectiveness and toxicity of a drug when the active ingredients of a herb inhibit or stimulate the expression of transporters. By reviewing published clinical and preclinical studies, this review aims to raise awareness of herbdrug interactions and discuss their evidence-based mechanisms and clinical consequences. More clinical information on herb-drug interactions is required to make choices regarding patient safety as the incidence and severity of herb-drug interactions are rising due to an increase in the use of herbal preparations globally.This review seeks to increase understanding of herb-drug interactions and explore their evidence-based mechanisms and clinical implications by reviewing published clinical and preclinical studies. The incidence and severity of herb-drug interactions are on the rise due to an increase in the use of herbal preparations worldwide, necessitating the need for more clinical data on these interactions in order to make decisions regarding patient safety. Healthcare workers and patients will become more alert to potential interactions as their knowledge of pharmacokinetic herb-drug interactions grows. The study's objective is to raise readers' awareness of possible interactions between herbal supplements and prescription medications who regularly take them.
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Affiliation(s)
- Haamid Rasheed
- Department of Quality Assurance, Indo Soviet Friendship (ISF), College of Pharmacy, Moga, 142001, Punjab, India
| | - Suhail Ahmed
- Department of Quality Assurance, Indo Soviet Friendship (ISF), College of Pharmacy, Moga, 142001, Punjab, India
| | - Alok Sharma
- Department of Pharmaceutical Technology, MIET, Meerut, 250005, U.P., India
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Del Carpio Orantes L. ["Herbalist" supplements maliciously expanding from Mexico to the world. Artriking and company]. Rev Med Inst Mex Seguro Soc 2023; 61:6-7. [PMID: 36542243 PMCID: PMC10395945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This letter aims to inform the medical community about herbal supplements that have steroidal and non-steroidal drugs hidden in their formulation, entailing risks to the health of consumers, in addition to the fact that they are not regulated at the local level and the producers of these supplements try to sell them internationally, which would bring serious consequences, since it would become a serious global health problem; these supplements have provoked Cushing's syndrome, diabetes mellitus, sepsis, pneumonitis and invasive helminthiasis.
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Affiliation(s)
- Luis Del Carpio Orantes
- Colegio de Medicina Interna del Estado de Veracruz. Veracruz, Veracruz, MéxicoColegio de Medicina Interna del Estado de VeracruzMéxico
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Guitouni O, Karimi I, Kazmouhi L, Berrekchi FZ, Bekkaoui S, Benabdellah N, Elyoubi R, Souaaid S, Abda N, Bentata Y. Consumption of nephrotoxic plants among chronic hemodialysis patients in the Eastern region of Morocco: A multicentric cross-sectional study. J Ethnopharmacol 2022; 288:114972. [PMID: 34990766 DOI: 10.1016/j.jep.2022.114972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 10/26/2021] [Accepted: 01/01/2022] [Indexed: 06/14/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The consumption of nephrotoxic plants is quite frequent in Morocco and could explain the high prevalence of indeterminate nephropathy in patients with End-Stage Kidney Disease (ESKD). AIM OF THE STUDY to determine, in a population of chronic hemodialysis (CHD) patients and before the occurrence of ESKD, the prevalence of the use of nephrotoxic plants, in particular, Aristolochia longa L. (Bereztam) and the etiological role of plants in the rapid progression of known and unknown nephropathy toward the end stage of chronic hemodialysis. MATERIALS AND METHODS This was a multicentric cross-sectional study spread over 12 months (May 2019-May 2020), carried out in public hemodialysis centers in the eastern region of Morocco. Clinical data were collected from medical records. Herbal and sociodemographic data were collected from a detailed and precise interview with each enrolled CHD patient. RESULTS A total of 404 CHD patients participated in the study. 71.5%, had used medicinal plants before the occurrence of ESKD and 32.9% had indeterminate nephropathy. Among the plants consumed, we identified plants whose kidney toxicity was well demonstrated, mainly Rhamnus alaternus L. (Mlilas) in 66.7%, Artemisia herba alba Asso (Chih) in 54.32%, Aristolochia longa L.(Bereztam) in 52.6%, and Rubia tinctorum L. (Fowa) in 47.4%. 27.7% of CHD patients had presented complications following the use of the plants before the occurrence of ESKD. In multivariate analysis, the use of plants to treat digestive disorders (OR 9.57; 95%CI [4.49-20.37], P < 0.001) and asthenia associated with anemia (OR 8.59; 95%CI [3.92-18.81], P < 0.001), as well as side effects observed after taking the plants (OR 4; 95%CI [1.09, 14.7], P = 0.03), were identified as significant risk factors for the occurrence of severe indeterminate nephropathy. CONCLUSIONS This study showed the high prevalence of consumption of nephrotoxic herbs which may be the root cause of chronic renal failure in CHD patients.
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Affiliation(s)
- Ouafae Guitouni
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohammed First, Oujda, Morocco.
| | | | | | | | - Samira Bekkaoui
- Public Hemodialysis Center Al Farabi Hospital, Oujda, Morocco
| | | | | | | | - Naima Abda
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohammed First, Oujda, Morocco
| | - Yassamine Bentata
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, University Mohammed First, Oujda, Morocco; Nephrology-Dialysis and Kidney Transplantation Unit, University Hospital Mohammed VI, Oujda, Morocco
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Berlowitz I, O'Shaughnessy DM, Heinrich M, Wolf U, Maake C, Martin-Soelch C. Teacher plants - Indigenous Peruvian-Amazonian dietary practices as a method for using psychoactives. J Ethnopharmacol 2022; 286:114910. [PMID: 34933085 DOI: 10.1016/j.jep.2021.114910] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/30/2021] [Accepted: 12/08/2021] [Indexed: 05/27/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Indigenous groups of the Amazon have developed intricate methods for the application of psychoactives, among which particularly the dieta or diet method of Peruvian-Amazonian traditional medicine stands out. It is a retreat-like intervention involving lengthy periods of social, behavioural, and alimentary restrictions, while ingesting specially prepared plant substances. The interplay of the dietary conditions and plants ingested sensitizes the dieter to receive healing, strength, guidance, and knowledge. From a clinical scientific point of view, the method has remained largely underexplored, but seems more pertinent than ever given the increasing interest in Amazonian psychoactive preparations including ayahuasca (Banisteriopsis caapi) and the burgeoning field of psychedelic-assisted therapies in general. AIM OF THE STUDY This study offers a descriptive account and emic interpretation of the Peruvian-Amazonian dieta. More specifically we document in detail the procedure, its context and purpose of application, effects, modes of action, adverse effects, and risks, from the perspectives of a sample of Peruvian traditional healers. The Peruvian-Amazonian dieta is a multi-purpose method for making use of medicinal plants, many of which (but not all), are psychoactive; the current work especially focuses on its therapeutic applications in conjunction with psychoactives. METHODS We interviewed 16 healers working in the Ucayali, San Martín, and Loreto provinces of Peru using a semi-structured interview approach. Interviews were audio-recorded and transcribed verbatim. The extensive data derived from these interviews were analysed by means of computer-assisted manifest qualitative content analysis using a theory-advancing approach. Over 500 coded text segments were categorized, resulting in 7 main theme clusters and corresponding sub-themes. RESULTS The interviewed healers described a complex intervention with multifaceted applications (treatment, prevention, training) and effects in various domains (body, mind, spirit, energy). The process was portrayed as transformative, with benefits attributed to the effects of the so-called teacher plants in conjunction with the diet's conditions, along with the skill of the healer guiding the intervention. Further, a detailed risk assessment revealed sophisticated safety measures and tools designed to address adverse responses. The importance of adequate training of the healer that administers the diet was particularly highlighted in this context. CONCLUSIONS The dieta is a central therapeutic concept and tool in Peruvian-Amazonian traditional medicine and a unique method for using psychoactive plants. Multidisciplinary health research that includes traditional treatment methods from Indigenous cultures, Amazonian and other, should not be neglected in the current global interest in psychedelic therapies; such research may in the long-term contribute to a more inclusive psychedelic research paradigm as well as healthcare practice in countries where rich traditional healing systems exist, and perhaps beyond. It may also contribute to the recognition of the Indigenous healers as not only historical forerunners, but also current leading experts in psychedelic medicine.
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Affiliation(s)
- Ilana Berlowitz
- Institute of Anatomy, Faculty of Medicine, University of Zurich, Zurich, Switzerland; Department of Psychology, University of Fribourg, Fribourg, Switzerland.
| | | | | | - Ursula Wolf
- Institute of Complementary and Integrative Medicine, University of Bern, Switzerland
| | - Caroline Maake
- Institute of Anatomy, Faculty of Medicine, University of Zurich, Zurich, Switzerland
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van de Koppel S, Kooijman M, Ohana D, van Hunsel FPAM. [Dangerous herbal preparations being sold by web shops]. Ned Tijdschr Geneeskd 2022; 166:D6591. [PMID: 35499755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND A large number of herbal preparations are offered on the internet. Some of these may contain substances not listed on the label. When these are illegal "regular" drugs, this can lead to serious side effects. CASE DESCRIPTION In January 2021, The Netherlands Pharmacovigilance Centre Lareb received 4 reports of side effects after using the herbal preparation Montalin® from Indonesia. Laboratory analysis showed that effective amounts of paracetamol and meloxicam were also present in this herbal preparation. These have been added illegally and are not listed on the packaging. The five web shops that sold this product were ordered to immediately stop trading by order of the Dutch Food and Consumer Product Safety Authority (NVWA). CONCLUSION Consumers should be careful when purchasing herbal preparations over the internet. It is not always clear what is in it. Certainly if a clear effect is experienced, it may be that (illegally) effective amounts of pharmacologically active substances have been added.
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Bessone F, García-Cortés M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, Ridruejo E, Nunes V, Peralta M, Santos G, Anders M, Chiodi D, Tagle M, Montes P, Carrera E, Arrese M, Lizarzabal MI, Alvarez-Alvarez I, Caballano-Infantes E, Niu H, Pinazo J, Cabello MR, Lucena MI, Andrade RJ. Herbal and Dietary Supplements-Induced Liver Injury in Latin America: Experience From the LATINDILI Network. Clin Gastroenterol Hepatol 2022; 20:e548-e563. [PMID: 33434654 DOI: 10.1016/j.cgh.2021.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Herbal and dietary supplements (HDS) consumption, a growing cause of hepatotoxicity, is a common practice among Latin-American populations. OBJECTIVES To evaluate clinical, laboratory features and outcome in HDS-hepatotoxicity included in the Latin America-Drug Induced Liver Injury (LATINDILI) Network. METHODS A total of 29 adjudicated cases of HDS hepatotoxicity reported to the LATINDILI Network from October 2011 through December 2019 were compared with 322 DILI cases due to conventional drugs and 16 due to anabolic steroids as well as with other series of HDS-hepatotoxicity. RESULTS From 367 DILI cases, 8% were attributed to HDS. An increasing trend in HDS-hepatotoxicity was noted over time (p = .04). Camellia sinensis, Herbalife® products, and Garcinia cambogia, mostly used for weight loss, were the most frequently adjudicated causative agents. Mean age was 45 years (66% female). Median time to onset was 31 days. Patients presented typically with hepatocellular injury (83%) and jaundice (66%). Five cases (17%) developed acute liver failure. Compared to conventional medications and anabolic steroids, HDS hepatotoxicity cases had the highest levels of aspartate and alanine transaminase (p = .008 and p = .021, respectively), had more re-exposure events to the culprit HDS (14% vs 3% vs 0%; p = .026), and had more severe and fatal/liver transplantation outcomes (21% vs 12% vs 13%; p = .005). Compared to other DILI cohorts, less HDS hepatotoxicity cases in Latin America were hospitalized (41%). CONCLUSIONS HDS-hepatotoxicity in Latin-America affects mainly young women, manifests mostly with hepatocellular injury and is associated with higher frequency of accidental re-exposure. HDS hepatotoxicity is more serious with a higher chance of death/liver transplantation than DILI related to conventional drugs.
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Affiliation(s)
- Fernando Bessone
- Hospital Provincial del Centenario, Universidad Nacional de Rosario, Rosario, Argentina; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Miren García-Cortés
- UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Inmaculada Medina-Caliz
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | | | - Raymundo Parana
- Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil
| | - Manuel Mendizabal
- Hospital Universitario Austral, Pilar Centro, Provincia de Buenos Aires, Argentina
| | - Maria I Schinoni
- Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil
| | - Ezequiel Ridruejo
- Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires, Argentina
| | - Vinicius Nunes
- Hospital Universitário Prof. Edgard Santos-UFBA, Salvador, Brazil
| | - Mirta Peralta
- Hospital de infecciosas F. J. Muñiz, CABA, Buenos Aires, Argentina
| | - Genario Santos
- Hospital Universitario Austral, Pilar Centro, Provincia de Buenos Aires, Argentina
| | | | | | | | - Pedro Montes
- Hospital Nacional Daniel Alcides Carrion, Callao, Perú
| | | | - Marco Arrese
- Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Ismael Alvarez-Alvarez
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Estefania Caballano-Infantes
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Hao Niu
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Jose Pinazo
- UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Maria R Cabello
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - M Isabel Lucena
- Servicio de Farmacología Clínica, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.
| | - Raúl J Andrade
- UGC de Aparato Digestivo, Instituto de Investigación Biomédica de Málaga, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain; Centro de Investigación Biomédica en Red: Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Qin YQ, Cheng CS, Jiang Y, Qi W, Zhang B, Wei DY. Potential propensity of traditional herbal materials ingested by collegiate athletes in South China for their consuming health care. Medicine (Baltimore) 2021; 100:e27635. [PMID: 34871231 PMCID: PMC8568446 DOI: 10.1097/md.0000000000027635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 10/11/2021] [Indexed: 01/05/2023] Open
Abstract
In south China, traditional herbal medicines have been widely used as functional foods or dietary supplements for daily health care. Many plant-derived chemical substances with biological activity are inadvertently ingested by collegiate athletes daily through canton-style herbal tea or herbal slow-cooked soup. In the view of the complexity of herbal ingredients, it is still no full survey reported for the sports risk of plant-derived sports doping. This research is firstly a descriptive statistical analysis. Collegiate athletes with different socio-economic characteristics from medical colleges in 3 different regions in China participated in the questionnaire survey. Three survey forms, including the oral interview, email inquiry, handing out and recovering the questionnaires in live, were developed and performed by researchers. It was first found that collegiate athletes resorted to some traditional herbal materials to protect their health care that there were regional differences (P < .01). Collegiate athletes with Health Fitness and Traditional Wushu as their sports expertise showed a higher frequency of recognition or ingestion in the use of traditional herbal materials (P < .01), while their different living types and cuisine preferences did not seem to be associated with the ingestion frequency of traditional herbal materials. In addition, in the view of the significant differences in the use of herbal preparations to relieve sports stress among young athletes in different regions (P < .01), the findings strongly suggested that athletes should strictly control their use of various herbal preparations during sports training and competition, including herbal wines, herbal oils, topical plasters, analgesic tablets.
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Affiliation(s)
- Yue-Quan Qin
- Institute of Physical Education, Guangxi University of Chinese Medicine, Nanning, China
| | - Chun-Song Cheng
- Ganjiang Institute of Medicinal Plants, Lushan Botanical Garden, Chinese Academy of Sciences, Jiujiang, China
| | - Ying Jiang
- Institute of Physical Education, Anhui Normal University, Wuhu, China
| | - Wei Qi
- Macau University of Science and Technology, Taipa, Macao, China
| | - Bin Zhang
- Sports Teaching and Research Room, Anhui University of Traditional Chinese Medicine, Hefei, China
| | - Dong-Yi Wei
- Institute of Physical Education, Guangxi University of Chinese Medicine, Nanning, China
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Mathew LS, Peter EL, Weisheit A, Tolo CU, Deng AL, Ogwang PE. Ethno medical knowledge and traditional use of Aristolochia bracteolata Lam. for malaria among local communities in Jubek State of South Sudan: A cross-sectional survey. J Ethnopharmacol 2021; 279:114314. [PMID: 34126212 DOI: 10.1016/j.jep.2021.114314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/12/2021] [Accepted: 06/04/2021] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The recognized challenges to access conventional antimalarial medicines could have contributed to the extensive use of Aristolochia bracteolata Lam. (Aristolochiaceae)to manage malaria in South Sudan traditionally. However, the use and acquired experiences are notwell documented. AIM OF THE STUDY This study aimed to document the traditional use of A. bracteolata for malaria treatment and experiences among the local communities in Jubek State of South Sudan. METHODS We performed a cross-sectional study in four counties in Jubek State and interviewed 396 community members, including traditional healers, using a semi-structured questionnaire. Four focused group discussions (FGDs) were also conducted using the interviewer guide. The inclusion criteria were; adults 18 years and older, men andwomen participants, at least one year residing in the study area before the study, and those with a history of medicinal plant use. Data were summarized and presented as proportions. Qualitative data were analyzed using a thematic content approach. The major themes that emerged were discussed. We applied the Pearson Chi-Square test at α = 0.05 to test the study's significant differences in responses. The statistical package for social sciences version 21 software was used for data analysis. RESULTS Women accounted for 208 (52.5%) of participants, with the majority 321 (81.1%) were between 18 and 45 years. Interestingly, most 312 (78.8%) had formal education. Moreover, about 208 (52.5%) participants collect the plant in their vicinity, where leaves were the most commonly used part 277 (46.4%), followed by the roots, seeds, and stems at 245(41.0%), 71 (11.9%), and 4 (0.7%), respectively. Furthermore, about 63 (15.9%) of the participants experienced side effects, including early abortions, heartburns, sweating, and stomach discomforts. Conversely, a total of 387 (96.0%) reported getting cured of malaria. Generally, the quantity of medicine taken per day differs concerning parts of the plant, with leaves ranging from 1 to 10 pieces, roots at 0.4-1 g, and seeds at 0.1-0.5 g. The locals used these plant parts to prepare infusion and decoction traditional dosage forms for oral use. CONCLUSION The documented medicinal plant's therapeutic uses provided critical information on the traditional use of A. bracteolata by the community in Jubek state of South Sudan to treat malaria. Although most users reported getting cured of malaria, a notable proportion of them experienced side effects, including early-stage abortion and stomach discomforts. Thus, the use of A. bracteolata preparations, particularly in pregnant women, should be avoided. Finally, further studies are needed to devise a strategy to neutralize the toxic compounds and create community awareness on best practices to minimize side effects.
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Affiliation(s)
- Lina S Mathew
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Emanuel L Peter
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Anke Weisheit
- Pharmbiotechnology and Traditional Medicine Center of Excellence, Mbarara University of Science and Technology, Mbarara Uganda.
| | - Casim Umba Tolo
- Pharmbiotechnology and Traditional Medicine Center of Excellence, Mbarara University of Science and Technology, Mbarara Uganda.
| | - Arop L Deng
- College of Natural Resources and Environmental Studies, Juba University, South Sudan.
| | - Patrick Engeu Ogwang
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; Pharmbiotechnology and Traditional Medicine Center of Excellence, Mbarara University of Science and Technology, Mbarara Uganda.
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Villar-López M, Soto-Becerra P, Curse Choque R, Al-Kassab-Córdova A, Bernuy-Barrera F, Palomino H, Rojas PA, Vera C, Lugo-Martínez G, Mezones-Holguín E. Safety and tolerability of a natural supplement containing glucosinolates, phytosterols and citrus flavonoids in adult women: a randomized phase I, placebo-controlled, multi-arm, double-blinded clinical trial. Gynecol Endocrinol 2021; 37:906-913. [PMID: 34379025 DOI: 10.1080/09513590.2021.1960965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To evaluate the safety and tolerability of an oral herbal supplement containing glucosinolates, phytosterols, and citrus flavonoids (Warmi®, Lima Perú;) in otherwise healthy adult women. METHODS This was a phase-I, randomized parallel three arms, double-blinded, and a placebo-controlled clinical trial. A total of 55 participants aged 18-40 were randomly assigned to one of three groups to receive for three months: (1) an oral herbal supplement of 1650 mg/day; (2) an oral herbal supplement of 3300 mg/day; or (3) an oral placebo 3300 mg/day. The primary endpoints were oral safety and tolerability of the supplement. The secondary endpoint was its effect on vital functions, anthropometrics, and laboratory tests. We used an exploratory approach by covariance analysis (ANCOVA) adjusted for the variables' baseline value for the secondary outcomes. RESULTS All women completed three months of follow-up, reporting no side effects. Our exploratory analysis revealed that treatment with the herbal supplement of 1650 mg/day was associated with increased glucose and uric acid levels. In comparison, the herbal supplement 3300 mg/day was associated with reduced breathing rate, increased basal temperature, and systolic blood pressure, both compared to the placebo group. However, despite significant differences, none of these was clinically significant. CONCLUSION The oral herbal supplement had a favorable safety and tolerability profile in studied women. There is a need to study its potential as an option to treat menopausal symptoms.
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Affiliation(s)
- Martha Villar-López
- Universidad Nacional Mayor de San Marcos, Facultad de Medicina "San Fernando", Departamento de Medicina Preventiva y Salud Pública, Lima, Perú
| | - Percy Soto-Becerra
- Universidad San Ignacio de Loyola, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Perú
- Epi-gnosis Solutions, Piura, Perú
| | - Ruth Curse Choque
- Hospital Carlos Alcántara Butterfield, Servicio de Pediatría, Lima, Perú
| | - Ali Al-Kassab-Córdova
- Universidad Peruana de Ciencias Aplicadas, Facultad de Ciencias de la Salud, Lima, Perú
| | - Félix Bernuy-Barrera
- Universidad Nacional Federico Villarreal, Facultad de Medicina Hipólito Unanue, Lima, Perú
| | - Henry Palomino
- Hospital Nacional Edgardo Rebagliati Martins, Departamento de Obstetricia y Ginecología, Lima, Perú
| | - Percy A Rojas
- Universidad Peruana Cayetano Heredia, Laboratorios de Investigación y Desarrollo, Unidad de Biotecnología Molecular, Lima, Perú
| | - Carmela Vera
- Hospital Nacional Edgardo Rebagliati Martins Lima, Servicio de Psicología, Perú
| | - Gabriela Lugo-Martínez
- Instituto Politécnico Nacional, Escuela Superior de Medicina, Sección de Estudios de Posgrado e Investigación, Ciudad de México, México
| | - Edward Mezones-Holguín
- Universidad San Ignacio de Loyola, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Lima, Perú
- Epi-gnosis Solutions, Piura, Perú
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Lu C, Ke L, Li J, Zhao H, Lu T, Mentis AFA, Wang Y, Wang Z, Polissiou MG, Tang L, Tang H, Yang K. Saffron (Crocus sativus L.) and health outcomes: a meta-research review of meta-analyses and an evidence mapping study. Phytomedicine 2021; 91:153699. [PMID: 34419735 DOI: 10.1016/j.phymed.2021.153699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Although a number of systematic reviews and meta-analyses of saffron (Crocus sativus L.) have been published, no study has comprehensively summarized the clinical evidence from meta-analyses, or assessed the reporting or methodological quality of these reviews. PURPOSE The present meta-research study was designed to fill the gaps in knowledge to inform future studies and allow enhanced clinical decision-making on saffron. METHODS The PubMed, Cochrane Library, Embase, and CNKI databases were systematically searched from inception to April 3 rd, 2021, for meta-analyses of clinical trials that assessed the efficacy and safety of saffron. PRISMA 2009 and AMSTAR-2 were employed to assess the reporting and methodological quality of meta-analyses identified in the search, respectively. The present study was registered on PROSPERO with registration number CRD42020220274. RESULTS Nineteen eligible systematic reviews with meta-analyses published in English were identified from 235 records. These meta-analyses were published in 12 peer-reviewed journals from 2013 to 2021. The heterogeneous results indicated that saffron significantly reduced fasting blood glucose, waist circumference, diastolic blood pressure, concentrations of total cholesterol and low-density lipoprotein cholesterol, and improved symptoms of depression, cognitive function and sexual dysfunction compared with controls (mainly placebos). Common side effects of saffron consumption included nausea, dry mouth, poor appetite, and headache, but no serious adverse reactions were reported. Primary analysis and sensitivity analysis confirmed that the reporting and methodological quality of reviews included in the study were highly correlated (p < 0.001). The quality of meta-analyses of saffron requires improvement by including a structured abstract, a prospective protocol and registration, explanation of the study designs within each study that is reviewed, the searches, risk of bias assessment, literature selection, and reporting of funding sources. CONCLUSION The available evidence indicates that saffron is a safe plant for administration as a medicine and can improve diverse clinical outcomes, but the scientific quality of the published systematic reviews needs to be improved. Moreover, the clinical effects of saffron need to be confirmed through high-quality randomized trials in multiple countries with large sample sizes.
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Affiliation(s)
- Cuncun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China.
| | - Lixin Ke
- Hepatobiliary and pancreatic center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Jieyun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Haitong Zhao
- Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Tingting Lu
- Institute of Clinical Research and Evidence Based Medicine, Gansu Provincial Hospital, Lanzhou, Gansu 730000, China
| | - Alexios Fotios A Mentis
- University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Athens 10183, Greece
| | - Youyou Wang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Zhifei Wang
- Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Moschos G Polissiou
- Laboratory of Chemistry, Department of Science, Agricultural University of Athens, Athens 10183, Greece
| | - Liyao Tang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Hao Tang
- Clinical College of Chinese Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, China
| | - Kehu Yang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu 730000, China; Evidence-Based Social Science Center, School of Public Health, Lanzhou University, Lanzhou, Gansu 730000, China.
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11
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Dugo M. [Environmental toxicity and direct renal toxicity from drugs: herbs and plants]. G Ital Nefrol 2021; 38:38-s77-2021-04. [PMID: 34669303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Traditional medicine is a widespread treatment method in the world. Despite the WHO's confirmation of the progressive spread of national policies responsible for controlling the production and distribution of phytotherapy, the risk of toxic side effects is high even if the real incidence is not known. These risks largely result from the self-prescription supported by the assumption that what is natural is not dangerous to health. The phytotherapic industry turnover is progressively increasing, favored by the ease with which products can be purchased without prescription in pharmacies in some countries or online. In particular, Chinese herbs can be nephrotoxic and clinicians should consider the possibility of their role in some cases of AKI or CKD with unknown etiology. Furthermore, in the collection of the pharmacological history of patients with CKD or kidney transplantation it is necessary to exclude the use of some phytotherapics of common use that may be contraindicated for possible interactions with drugs of conventional medicine.
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Affiliation(s)
- Mauro Dugo
- UOC Nefrologia, Dialisi e Trapianti Renali, Ospedale Ca'Foncello, Treviso, Italy
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12
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Alonso-Castro AJ, Ruiz-Padilla AJ, Ortiz-Cortes M, Carranza E, Ramírez-Morales MA, Escutia-Gutiérrez R, Ruiz-Noa Y, Zapata-Morales JR. Self-treatment and adverse reactions with herbal products for treating symptoms associated with anxiety and depression in adults from the central-western region of Mexico during the Covid-19 pandemic. J Ethnopharmacol 2021; 272:113952. [PMID: 33610705 PMCID: PMC9387533 DOI: 10.1016/j.jep.2021.113952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 05/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE There are plant species used in the Mexican traditional medicine for the empirical treatment of anxiety and depression. AIM OF THE STUDY This work assessed the prevalence of self-medication with medicinal plants and the prevalence of the concomitant use of prescribed psychiatric drugs and medicinal plants for treating symptoms associated with anxiety and depression during the Covid-19 lockdown in Mexico. MATERIALS AND METHODS The suspected adverse reactions associated with drug-herb interactions were assessed. The factors associated with self-medication, the concomitant use of herb-drug combinations, and the presence of adverse reactions due their combined use is also reported. The study was descriptive and cross-sectional using an online questionnaire conducted among population with symptoms associated with anxiety and depression (n = 2100) from seven states of central-western Mexico. RESULTS The prevalence of the use of herbs (61.9%) and the concomitant use of drug-herb combinations (25.3%) were associated with being diagnosed with mental illness [OR:2.195 (1.655-2.912)] and the use of psychiatric medications [OR:307.994 (178.609-531.107)], respectively. The presence of adverse reactions (n = 104) by the concomitant use of drug-herb combinations was associated with being unemployed [p = 0.004, OR: 3.017 (1.404-6.486)]. CONCLUSION Health professionals should be aware if their patients concomitantly use medicinal plants and psychiatric drugs. Public health campaigns should promote the possible adverse reactions that might produce the concomitant use of drug-herb combinations for mental illnesses.
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Affiliation(s)
- Angel Josabad Alonso-Castro
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico.
| | - Alan Joel Ruiz-Padilla
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
| | - Miriam Ortiz-Cortes
- Doctorado Interinstitucional en Arte y Cultura, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, Mexico
| | - Eleazar Carranza
- Instituto de Investigación de Zonas Desérticas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico, Mexico
| | | | - Raymundo Escutia-Gutiérrez
- Departamento de Farmacobiología, Centro Universitario de Ciencias Exactas e Ingenierias, Universidad de Guadalajara, Guadadalajara, Jalisco, Mexico
| | - Yeniley Ruiz-Noa
- Departamento de Ciencias Médicas, División de Ciencias de La Salud, Universidad de Guanajuato, León, Guanajuato, Mexico
| | - Juan Ramon Zapata-Morales
- Departamento de Farmacia, División de Ciencias Naturales y Exactas, Universidad de Guanajuato, Guanajuato, Mexico
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Peter EL, Nagendrappa PB, Hilonga S, Tuyiringire N, Ashuro E, Kaligirwa A, Sesaazi CD. Pharmacological reflection of plants traditionally used to manage diabetes mellitus in Tanzania. J Ethnopharmacol 2021; 269:113715. [PMID: 33358853 DOI: 10.1016/j.jep.2020.113715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/01/2020] [Accepted: 12/18/2020] [Indexed: 06/12/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The increasing national prevalence of diabetes mellitus (DM) and its complications have overstretched the health care system in Tanzania and influenced patients to use herbal medicines as alternative therapeutic strategies. Therefore, an urgent need exists to validate the safety and efficacy of plants used locally. AIM OF THE STUDY To identify plants used for the management of DM in Tanzania and analyses their pharmacological, phytochemistry, and safety evidence with a special focus on the mechanism of action. METHODS Researchers searched Medline, web of science, and Scopus for published articles. Also, specialized herbarium documents of Muhimbili Institute of traditional medicine were reviewed. Articles were assessed for relevance, quality, and taxonomical accuracy before being critically reviewed. RESULTS We identified 62 plant species used locally for DM management. Moringa oleifera Lam. and Cymbopogon citratus (D.C) stapf were the most mentioned. Fifty-four phytochemicals from 13 species had DM activities. These were mainly; polyphenolics, phytosterols, and triterpenoids. Extracts, fractions, and pure compounds from 18 species had in vitro antidiabetic activities of which 14 had α-glucosidase and α-amylase inhibition effects. The most studied -Momordica charantia L. increased; glucose uptake and adiponectin release in 3T3-L1 adipocytes, insulin secretion, insulin receptor substrate-1 (IRS-1), GLUT-4 translocation, and GLP-1 secretion; and inhibited protein tyrosine phosphatase 1 B (PTP1B). Preclinical studies reported 30 species that lower plasma glucose with molecular targets in the liver, skeletal muscles, adipose tissues, pancreases, and stomach. While three species; Aspilia mossambiscensis (Oliv.) Willd, Caesalpinia bonduc (L.) Roxb, and Phyllanthus amarus Schumach. & Thonn. had mild toxicity in animals, 33 had no report of their efficacy in DM management or toxicity. CONCLUSION Local communities in Tanzania use herbal medicine for the management of DM. However, only a fraction of such species has scientific evidence. A. mossambiscensis, C. bonduc., and P. amarus had mild toxicity in animals. Together, our findings call for future researches to focus on in vitro, in vivo, and phytochemical investigation of plant species for which their use in DM among the local communities in Tanzania have not been validated.
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Affiliation(s)
- Emanuel L Peter
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Prakash B Nagendrappa
- Centre for Local Health Traditions & Policy, The University of Trans-disciplinary Health Sciences and Technology, Bengaluru, India.
| | - Samson Hilonga
- Institute of Traditional Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Naasson Tuyiringire
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Efrata Ashuro
- Department of Pharmacy, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Anita Kaligirwa
- Department of Pharmacology, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Crispin Duncan Sesaazi
- Department of Pharmaceutical Sciences, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
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Park JE, Kang S, Jang BH, Shin YC, Ko SG. Adverse events from pharmacopuncture treatment in Korea: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2021; 100:e25107. [PMID: 33725988 PMCID: PMC7982247 DOI: 10.1097/md.0000000000025107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Pharmacopuncture is a combination of acupuncture and herbal medicine, which involves the injection of herbal extracts into acupuncture points (acupoints). Pharmacopuncture has become one of the major therapeutic tools used in Korea; however, safety is one of the major concerns associated with it. We aim to systematically review clinical studies on the adverse events of pharmacopuncture in Korea. METHODS To collect data on the incidence and characteristics of adverse events (AEs) and to evaluate pharmacopuncture safety, 2 or more researchers will conduct a comprehensive search of pertinent English and Korean databases using the keywords "pharmacopuncture" and "adverse events." Regardless of the participants' conditions or treatment types, we will include clinical studies on the AEs of pharmacopuncture. Studies that were not conducted in Korea, and acupoint injections containing Western medications, vitamins, or autologous serum will be excluded from this study. The severity of AEs will be classified using the common terminology criteria for adverse events, and the causality between pharmacopuncture and AEs will be assessed using the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) causality scale. The quality of identifying and reporting the AEs will be assessed using the McHarm scale. The risk of selection bias will be assessed using the Cochrane risk of bias and the risk of bias for non-randomized studies tools. Studies will be assessed for heterogeneity utilizing Higgins's I2 statistics, and the risk of publication bias will be assessed and expressed in the form of a contour-enhanced funnel plot. RESULTS AND CONCLUSION Comprehensive investigation of all types of clinical studies in Korea will provide clearer evidence of the safety of pharmacopuncture. The results of this study will be useful for traditional medical doctors and patients who use such treatments and interventions.Systematic Review Registration: Open Science Foundation (osf.io/umhyz).
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Affiliation(s)
- Jae Eun Park
- Department of Global Public Health and Korean Medicine Management, Graduate School
| | - Sohyeon Kang
- Department of Global Public Health and Korean Medicine Management, Graduate School
| | - Bo-Hyoung Jang
- Department of Global Public Health and Korean Medicine Management, Graduate School
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong-Cheol Shin
- Department of Global Public Health and Korean Medicine Management, Graduate School
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seong-Gyu Ko
- Department of Global Public Health and Korean Medicine Management, Graduate School
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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15
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Chen S, Li X, Wu J, Li J, Xiao M, Yang Y, Liu Z, Cheng Y. Plumula Nelumbinis: A review of traditional uses, phytochemistry, pharmacology, pharmacokinetics and safety. J Ethnopharmacol 2021; 266:113429. [PMID: 33011369 DOI: 10.1016/j.jep.2020.113429] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/06/2020] [Accepted: 09/26/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Plumula Nelumbinis, the green embryo of the mature seeds of Nelumbo nucifera Gaertn, has a medical history of over 400 years. It is widely used for clearing the heart and heat, calming the mind, and promoting astringent essence and hemostasis in traditional Chinese medicine. Moreover, it usually dual use as food and medicine. This review aimed to evaluate the therapeutic potential of Plumula Nelumbinis by summarizing its botany, traditional uses, phytochemistry, pharmacology, pharmacokinetics and safety. METHODS This review summarized published studies on Plumula Nelumbinis in the Chinese Pharmacopoeia and literature databases including PubMed, Web of Science, Baidu Scholar, Wiley and China Knowledge Resource Integrated Database (CNKI), and limits the different research articles in botany, traditional uses, phytochemistry, pharmacology, pharmacokinetics and safety about Plumula Nelumbinis. RESULTS Plumula Nelumbinis is used to treat hypertension, arrhythmia, severe aplastic anemia, insomnia, encephalopathy and gynecological disease in traditional Chinese medicine and clinical studies. More than 130 chemicals have been isolated and identified from Plumula Nelumbinis, including alkaloids, flavonoids, polysaccharides and volatile oil. In addition, pharmacological effects, such as protective effects against cardiovascular diseases, neurological diseases, lung and kidney injury, anti-inflammatory and anticancer activities, were also evaluated by in vitro and in vivo studies. Moreover, the potential signaling pathways regulated by Plumula Nelumbinis in cardiovascular and neurological diseases and perspectives on Plumula Nelumbinis research were discussed. CONCLUSION Plumula Nelumbinis, a commonly used Chinese medicine, has a variety of traditional and modern therapeutic uses. Some traditional uses, especially the treatment of cardiovascular and neurological diseases, have been verified by pharmacological investigation. However, the pharmacological molecular mechanisms, pharmacokinetics and toxicology of Plumula Nelumbinis are still incomplete. In the future, a series of systematic studies on active compounds identification, pharmacological mechanism clarification, quality and safety evaluation are necessary.
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Affiliation(s)
- Sixuan Chen
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Xuping Li
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Junxuan Wu
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Jingyan Li
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Mingzhu Xiao
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Ying Yang
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Zhongqiu Liu
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China
| | - Yuanyuan Cheng
- Joint Laboratory for Translational Cancer Research of Chinese Medicine of the Ministry of Education of the People's Republic of China, International Institute for Translational Chinese Medicine, School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, 510006, China.
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Jin B, Liu H, Qiao L. Unveiling the comparative efficacy and tolerability of comprehensive treatments for migraine: A protocol of systematic review and Bayesian network meta-analysis. Medicine (Baltimore) 2021; 100:e24083. [PMID: 33530202 PMCID: PMC7850759 DOI: 10.1097/md.0000000000024083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 12/07/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Migraine is a chronic paroxysmal incapacitating neurological disorder, which endangers the health of human worldwide ranking as the third most prevalent medical condition. There are no comprehensive estimates of treatments for migraine. We will conduct this systematic review and Bayesian network meta-analysis (NMA) to synthesis quantitative and comparative evidence on the efficacy and tolerability of all the known pharmacological and non-pharmacological interventions for migraine. METHOD We will perform the systematic electronic search of the literature utilizing MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing & Allied Health (CINAHL), and PsycINFO. We will only include randomized controlled trials (RCTs) of high quality which appraise the efficacy or safety of any potential pharmacological or non-pharmacological interventions in the treatment of patients with migraine. The traditional pairwise meta-analyses will be performed to anticipate the heterogeneities and publication bias and the NMA will be conducted within a Bayesian hierarchical model framework to obtain estimates for all valuable treatments for migraine. The entire heterogeneity will be quantified by Q statistic and I2 index. Other analyses included sensitivity analyses, meta-regression, and subgroup analyses will also be conducted. The whole process will be conducted using in R-3.6.0 software. RESULTS This study will obtain the efficacy and tolerability of all potential treatments for migraine, aiming at providing consolidated evidence to help make the best choice of interventions. The results will be published in a peer-reviewed journal. DISCUSSION This Bayesian network meta-analysis may be the first attempt to quantitatively synthesize the efficacy and tolerability of all potential treatments for migraine. And this method can ensure us to fully utilize both the direct and indirect evidence as well as gain the comparative estimates displayed in the derived hierarchies. Besides, we have registered this protocol on the international prospective register of systematic review (PROSPERO) (CRD42020157278).
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Affiliation(s)
- Boru Jin
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Huayan Liu
- Department of Neurology, First Affiliated Hospital, China Medical University
| | - Lei Qiao
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, People's Republic of China
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Jędrejko K, Lazur J, Muszyńska B. Risk Associated with the Use of Selected Ingredients in Food Supplements. Chem Biodivers 2021; 18:e2000686. [PMID: 33410585 DOI: 10.1002/cbdv.202000686] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/05/2021] [Indexed: 12/30/2022]
Abstract
This review focuses on four new product categories of food supplements: pre-workout, fat burner/thermogenic, brain/cognitive booster, and hormone/testosterone booster. Many food supplements have been shown to be contaminated with unauthorized substances. In some cases, the ingredients in the new categories of dietary supplements were medicinal products or new synthetic compounds added without performing clinical trials. Some of the new ingredients in dietary supplements are plant materials that are registered in the pharmacopoeia as herbal medicines. In other cases, dietary supplements may contain plant materials that have no history of human use and are often used as materials to 'camouflage' stimulants. In the European Union, new ingredients of dietary supplements, according to European Food Safety Authority or unauthorized novel food. Furthermore, selected ingredients in dietary supplements may be prohibited in sports and are recognized as doping agents by World Anti-Doping Agency.
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Affiliation(s)
- Karol Jędrejko
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
| | - Jan Lazur
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
| | - Bożena Muszyńska
- Jagiellonian University Medical College, Faculty of Pharmacy, Department of Pharmaceutical Botany, Medyczna 9 Street, PL, 30-688, Kraków, Poland
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Abstract
OBJECTIVE The etiology of ground glass-like inclusions is heterogenous and the pathology has been described in various conditions including HBV infection, Lafora's disease, fibrinogen storage disease, type IV glycogenosis, and alcohol reversion therapy. Similar ground glass-like inclusions are also associated with immunosuppressed conditions and multiple medications, for which the clinical significance is still unclear. Additional cases, some with previously unreported unique etiologies, and their follow-up were described in this study. MATERIALS AND METHODS Eleven cases were examined between 2008 and 2019 for this study. The clinical data and histologic slides were reviewed. All of the cases were negative for Hepatitis B virus. None of the patients declared alcohol intake or a history of epilepsy. RESULTS Liver histology showed mild lobular inflammation in most of the cases (72%). Ground glass-like hepatocytes were distributed in the patchy-panlobular, periportal, and centrizonal pattern at 55%, 27%, and 18%, respectively. Clinical history revealed medication use in nine (82%) patients including NSAIDs, steroids, and chemotherapy. Ground glass-like inclusions were related to herbal toxicity in two of the patients. Liver function tests were elevated in all of the cases. Follow-up data revealed four patients with malignancy who died of their cancer. Seven patients showed resolution of elevated liver enzymes with a median follow-up period of 37 months (range 7-132 months). CONCLUSIONS Medication is the most relevant etiology for the development of these inclusions. Ground glass-like inclusions may also seen in herbal toxicity. Transplantation was not an etiologic factor in our patients. Most of the patients displayed an indolent course with resolution of the elevated transaminases.
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Affiliation(s)
- Kemal Deniz
- Department of Pathology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
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Modak BK, Gorai P, Pandey DK, Dey A, Malik T. An evidence based efficacy and safety assessment of the ethnobiologicals against poisonous and non-poisonous bites used by the tribals of three westernmost districts of West Bengal, India: Anti-phospholipase A2 and genotoxic effects. PLoS One 2020; 15:e0242944. [PMID: 33253320 PMCID: PMC7703885 DOI: 10.1371/journal.pone.0242944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 11/12/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction To explore the ethnobiological wisdom of the tribals of three western districts of West Bengal, India against poisonous and non-poisonous bites and stings, a quantitative approach was adopted. These age-old yet unexplored knowledge can be utilized in finding lead-molecules against poisonous and non-poisonous animal-bites. Further, an evidence-based approach is needed to assess the venom-neutralization ability of plants by experimental studies. Materials and methods During 2008–2009 and 2012–2017, 11 ethnomedicinal surveys were carried out to explore the use of medicinal flora and fauna via conducting open semi-structured interviews with 47 traditional healers (THs) or informants. The retrieved dataset was statistically evaluated using seven quantitative-indexes: use-value (UV), informants'-consensus-factor (ICF), fidelity-level (FL), relative-importance (RI), cultural importance-index (CI), index of agreement on remedies (IAR) and cultural agreement-index (CAI). Anti-phospholipaseA2 (PLA2) properties of selected plant extracts were also examined. In addition, the cytotoxicity and genotoxicity of the water extract of the plants showing high FL as well as significant PLA2 inhibitory potential were investigated using Allium cepa root tip assay. Results A total of 41 traditional-formulations (TFs) containing 40 plant species (of 39 genera from 28 families) and 3 animal species were prescribed by the THs. Fabaceae exhibited most number of medicinal plants. Piper nigrum (1.78) and Apis cerana indica and Crossopriza lyoni (both 0.21) exhibited the highest UV among the plants and the animals respectively. Stinging of centipede and dog/cat/hyena bite displayed highest ICF (1.00 each). Among the plants, the maximum RI (0.91) and CI (4.98) values were observed for Aristolochia indica. IAR (1.00) was recorded maximum for Achyranthes aspera, Gloriosa superba, Lycopodium cernuum, Smilax zeylanica and Streblus asper. Maximum CAI value was noted for Piper nigrum (5.5096). Among the animals, Apis cerana indica (0.31) and Crossopriza lyoni (1.52) displayed the highest RI and CI values respectively. Crossopriza lyoni (0.99) and Apis cerana indica (1.3871) exhibited maximum IAR and CAI values respectively. Plants showing higher FL exhibited higher anti-PLA2 activity via selective inhibition of human-group PLA2. In addition, Allium cepa root tip assay has indicated the safety and/or toxicity of the plant parts prescribed by the THs. Root water extracts of Aristolochia indica and Gloriosa superba exhibited significant genotoxicity and cytotoxicity. Conclusions Three western districts of West Bengal is the natural abode for many tribal and non-tribal communities. A noteworthy correlation was established between the plants used against poisonous-bites and their anti-PLA2 activity. A few plant parts used by the THs also exhibited high toxicity. Such alternative medical practices serve as the only option in these underprivileged and backward areas during medical-exigencies.
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Affiliation(s)
- Biplob Kumar Modak
- Department of Zoology, Sidho-Kanho-Birsha University, Lagda, West Bengal, India
| | - Partha Gorai
- Department of Zoology, Sidho-Kanho-Birsha University, Lagda, West Bengal, India
| | - Devendra Kumar Pandey
- Department of Biotechnology, Lovely Faculty of Technology and Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata, West Bengal, India
- * E-mail: (TM); (AD)
| | - Tabarak Malik
- Department of Medical Biochemistry, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail: (TM); (AD)
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Talib WH, AL-ataby IA, Mahmod AI, Jawarneh S, Al Kury LT, AL-Yasari IH. The Impact of Herbal Infusion Consumption on Oxidative Stress and Cancer: The Good, the Bad, the Misunderstood. Molecules 2020; 25:E4207. [PMID: 32937891 PMCID: PMC7570648 DOI: 10.3390/molecules25184207] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022] Open
Abstract
The release of reactive oxygen species (ROS) and oxidative stress is associated with the development of many ailments, including cardiovascular diseases, diabetes and cancer. The causal link between oxidative stress and cancer is well established and antioxidants are suggested as a protective mechanism against cancer development. Recently, an increase in the consumption of antioxidant supplements was observed globally. The main sources of these antioxidants include fruits, vegetables, and beverage. Herbal infusions are highly popular beverages consumed daily for different reasons. Studies showed the potent antioxidant effects of plants used in the preparation of some herbal infusions. Such herbal infusions represent an important source of antioxidants and can be used as a dietary protection against cancer. However, uncontrolled consumption of herbal infusions may cause toxicity and reduced antioxidant activity. In this review, eleven widely consumed herbal infusions were evaluated for their antioxidant capacities, anticancer potential and possible toxicity. These herbal infusions are highly popular and consumed as daily drinks in different countries. Studies discussed in this review will provide a solid ground for researchers to have better understanding of the use of herbal infusions to reduce oxidative stress and as protective supplements against cancer development.
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Affiliation(s)
- Wamidh H. Talib
- Department of Clinical Pharmacy and Therapeutic, Applied Science Private University, Amman 11931-166, Jordan; (I.A.A.); (A.I.M.); (S.J.)
| | - Israa A. AL-ataby
- Department of Clinical Pharmacy and Therapeutic, Applied Science Private University, Amman 11931-166, Jordan; (I.A.A.); (A.I.M.); (S.J.)
| | - Asma Ismail Mahmod
- Department of Clinical Pharmacy and Therapeutic, Applied Science Private University, Amman 11931-166, Jordan; (I.A.A.); (A.I.M.); (S.J.)
| | - Sajidah Jawarneh
- Department of Clinical Pharmacy and Therapeutic, Applied Science Private University, Amman 11931-166, Jordan; (I.A.A.); (A.I.M.); (S.J.)
| | - Lina T. Al Kury
- Department of Health Sciences, College of Natural and Health Sciences, Zayed University, Abu Dhabi 144534, UAE;
| | - Intisar Hadi AL-Yasari
- Department of Genetic Engineering, College of Biotechnology, Al-Qasim Green University, Babylon 00964, Iraq;
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Abstract
OBJECTIVES Cancer patients are using medical cannabis (MC) to address symptoms; however, little data exist to guide clinicians when counseling patients. We seek to define the patterns of MC use among cancer patients, as well as efficacy and safety of MC. MATERIALS AND METHODS Cancer patients attending oncology office visits at Beaumont Hospital, Michigan from July to December 2018 were anonymously surveyed. The survey included data regarding demographics, diagnosis, treatment, symptom burden, and MC use. Patients who reported MC use since their cancer diagnosis completed a section on patterns of use, efficacy, and safety. RESULTS The response rate was 188 of 327 (57.5%). MC use was reported by 46 of 188 (24.5%). A median composite baseline symptom score ranging from 8 (best) to 32 (worst) was higher in patients using MC versus nonusers; 17.5 versus 14.4 (P<0.001). Pain was the symptom with the highest frequency of improvement 34/42 (81%), followed by appetite 34/44 (77.3%), and anxiety 32/44 (73%). MC improved the ability to tolerate treatment in 24/44 (54.5%). Cloudy thinking is the symptom that worsened the most 7/42 (16.7%), with decreased energy being experienced by 4/41 (9.8%) of the users. CONCLUSIONS MC was utilized by a significant portion of cancer patients in this sample, across age, diagnosis, stage, and treatment. Patients with a higher severity of baseline symptoms were more likely to use MC and report a favorable efficacy profile of MC. Minimal toxicity was reported in this cohort. Prospective studies are needed to define the efficacy and safety of MC.
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Affiliation(s)
- David M Macari
- Department of Hematology Oncology, Beaumont Health, Royal Oak, MI
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Rahman S, Jahan N, Makbul SAA, Ahmad M, Gani MA. Scientific appraisal of Unani concept of islah-e-advia (rectification/purification of drugs) and its importance. J Ethnopharmacol 2020; 258:112880. [PMID: 32360562 DOI: 10.1016/j.jep.2020.112880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/10/2020] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Unani system of medicine uses drugs from plants, minerals and animals (Mawaleed-e-salasa) origin. Most of the drugs used are believed to be safe, but some drugs may have toxins and produce harmful effects, so it is very important to remove the toxins or to minimize their harmful effects before using, so as to increase their therapeutic values and make easy for use. AIM OF THE STUDY To explore the concept, aims and objectives of islah-e-advia (rectification/purification of drugs) in Unani system of medicine. MATERIALS AND METHODS A through literature survey was undertaken using the various online bibliographic databases like Pub Med, Google Scholar, Science Direct, Web of Science and Scopus. Classical Unani literature books which are translated in Urdu by CCRUM were used for Unani references. The keywords used for the search included "Tadbeer-e-Advia", "Islah-e-advia", Mudabbar process, detoxification and purification of drug. RESULTS The ancient Unani physicians were well aware of toxicity of the drugs and have divided drugs into four degrees (1°, 2°, 3° and 4°) according to the Mizaj (temperament) of drugs. The fourth degree drugs produce so strong effects that the physiological functions of the body get disturbed; such drugs are also considered to be poisonous drugs. Different methods of purification have been mentioned for drugs belonging to the third and fourth degree temperament and always recommended their use after subjecting them to certain Tadbeer (rectification/purification). Otherwise these drugs may destroy the physiological function of the body. After purification process the drugs become physically and chemically pure, therapeutically more effective and less toxic. Very few pharmacological and toxicity studies have been conducted. CONCLUSION Third and fourth degree drugs and its formulations have been claimed by Unani scholars to be useful in the management of various diseases of the body. After purification toxicity has been reduced in comparison crude drug. However, further elaborate and comprehensive studies are required to validate such claims.
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Affiliation(s)
- Sayeedur Rahman
- Dept. of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Kottigepalaya, Magadi Main Road, Bengaluru, 560091, India.
| | - Najeeb Jahan
- Dept. of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Kottigepalaya, Magadi Main Road, Bengaluru, 560091, India.
| | - Shaikh Ajij Ahmed Makbul
- Dept. of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Kottigepalaya, Magadi Main Road, Bengaluru, 560091, India.
| | - Masood Ahmad
- Dept. of Tahafuzi wa Samaji Tib (Preventive and Social Medicine), National Institute of Unani Medicine, Kottigepalaya, Magadi Main Road, Bengaluru, 560091, India.
| | - Mohd Abul Gani
- Dept. of Ilmul Advia (Pharmacology), National Institute of Unani Medicine, Kottigepalaya, Magadi Main Road, Bengaluru, 560091, India.
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Cho EC, Kim K. A comprehensive review of biochemical factors in herbs and their constituent compounds in experimental studies on alopecia. J Ethnopharmacol 2020; 258:112907. [PMID: 32360043 DOI: 10.1016/j.jep.2020.112907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 06/11/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Alopecia is a chronic condition that may cause emotional and psychological distress to patients, which may significantly impact a patient's quality of life. As conventional treatments have only a transient therapeutic effect and result in unwanted side effects, many patients have attempted to find therapeutic herbs or compounds that function as safer and more potent treatments for alopecia. Many such herbs have been used in complementary and alternative medicine (CAM) for centuries; however, there is a lack of information on the therapeutic mechanisms of herbs used for the treatment of alopecia. AIM OF THE STUDY The aim of this review was to perform a critical assessment of the methods and results of experimental studies related to alopecia and to provide the potential mechanisms of action of herbs and their constituent compounds used in the identified studies, in particular, in relation to the stages of the cell cycle. We hope to better guide the clinical application and scientific research of herbs for the treatment of alopecia. MATERIALS AND METHODS We reviewed experimental studies to determine the methods used and the mechanism of action of the herbs and constituent compounds. Databases, including Medline (via PubMed), EMBASE, OASIS, and RISS, were searched for the following keywords: "medicinal plants," "alopecia," "alopecia areata," "androgenetic alopecia," "animal experiment," and "in vitro study." We also assessed the risks of bias, toxicity, and taxonomy to determine the quality of information. RESULTS C57BL/6 mice and human dermal papilla cells were the most commonly used models for in vivo and in vitro studies, respectively. Many herbs and their constituent compounds were used to treat alopecia by managing the hair cycle, keratinocyte proliferation, apoptosis, angiogenesis, hormones, and inflammation. These compounds prolong the anagen phase, shorten the transition from the telogen to phase anagen, and inhibit premature catagen phase. CONCLUSIONS This review has further elucidated the therapeutic mechanisms of herbs and their constituent compounds that are relevant to alopecia and discussed the effectiveness of using herbal treatments. There is a need to develop evidence regarding the quality control, taxonomy, and toxicology of these compounds. Such improvements will provide a better quality of evidence to ensure the efficacy and safety of herbs and compounds used for the treatment of alopecia.
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Affiliation(s)
- Eun Chai Cho
- College of Korean Medicine, Kyung Hee University, South Korea.
| | - Kyuseok Kim
- Department of Ophthalmology, Otolaryngology and Dermatology of Korean Medicine, College of Korean Medicine, Kyung Hee University, South Korea.
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Abstract
RATIONALE Excessive ingestion of licorice can cause pseudohyperaldosteronism. A few case reports in the available literature have described significant hypokalemia secondary to licorice consumption with clinical manifestations of muscle weakness, paralysis, or severe hypertension. To our knowledge, no report has discussed severe asymptomatic hypokalemia associated with licorice consumption. PATIENT CONCERNS A 79-year-old man presented to the urology clinic with a several-month history of urinary frequency and a weak stream. Routine laboratory investigations revealed serum potassium (K) level of 1.8 mmol/L, and he was immediately admitted to the nephrology department. DIAGNOSES He was in a good state of health, and systemic and neurological examinations were unremarkable. However, laboratory investigations revealed severe hypokalemia and metabolic alkalosis accompanied with renal K wasting and hypertension, suggesting a state of mineralocorticoid excess. Hormonal studies revealed low serum renin and aldosterone but normal serum cortisol levels. Detailed history taking revealed that he had used licorice tea daily during the preceding 18 months. INTERVENTIONS AND OUTCOME The patient's serum K returned to normal levels after vigorous K replacement and discontinuation of licorice intake. He was also diagnosed with benign prostatic hyperplasia during hospitalization and was treated. LESSONS Chronic licorice ingestion can precipitate severe hypokalemia, although patients may remain asymptomatic. This case report indicates that the severity of a patient's clinical presentation depends on individual susceptibility, as well as the dose and duration of licorice intake.
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Affiliation(s)
- Yichang Yang
- Department of Traditional Chinese Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
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Kopp T, Abdel-Tawab M, Mizaikoff B. Extracting and Analyzing Pyrrolizidine Alkaloids in Medicinal Plants: A Review. Toxins (Basel) 2020; 12:E320. [PMID: 32413969 PMCID: PMC7290370 DOI: 10.3390/toxins12050320] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 04/27/2020] [Accepted: 05/05/2020] [Indexed: 12/11/2022] Open
Abstract
Pyrrolizidine alkaloids (PAs) are distributed in plant families of Asteraceae, Boraginaceae, and Fabaceae and serve in the chemical defense mechanism against herbivores. However, they became a matter of concern due to their toxicity associated with the high risk of intake within herbal preparations, e.g., phytopharmaceutical formulations, medicinal teas, or other plant-derived drug products. In 1992, the German Federal Ministry of Health established the first limits of PA content for fourteen medicinal plants. Because of the toxic effects of PAs, the Federal Institute of Risk Assessment (BfR) established more stringent limits in 2011, whereby a daily intake <0.007 µg/kg body weight was recommended and valid until 2018. A threefold higher limit was then advised by BfR. To address consumer safety, there is the need for more efficient extraction procedures along with robust, selective, and sensitive analytical methods to address these concerns. With the increased prevalence of, e.g., phytopharmaceutical formulations, this timely review comprehensively focuses on the most relevant extraction and analysis strategies for each of those fourteen plant genera. While a variety of extraction procedures has been reported, differences in PA content of up to 1110 ppm (0.11% (w/w)) were obtained dependent on the nature of the solvent and the applied extraction technique. It is evident that the efficient extraction of PAs requires further improvements or at least standardization of the extraction conditions. Comparing the various analytical techniques applied regarding selectivity and sensitivity, LC-MS methods appear most suited. This review shows that both standardized extraction and sensitive determination of PAs is required for achieving appropriate safety levels concerning public health in future.
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Affiliation(s)
- Thomas Kopp
- Department of Chemistry, Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081 Ulm, Germany;
- Central Laboratory of German Pharmacists, 65760 Eschborn, Germany;
| | - Mona Abdel-Tawab
- Central Laboratory of German Pharmacists, 65760 Eschborn, Germany;
| | - Boris Mizaikoff
- Department of Chemistry, Institute of Analytical and Bioanalytical Chemistry, Ulm University, 89081 Ulm, Germany;
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Gerometta E, Grondin I, Smadja J, Frederich M, Gauvin-Bialecki A. A review of traditional uses, phytochemistry and pharmacology of the genus Indigofera. J Ethnopharmacol 2020; 253:112608. [PMID: 32004627 DOI: 10.1016/j.jep.2020.112608] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 01/20/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Indigofera is the third-largest genus in the family of Fabaceae, with approximately 750 species. It is distributed across all tropical regions. Indigofera species are widely employed in traditional medicine all around the world, against many ailments. Thus, based on these medicinal properties, various investigations have been undertaken in order to appraise the pharmacological activities and the chemical composition of these species. A recent paper provides a summary of the phytochemistry and pharmacology of the genus Indigofera. Consequently, this review is a continuation of this previous study by updating some data and adding information about the phylogeny and traditional uses of the genus. AIM OF THE STUDY To provide an overview of the phylogeny, traditional uses, phytochemistry, pharmacology and toxicity of the genus Indigofera, and to identify the remaining gaps and thus supply a basis for further investigations. MATERIALS AND METHODS A review of the literature was performed by consulting scientific databases such as 'ScienceDirect', 'PubMed', 'Google Scholar' and 'SpringerLink' and using the keyword Indigofera. RESULTS Over 60 Indigofera species are reported in traditional medicine. The uses depend on the country and the species, but similarities have been noticed. Indeed, treatments of gastrointestinal disorders, inflammatory conditions and pain, skin ailments, and respiratory and infectious diseases are recurring. Phytochemical studies have led to the identification of more than 200 compounds, notably flavonoids and terpenoids. Many pharmacological activities have been demonstrated, particularly antimicrobial, cytotoxic and anti-inflammatory activities, and thus allowed to assert most of the traditional uses of the genus. Some active compounds have been isolated and have shown remarkable therapeutic potential, like the alkaloid indirubin, which is currently being clinically trialed. CONCLUSIONS The data on the genus Indigofera are extensive, but gaps still remain. Indeed, some promising species have not been assessed for their phytochemistry and/or pharmacology and thus remain unexplored. Moreover, relatively few active compounds have been isolated and tested for their biological activity, and studies to explain their mechanism of action are nearly inexistent. Furthermore, some pharmacological studies have inappropriate methodologies that make the results difficult to interpret. Consequently, further in-depth and relevant research is required to supplement the knowledge on this wide-ranging genus and to confirm its reported therapeutic potential.
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Affiliation(s)
- Elise Gerometta
- Laboratoire de Chimie des Substances Naturelles et des Sciences des Aliments, Faculté des Sciences et Technologies, Université de la Réunion, 15 Avenue René Cassin, BP 7151, St Denis Messag Cedex 9, La Réunion, 97 715, France.
| | - Isabelle Grondin
- Laboratoire de Chimie des Substances Naturelles et des Sciences des Aliments, Faculté des Sciences et Technologies, Université de la Réunion, 15 Avenue René Cassin, BP 7151, St Denis Messag Cedex 9, La Réunion, 97 715, France.
| | - Jacqueline Smadja
- Laboratoire de Chimie des Substances Naturelles et des Sciences des Aliments, Faculté des Sciences et Technologies, Université de la Réunion, 15 Avenue René Cassin, BP 7151, St Denis Messag Cedex 9, La Réunion, 97 715, France.
| | - Michel Frederich
- Université de Liège, Département de Pharmacie, Centre Interfacultaire de Recherche sur le Médicament (CIRM), Laboratoire de Pharmacognosie, Campus du Sart-Tilman, Quartier Hôpital, Avenue Hippocrate, 15 B36, 4000, Liège, Belgium.
| | - Anne Gauvin-Bialecki
- Laboratoire de Chimie des Substances Naturelles et des Sciences des Aliments, Faculté des Sciences et Technologies, Université de la Réunion, 15 Avenue René Cassin, BP 7151, St Denis Messag Cedex 9, La Réunion, 97 715, France.
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Niu B, Zheng FH, Xu JP. Protective effect of gui zhi (Ramulus Cinnamomi) on abnormal levels of four amino acid neurotransmitters by chronically ma huang (Herb Ephedra) intoxicated prefrontal cortex in rats treated with a ma huang-gui zhi herb pair. J Ethnopharmacol 2020; 249:112408. [PMID: 31751653 DOI: 10.1016/j.jep.2019.112408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/06/2019] [Accepted: 11/14/2019] [Indexed: 06/10/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The Herb Ephedra (Ma Huang in Chinese)-Ramulus Cinnamomi (Gui Zhi in Chinese) herb pair is a classic traditional Chinese herb pair used to treat asthma, nose and lung congestion, and fever with anhidrosis. In previous study, we found that chronic administration of ma huang induced obvious neurodegeneration in rat brains, with the prefrontal cortex showing the greatest effect. Gui zhi decreased hyperactivity produced by repeated ma huang administration, and attenuated oxidative stress in rat prefrontal cortex induced by ma huang. AIM OF THE STUDY The study was aimed to investigate the protective effect of gui zhi on ma huang-induced abnormal levels of four amino acid neurotransmitters in rat prefrontal cortex. MATERIALS AND METHODS All ma huang and ma huang-gui zhi herb pair extracts were prepared using methods of traditional Chinese medicine and were normalized based on the ephedrine content. Two-month-old male Sprague-Dawley rats (6 rats/group) were administered ma huang or ma huang-gui zhi herb pair extracts for 1, 3, 5 or 7 days (ephedrine = 48 mg/kg). The contents of ephedrine, glutamate (Glu), aspartic acid (Asp), glycine (Gly), and gamma-aminobutyric acid (GABA) in the prefrontal cortex were determined using ultra-high-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) at 0.5, 1.0, 5.0 h after administration. RESULTS Ma huang significantly enhanced the levels of GABA, Gly, Glu and Asp in the prefrontal cortex, while gui zhi partially abolished the effects. CONCLUSIONS Ma huang-induced neurotoxicity may be associated with its effects on amino acid neurotransmitters. Gui zhi is a promising neuroprotective agent against for ma huang-induced neurotoxicity. The information presented in this study will help supplement the available data for future ma huang-gui zhi herb pair compatibility studies.
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Affiliation(s)
- Bo Niu
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, PR China.
| | - Fang-Hao Zheng
- Foshan Hospital of Traditional Chinese Medicine, Foshan, 528000, PR China.
| | - Jiang-Ping Xu
- Department of Neuropharmacology and Drug Discovery, School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, 510515, PR China.
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Grewal P, Ahmad J. Severe liver injury due to herbal and dietary supplements and the role of liver transplantation. World J Gastroenterol 2019; 25:6704-6712. [PMID: 31857773 PMCID: PMC6920659 DOI: 10.3748/wjg.v25.i46.6704] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 02/06/2023] Open
Abstract
Herbal and dietary supplements (HDS) are increasingly used worldwide for numerous, mainly unproven health benefits. The HDS industry is poorly regulated compared to prescription medicines and most products are easily obtainable. Drug induced liver injury (DILI) is a well-recognized entity associated with prescription and over the counter medications and many reports have emerged of potential HDS-related DILI. There is considerable geographic variability in the risk and severity of DILI associated with HDS but the presentation of severe liver injury is similar with a hepatocellular pattern accompanied by jaundice. This type of injury can lead to acute liver failure and the need for liver transplantation. Patients will often fail to mention their use of HDS, considering it natural and therefore harmless. Hence physicians should understand that these products can be associated with DILI and explicitly ask about HDS use in any patient with otherwise unexplained acute liver injury.
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Affiliation(s)
- Priya Grewal
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Jawad Ahmad
- Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Abstract
Ten percent of the world's population is affected by chronic kidney disease that can lead to kidney failure. In France, nearly three million people are concerned, half of whom are undiagnosed, 85,000 people are on dialysis or waiting for a kidney transplant. Each year, 11,000 new diagnoses of severe renal failure are made, one third of which had not been treated before. Kidney failure is constantly increasing due to the aging of the population and the resurgence of chronic diseases, including obesity and cardiovascular diseases such as high blood pressure and diabetes, two conditions that impair renal function. The pharmacist, a local actor, is well placed to help patients adhere to their treatment and manage it to the best of their quality of life. It is up to the pharmacist to check the dosages according to the degree of renal involvement, ideally noted on the prescription or, failing that, by asking the patient the results of his recent biological examinations. The consultation of the pharmaceutical file and, ultimately, the shared medical file, will make it possible, in a concerted management of the patient's care pathway, to also detect possible drug interactions. By dispensing the prescribed drugs, the pharmacist can also warn against those known to be known for their nephrotoxicity, especially nonsteroidal anti-inflammatory drugs. In the case of over-the-counter products, the pharmacist may discourage a person at risk from taking certain drugs containing nonsteroidal anti-inflammatory drugs, including aspirin and ibuprofen. Because of their potential renal toxicity, the pharmacist is competent to alert, especially on certain food supplements, herbal products, and is legitimate to participate in screening campaigns.
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Affiliation(s)
- Daniel Vasmant
- Académie nationale de pharmacie, 4, avenue de l'Observatoire, 75270 Paris cedex 06, France; Réseau de néphrologie d'Île-de-France (Rénif), 3-5, rue de Metz, 75010 Paris, France.
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Costache II, Miron A, Hăncianu M, Aursulesei V, Costache AD, Aprotosoaie AC. Pharmacokinetic Interactions between Cardiovascular Medicines and Plant Products. Cardiovasc Ther 2019; 2019:9402781. [PMID: 32089733 PMCID: PMC7012273 DOI: 10.1155/2019/9402781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/25/2019] [Indexed: 12/22/2022] Open
Abstract
The growing use of plant products among patients with cardiovascular pharmacotherapy raises the concerns about their potential interactions with conventional cardiovascular medicines. Plant products can influence pharmacokinetics or/and pharmacological activity of coadministered drugs and some of these interactions may lead to unexpected clinical outcomes. Numerous studies and case reports showed various pharmacokinetic interactions that are characterized by a high degree of unpredictability. This review highlights the pharmacokinetic clinically relevant interactions between major conventional cardiovascular medicines and plant products with an emphasis on their putative mechanisms, drawbacks of herbal products use, and the perspectives for further well-designed studies.
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Affiliation(s)
- Irina-Iuliana Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Anca Miron
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Monica Hăncianu
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Viviana Aursulesei
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
- “Sf. Spiridon” University Hospital, 700111 Iasi, Romania
| | - Alexandru Dan Costache
- Faculty of Medicine, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
| | - Ana Clara Aprotosoaie
- Faculty of Pharmacy, Grigore T.Popa University of Medicine and Pharmacy Iasi, 700115 Iasi, Romania
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Abstract
Objective Kikyo-to (KKT) is a fixed combination of glycyrrhiza root and platycodon root extracts. It is an herbal medicine traditionally used in Japan for relieving sore throat associated with acute upper respiratory tract infection (URTI). No controlled studies have yet demonstrated its effect, however. We investigated the efficacy of KKT on sore throat associated with acute URTI. Methods Patients with sore throat who were diagnosed with URTI at the General Medicine Department Office, Akashi Medical Center Hospital, between December 2017 and May 2018 were enrolled. Participants were randomly assigned to two groups at a 1:1 ratio, with stratification by age and sore throat score on a Visual Analogue Scale (VAS), to receive 2.5 g of either KKT or a placebo. Participants and investigators were blinded to group allocation. The primary outcome was the change in sore throat score on VAS 10 minutes after KKT administration. Secondary outcomes were the impact of the sore throat on daily life (none, mild, moderate, and severe) at 10 minutes after administration. Results Thirty-five participants were assigned to each group (n=70, total). The difference in the mean change of sore throat score according to VAS within 10 minutes between the two groups was not statistically significant (KKT 14.40 vs. placebo 17.00; p=0.39). The proportion of patients with a moderate or greater impact of their sore throat on their daily life was also not significantly different between the groups (KKT 22.9% vs. placebo 40.0%; p=0.20). Patients reported no side effects. Conclusion KKT did not significantly relieve sore throat associated with acute URTI compared with placebo.
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Affiliation(s)
- Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Toshio Shimokawa
- Clinical Study Support Centre, Wakayama Medical University, Japan
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
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He S, Zhang C, Zhou P, Zhang X, Ye T, Wang R, Sun G, Sun X. Herb-Induced Liver Injury: Phylogenetic Relationship, Structure-Toxicity Relationship, and Herb-Ingredient Network Analysis. Int J Mol Sci 2019; 20:ijms20153633. [PMID: 31349548 PMCID: PMC6695972 DOI: 10.3390/ijms20153633] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/08/2019] [Accepted: 07/18/2019] [Indexed: 02/06/2023] Open
Abstract
Currently, hundreds of herbal products with potential hepatotoxicity were available in the literature. A comprehensive summary and analysis focused on these potential hepatotoxic herbal products may assist in understanding herb-induced liver injury (HILI). In this work, we collected 335 hepatotoxic medicinal plants, 296 hepatotoxic ingredients, and 584 hepatoprotective ingredients through a systematic literature retrieval. Then we analyzed these data from the perspectives of phylogenetic relationship and structure-toxicity relationship. Phylogenetic analysis indicated that hepatotoxic medicinal plants tended to have a closer taxonomic relationship. By investigating the structures of the hepatotoxic ingredients, we found that alkaloids and terpenoids were the two major groups of hepatotoxicity. We also identified eight major skeletons of hepatotoxicity and reviewed their hepatotoxic mechanisms. Additionally, 15 structural alerts (SAs) for hepatotoxicity were identified based on SARpy software. These SAs will help to estimate the hepatotoxic risk of ingredients from herbs. Finally, a herb-ingredient network was constructed by integrating multiple datasets, which will assist to identify the hepatotoxic ingredients of herb/herb-formula quickly. In summary, a systemic analysis focused on HILI was conducted which will not only assist to identify the toxic molecular basis of hepatotoxic herbs but also contribute to decipher the mechanisms of HILI.
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Affiliation(s)
- Shuaibing He
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Chenyang Zhang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Ping Zhou
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Xuelian Zhang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Tianyuan Ye
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Ruiying Wang
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China
| | - Guibo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
| | - Xiaobo Sun
- Beijing Key Laboratory of Innovative Drug Discovery of Traditional Chinese Medicine (Natural Medicine) and Translational Medicine, Institute of Medicinal Plant Development, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100193, China.
- Key Laboratory of Bioactive Substances and Resource Utilization of Chinese Herbal Medicine, Ministry of Education, Beijing 100193, China.
- Key Laboratory of Efficacy Evaluation of Chinese Medicine against Glycolipid Metabolic Disorders, State Administration of Traditional Chinese Medicine, Beijing 100193, China.
- Key Laboratory of new drug discovery based on Classic Chinese medicine prescription, Chinese Academy of Medical Sciences, Beijing 100193, China.
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Affiliation(s)
- Jay H Hoofnagle
- From the Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.H.H.); and the Department of Internal Medicine, National University Hospital of Iceland, and the Faculty of Medicine, University of Iceland - both in Reykjavík (E.S.B.)
| | - Einar S Björnsson
- From the Liver Disease Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD (J.H.H.); and the Department of Internal Medicine, National University Hospital of Iceland, and the Faculty of Medicine, University of Iceland - both in Reykjavík (E.S.B.)
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Ko Y, Jang BH, Oh MS, Kim SJ, Cha YY, Lee EJ, Song YK, Ko SG. Evaluation of the efficacy and safety of herbal medicine for treating work-related chronic low back pain: A study protocol for a multicenter, randomized, controlled, clinical trial. Medicine (Baltimore) 2019; 98:e16466. [PMID: 31348248 PMCID: PMC6708960 DOI: 10.1097/md.0000000000016466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION In Korea, low back pain (LBP) which is occupation-related symptom is one of the major health issues owing to rapid industrialization. Even traditional Korean medicine has the long history in pain treatment, there still has been lack of supporting evidence on herbal prescription itself. Sogyeonghwalhyeol-tang, a Korean herbal medicine prescription, has been suggested as a medication for treating chronic LBP as well as work-related pains. OBJECTIVE This study aims to evaluate the clinical efficacy and safety of herbal medicine, Sogyeonghwalhyeol-tang on work-related chronic LBP patients. METHOD This trial is designed as a multicenter, randomized, controlled, clinical trial. Seventy-two participants who have chief complaint of LBP in Korean medicine rehabilitation center will be randomly assigned to ether Sogyeonghwalhyeol-tang group or placebo group with a ratio of 1:1. They will receive assigned drugs in 4 weeks and follow-up for 2 weeks. DISCUSSION The result of this study will provide the valuable information for efficacy and safety of Sogyeonghwalhyeol-tang for patients with work-related chronic LBP.
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Affiliation(s)
- Youme Ko
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University
| | - Bo-Hyoung Jang
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University
| | - Min-Seok Oh
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Sun Joong Kim
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Semyung University, Jecheon
| | - Yun-Yeop Cha
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Sang-ji University, Wonju
| | - Eun Jung Lee
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Dae-Jeon University, Daejeon
| | - Yun-Kyung Song
- Department of Korean Rehabilitation Medicine, College of Korean Medicine, Gachon University, Seongnam-si, The Republic of Korea
| | - Seung-Gyu Ko
- Department of Science in Korean Medicine, Graduate School, Kyung Hee University
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Yasri S, Wiwanitkit V. Drugs Causing Pigmented Purpuric Dermatoses: Herbal Regimen. Skinmed 2019; 17:138-139. [PMID: 31145071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Sora Yasri
- KMT Primary Care Center, Bangkok, Thailand;
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Sharma R, Martins N, Kuca K, Chaudhary A, Kabra A, Rao MM, Prajapati PK. Chyawanprash: A Traditional Indian Bioactive Health Supplement. Biomolecules 2019; 9:E161. [PMID: 31035513 PMCID: PMC6571565 DOI: 10.3390/biom9050161] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/15/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022] Open
Abstract
Chyawanprash (CP) is an Ayurvedic health supplement which is made up of a super-concentrated blend of nutrient-rich herbs and minerals. It is meant to restore drained reserves of life force (ojas) and to preserve strength, stamina, and vitality, while stalling the course of aging. Chyawanprash is formulated by processing around 50 medicinal herbs and their extracts, including the prime ingredient, Amla (Indian gooseberry), which is the world's richest source of vitamin C. Chyawanprash preparation involves preparing a decoction of herbs, followed by dried extract preparation, subsequent mixture with honey, and addition of aromatic herb powders (namely clove, cardamom, and cinnamon) as standard. The finished product has a fruit jam-like consistency, and a sweet, sour, and spicy flavor. Scientific exploration of CP is warranted to understand its therapeutic efficacy. Scattered information exploring the therapeutic potential of CP is available, and there is a need to assemble it. Thus, an effort was made to compile the scattered information from ancient Ayurvedic texts and treatises, along with ethnobotanical, ethnopharmacological, and scientifically validated literature, that highlight the role of CP in therapeutics. Citations relevant to the topic were screened.
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Affiliation(s)
- Rohit Sharma
- Central Ayurveda Research Institute for Drug Development (CCRAS), Ministry of AYUSH, Government of India, 4-CN Block, Sector-V, Bidhannagar, Kolkata-700091, India.
| | - Natália Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, 4200-319 Porto, Portugal.
- Institute for research and Innovation in Heath (i3S), University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal.
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Králové, Rokitanskeho 62, 50003 Hradec Králové, Czech Republic.
| | - Ashun Chaudhary
- Department of Biotechnology, MMEC, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala-133207, India.
| | - Atul Kabra
- Department of Pharmacology, Kota College of Pharmacy, Kota, Rajasthan-324005, India.
| | - Meda M Rao
- Central Ayurveda Research Institute for Drug Development (CCRAS), Ministry of AYUSH, Government of India, 4-CN Block, Sector-V, Bidhannagar, Kolkata-700091, India.
| | - Pradeep Kumar Prajapati
- Department of Rasashastra & Bhaishajya Kalpana, All India Institute of Ayurveda, New Delhi- 110076, India.
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Clairet AL, Boiteux-Jurain M, Curtit E, Jeannin M, Gérard B, Nerich V, Limat S. Interaction between phytotherapy and oral anticancer agents: prospective study and literature review. Med Oncol 2019; 36:45. [PMID: 30993543 DOI: 10.1007/s12032-019-1267-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/26/2019] [Indexed: 12/23/2022]
Abstract
Cancer is becoming more prevalent in elderly patient. Due to polypharmacy, older adults with cancer are predisposed to drug-drug interactions. There is also an increasing interest in the use of complementary and alternative medicine (CAM). Thirty to seventy percent of patients with cancer have used CAM. Through pharmaceutical counseling sessions, we can provide advices on herb-drug interactions (HDI). All the patients seen in pharmaceutical counseling sessions were prospectively included. Information was collected during these sessions: prescribed medication (oral anticancer agents (OAA) and other drugs), CAM (phytotherapy especially), and use of over-the-counter (OTC) drugs. If pharmacist considered an interaction or an intervention clinically relevant, the oncologist was notified. Then, a literature review was realized to identify the potential HDI (no interactions, precautions for use, contraindication). Among 201 pharmacist counseling sessions, it resulted in 104 interventions related to 46 HDI, 28 drug-drug interactions and 30 others (wrong dosage, omission…). To determine HDI, we review 73 medicinal plants which are used by our patients with cancer and 31 OAA. A total of 1829 recommendations were formulated about 59 (75%) medical plants and their interaction with an OAA. Herb-drug interactions should not be ignored by healthcare providers in their management of cancer patients in daily practice.
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Affiliation(s)
- Anne-Laure Clairet
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
| | - Marie Boiteux-Jurain
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France
| | - Elsa Curtit
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
- Department of Medical Oncology, University Hospital of Besançon, 25000, Besançon, France
| | - Marie Jeannin
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France
| | - Blandine Gérard
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France
| | - Virginie Nerich
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France.
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France.
| | - Samuel Limat
- Department of Pharmacy, University Hospital of Besançon, 25000, Besançon, France
- Univ. Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, Interactions Hôte-Greffon-Tumeur/Ingénierie Cellulaire et Génique, 25000, Besançon, France
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Byeon JH, Kil JH, Ahn YC, Son CG. Systematic review of published data on herb induced liver injury. J Ethnopharmacol 2019; 233:190-196. [PMID: 30639232 DOI: 10.1016/j.jep.2019.01.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 05/13/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Herbal products have been widely used as a means of ethnomedicine worldwide. Recently, the potential hepatotoxicity of herbs has become a medical issue but comprehensive studies are limited. AIM OF THE STUDY This study aims to determine the clinical features of herb induced liver injury (HILI) including its constituent ratio among liver injury case cohorts that included both HILI and drug induced liver injury (DILI). MATERIALS AND METHODS A systematic review was conducted using a literature search for DILI/HILI in seven electric databases including PubMed, Cochrane and Embase. We analyzed the DILI/HILI cases and clinical characteristics in terms of herbs, conventional drugs, concomitant, or others. RESULTS Thirty-one studies met the necessary criteria and included 9 prospective and 22 retrospective studies. Among total number of overall DILI/HILI cases (7511, male 2819, female 3669 and unknown 1023), 25.0% (1874 cases) were implicated in herbs. HILI was relatively higher in females (69.8% vs. 30.2% male), compared to conventional drugs (57.3% female vs. 42.7% male, p < 0.01), while it was prone to induce hepatocellular injury (hepatocellular 78.8%, cholestatic 8.9%, mixed type 12.3%), contrary to conventional drugs (hepatocellular 56.7% vs. cholestatic 22.1% vs. mixed 21.2%), respectively (p < 0.01). The main herbs causing HILI included Polygonum multiflorum, Psoralea corylifolia, Corydalis yanhusuo, and Rheum officinale. CONCLUSIONS This review created the comparative and comprehensive feature of hepatotoxicity by herbal products, which provides reference data for the clinical applications and establishing pharmacovigilance system of herbs.
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Affiliation(s)
- Jung-Hwan Byeon
- Korean Medical College of Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Ji-Hye Kil
- Korean Medical College of Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Yo-Chan Ahn
- Department of Health Service Management, Daejeon University, 62, Daehak-ro Dong-gu, Daejeon 301-716, Republic of Korea.
| | - Chang-Gue Son
- Liver and Immunology Research Center, Dunsan Oriental Hospital of Daejeon University, 75, Daedeok-daero 176, Seo-gu, Daejeon 35253, Republic of Korea.
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Munyangi J, Cornet-Vernet L, Idumbo M, Lu C, Lutgen P, Perronne C, Ngombe N, Bianga J, Mupenda B, Lalukala P, Mergeai G, Mumba D, Towler M, Weathers P. Artemisia annua and Artemisia afra tea infusions vs. artesunate-amodiaquine (ASAQ) in treating Plasmodium falciparum malaria in a large scale, double blind, randomized clinical trial. Phytomedicine 2019; 57:49-56. [PMID: 30668322 PMCID: PMC6990969 DOI: 10.1016/j.phymed.2018.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 11/29/2018] [Accepted: 12/01/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND AND OBJECTIVE Prior small-scale clinical trials showed that Artemisia annua and Artemisia afra infusions, decoctions, capsules, or tablets were low cost, easy to use, and efficient in curing malaria infections. In a larger-scale trial in Kalima district, Democratic Republic of Congo, we aimed to show A. annua and/or A. afra infusions were superior or at least equivalent to artesunate-amodiaquine (ASAQ) against malaria. METHODS A double blind, randomized clinical trial with 957 malaria-infected patients had two treatment arms: 472 patients for ASAQ and 471 for Artemisia (248 A. annua, 223 A. afra) remained at end of the trial. ASAQ-treated patients were treated per manufacturer posology, and Artemisia-treated patients received 1 l/d of dry leaf/twig infusions for 7 d; both arms had 28 d follow-up. Parasitemia and gametocytes were measured microscopically with results statistically compared among arms for age and gender. RESULTS Artemisinin content of A. afra was negligible, but therapeutic responses of patients were similar to A. annua-treated patients; trophozoites cleared after 24 h, but took up to 14 d to clear in ASAQ-treated patients. D28 cure rates defined as absence of parasitemia were for pediatrics 82, 91, and 50% for A. afra, A. annua and ASAQ; while for adults cure rates were 91, 100, and 30%, respectively. Fever clearance took 48 h for ASAQ, but 24 h for Artemisia. From D14-28 no Artemisia-treated patients had microscopically detectable gametocytes, while 10 ASAQ-treated patients remained gametocyte carriers at D28. More females than males were gametocyte carriers in the ASAQ arm but were unaffected in the Artemisia arms. Hemoglobin remained constant at 11 g/dl for A. afra after D1, while for A. annua and ASAQ it decreased to 9-9.5 g/dl. Only 5.0% of Artemisia-treated patients reported adverse effects, vs. 42.8% for ASAQ. CONCLUSION A. annua and A. afra infusions are polytherapies with better outcomes than ASAQ against malaria. In contrast to ASAQ, both Artemisias appeared to break the cycle of malaria by eliminating gametocytes. This study merits further investigation for possible inclusion of Artemisia tea infusions as an alternative for fighting and eradicating malaria.
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Affiliation(s)
- Jérôme Munyangi
- Faculté de Médecine Université de Kolwezi-Lualaba, Congo DRC
| | - Lucile Cornet-Vernet
- Vice Présidente de La Maison de l'Artemisia(association Loi 1901), 20 rue Pierre Demours, 75017Paris, France.
| | | | - Chen Lu
- Department of Mathematics, Worcester Polytechnic Institute, USA
| | | | | | - Nadège Ngombe
- Faculté de Pharmacie, Université de Kinshasa, Congo DRC
| | - Jacques Bianga
- Programme National Lutte Contre le Paludisme, Maniema, Congo DRC
| | - Bavon Mupenda
- Ecole de Santé Publique Université de Kinshasa, Congo DRC
| | - Paul Lalukala
- Ministère Provincial de Santé Publique Maniema, Congo DRC
| | | | | | - Melissa Towler
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, USA
| | - Pamela Weathers
- Department of Biology and Biotechnology, Worcester Polytechnic Institute, USA
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Ganguli A, Rai P, Balachandran S, Gupta R, Sharma R, Neogi SB. Heavy Metals in Indigenous Preparations Used for Sex Selection During Pregnancy in India. Biol Trace Elem Res 2019; 188:239-244. [PMID: 29909490 DOI: 10.1007/s12011-018-1411-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/06/2018] [Indexed: 12/29/2022]
Abstract
Indigenous preparations (IPs) have evoked a considerable interest in alleviating infections and chronic diseases and improving wellbeing. While such formulations have been a part of traditional practice in several countries and many have been reviewed scientifically for their claims, several of them until date remain to be investigated. A class of IPs for sex selection by Indian pregnant women exists with an aim of begetting a male offspring. In view of the leads obtained from our previous studies on detrimental effects of the newborn, for instance stillbirths and congenital malformations, we attempted to investigate the samples for heavy metal toxicity. Three samples were chosen following phytochemical analysis and reproductive toxicity of such preparations under in vivo conditions. The selected samples were examined for heavy metals-lead, cadmium, arsenic, and mercury using Microwave-assisted atomic absorption spectroscopy. The upper limit level of lead, mercury, and cadmium was found to be 18.56, 0.11, and 0.84 mg/kg respectively whereas arsenic was not detected. The levels of lead and mercury were found to be manifolds high in the IP samples that were primarily contributed by its constituents. The results of our study indicate the potential risk conferred upon, to both the mother and fetus on account of high levels of lead, mercury, and cadmium.
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Affiliation(s)
| | - Pragya Rai
- Public Health Foundation of India, Indian Institute of Public Health, Delhi, India
| | | | | | - Rashmi Sharma
- Science for Equity, Empowerment and Development (SEED) Division, Department of Science and Technology, Delhi, India
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Peprah P, Agyemang-Duah W, Arthur-Holmes F, Budu HI, Abalo EM, Okwei R, Nyonyo J. 'We are nothing without herbs': a story of herbal remedies use during pregnancy in rural Ghana. BMC Complement Altern Med 2019; 19:65. [PMID: 30876425 PMCID: PMC6419816 DOI: 10.1186/s12906-019-2476-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 03/06/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Herbal medicine has become the panacea for many rural pregnant women in Ghana despite the modern western antenatal care which has developed in most parts of the country. To our knowledge, previous studies investigating herbal medicine use have primarily reported general attitudes and perceptions of use, overlooking the standpoint of pregnant women and their attitudes, and utilisation of herbal medicine in Ghana. Knowledge of herbal medicine use among rural pregnant women and the potential side effects of many herbs in pregnancy are therefore limited in the country; this qualitative study attempts to address this gap by exploring the perceptions of herbal medicine usage among pregnant women in rural Ghana. METHODS A sample of 30, conveniently selected pregnant women, were involved in this study from April 11 to June 22, 2017. Data from three different focus group discussions were thematically analysed and presented based on an a posteriori inductive reduction approach. RESULTS The main findings were that pregnant women used herbal medicine, most commonly ginger, peppermint, thyme, chamomile, aniseeds, green tea, tealeaf, raspberry, and echinacea leaf consistently throughout the three trimesters of pregnancy. Cultural norms and health beliefs in the form of personal philosophies, desire to manage one's own health, illness perceptions, and a holistic healing approach were ascribed to the widespread use of herbs. CONCLUSION We recommend public education and awareness on disclosure of herbal medicine use to medical practitioners among pregnant women.
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Affiliation(s)
- Prince Peprah
- Department of Natural and Built Environment, Sheffield Hallam University, Sheffield, UK
| | - Williams Agyemang-Duah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Hayford Isaac Budu
- Department of Nursing, Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Mawuli Abalo
- School of Geography and the Environment, University of Oxford, South-Parks Road, Oxford, GB OX1 3QY UK
| | - Reforce Okwei
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Julius Nyonyo
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Khan M, Rehman H, Naveed S, Zaidi SF, Ayaz S, Owais A, Usmanghani K. Chewable cough tablets with improved palatability: A comparative phase II clinical trial. Pak J Pharm Sci 2019; 32:339-343. [PMID: 30829213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cough is the common disease condition which affects patients of every age. Numerous OTC medications available in community pharmacies however no antiviral treatment and even antibiotics has been shown to be effective without pre-existing lung infection. The treatment approach of medicinal herbs has been recognized for many decades and even longer for the treatment and prevention of cough. The aim of this study was to evaluate the safety and efficacy of Mukalbion poly herbal chewable tablets for the treatment of cough with improved palatability against a marketed brand (Poly herbal). For the formulation development of test group, the herbs were supplied by the Procurement department of Herbion Pakistan Pvt. Ltd. Althea officinalis (roots), Hedera helix (leaves) and Sisymbrium irio (seeds) were used for the manufacturing of Mukalbion (poly herbal, test group) chewable tablet. The comparative control clinical trial was carried out during a time frame of 07 months with sample size of 70 patients as per epidemiological software for sample size and each group contained 35 (±5) patients. Chewable tablets were administered and evaluated for effectiveness after 15 days of treatment. The data were collected by the patients through clinical trial questionnaire. The validated quality of life questionnaire (LCQ) was also used for assessment. The results were analyzed by applying paired sample T test by using IBM SPSS version 20.00. The p value was <0.005 at 95% confidence interval for cough variables including cough bouts, viscosity of sputum, chest congestion, sore throat and shortness of breath. The LCQ cough scale score was higher in test group as compared to control group. The test group also showed well tolerated in term of palatability. None of the patient claimed any of the side effects and no compliance were observed against the marketed brand.
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Affiliation(s)
- Mehwish Khan
- Department of Pharmacognosy, Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
| | - Hina Rehman
- Department of Pharmacy Practice, Institute of Pharmaceutical Sciences, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Safila Naveed
- Department of Pharmacognosy, Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan
| | - Syed Faisal Zaidi
- Department of Basic Medical Sciences, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Kingdom of Saudi Arabia / King Abdullah International Medical Research Centre, Jeddah, Saudi Arabia
| | - Sultan Ayaz
- Department of Eastern Medicine, GC University, Faisalabad, Pakistan
| | - Aymen Owais
- College of Eastern Medicine, Jinnah University for Women, Karachi, Pakistan
| | - Khan Usmanghani
- Department of Pharmacognosy, Faculty of Pharmacy, Jinnah University for Women, Karachi, Pakistan / College of Eastern Medicine, Jinnah University for Women, Karachi, Pakistan
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Mazzari ALDA, Keating JJ, Sahm LJ. Understanding the factors that influence the consumption of herbals amongst pregnant women. J Ethnopharmacol 2018; 227:246-247. [PMID: 30179712 DOI: 10.1016/j.jep.2018.08.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Affiliation(s)
- André Luís Dias Araujo Mazzari
- Department of Pharmaceutical and Biological Chemistry, University College London (UCL) School of Pharmacy, London, UK; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - John James Keating
- Analytical & Biological Chemistry Research Facility (ABCRF), School of Pharmacy and School of Chemistry, University College Cork, Cork, Ireland.
| | - Laura Jane Sahm
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
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Abstract
BACKGROUND Studies focusing on plants used medicinally to heal and manage rhinitis are very scarce in Africa and elsewhere. OBJECTIVES To document plants used by traditional healers (THs) in the treatment and management of rhinitis and related symptoms in the Limpopo Province of South Africa. METHODS Data was gathered using a semi structured interviews with 105 THs in the Limpopo Province, supplemented by field expeditions for plant specimen collection and observation. RESULTS 63 plant species from 59 genera distributed across 40 botanical families, mainly the Asteraceae (7 spp.) and Euphorbiaceae (6 spp.) were therapeutically used by THs. Overall, 77 herbal recipes (87%=mono and 12.9%=poly), mainly prepared from roots (55.5%) and leaves (19%) were recorded. Most of these recipes were processed via pounding (59.7%) and boiling (20.7%). Oral (44.1%) and nasal (33.7%) was the preferred modes of dispensing remedies by THs. Artemisia afra, Clerodendrum ternatum, Cryptocarya transvaalensis, Enicostema axillare, Kalanchoe brachyloba, Lasiosiphon caffer, Lippia javanica, Schkuhria pinnata, Securidaca longepedunculata, Spirostachys africana, Stylochaeton natalensis and Zanthoxylum capense were the most widely used and preferred species for treatment of rhinitis and/or related symptom by all questioned THs. CONCLUSION This study is the first to document plants used traditionally to treat rhinitis in Africa. Therefore, it provides a baseline data on the plants used to heal rhinitis in the Limpopo Province. Finding of this study can be used as apedestal for further investigation in to effective plant-based anti-rhinitis drugs.
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Affiliation(s)
- Sebua Silas Semenya
- Technology Transfer office, Research Administration and Development Department, University of Limpopo, Private Bag X1106, Sovenga 0727, South Africa
- Medicinal Plants and Economic Development (MPED) Research Centre, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
| | - Alfred Maroyi
- Medicinal Plants and Economic Development (MPED) Research Centre, Department of Botany, University of Fort Hare, Private Bag X1314, Alice 5700, South Africa
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Stavropoulos K, Sotiriadis A, Patoulias D, Imprialos K, Dampali R, Athyros V, Dinas K. Pseudohyperaldosteronism due to mumijo consumption during pregnancy: a licorice-like syndrome. Gynecol Endocrinol 2018; 34:1019-1021. [PMID: 29933704 DOI: 10.1080/09513590.2018.1480713] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Herbal supplements are widely used during pregnancy, although there are insufficient data regarding their efficacy and safety. Some of them have been associated with hypertension, including licorice, which induces the so called mineralocorticoid-excess syndrome, a clinical picture resembling to pseudohyperaldosteronism. This action is mediated via inhibition of 11-hydroxysteroid dehydrogenase type 2 (11-HSD2), leading to impaired inactivation of cortisol to cortisone, accumulation of cortisol, and finally to excessive mineralocorticoid activity, especially in the distal and cumulative tubule of kidneys. This syndrome is characterized by hypertension and hypokalemia. Herein, we report a case of a 37-year-old pregnant woman, who was referred from obstetrics department to our department due to persistent hypertension and hypokalemia. She consumed a herbal supplement called "mumijo" during the last 6 months. After a thorough diagnostic work-up, the diagnosis of a "licorice-like syndrome" due to mumijo consumption was made. Potassium supplementation at the acute phase and discontinuation of mumijo were the treatment of choice. This is the first report of pseudohyperaldosteronism due to mumijo consumption in literature. Clinicians should be aware of this side effect and this agent should be included in those causing pseudohyperaldosteronism. Besides all, our case highlights the undeniable value of a detailed medical history.
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Affiliation(s)
- Konstantinos Stavropoulos
- a 2nd Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki Hospital General Hippokration , Thessaloniki , Greece
| | - Alexandros Sotiriadis
- b 2nd Department of Obstetrics and Gynecology , Aristotle University of Thessaloniki, Hippokration General Hospital , Thessaloniki , Greece
| | - Dimitrios Patoulias
- a 2nd Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki Hospital General Hippokration , Thessaloniki , Greece
| | - Konstantinos Imprialos
- a 2nd Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki Hospital General Hippokration , Thessaloniki , Greece
| | - Roxani Dampali
- b 2nd Department of Obstetrics and Gynecology , Aristotle University of Thessaloniki, Hippokration General Hospital , Thessaloniki , Greece
| | - Vasileios Athyros
- a 2nd Propedeutic Department of Internal Medicine , Aristotle University of Thessaloniki Hospital General Hippokration , Thessaloniki , Greece
| | - Konstantinos Dinas
- b 2nd Department of Obstetrics and Gynecology , Aristotle University of Thessaloniki, Hippokration General Hospital , Thessaloniki , Greece
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Zhu J, Seo JE, Wang S, Ashby K, Ballard R, Yu D, Ning B, Agarwal R, Borlak J, Tong W, Chen M. The Development of a Database for Herbal and Dietary Supplement Induced Liver Toxicity. Int J Mol Sci 2018; 19:E2955. [PMID: 30274144 PMCID: PMC6213387 DOI: 10.3390/ijms19102955] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/10/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
The growing use of herbal dietary supplements (HDS) in the United States provides compelling evidence for risk of herbal-induced liver injury (HILI). Information on HDS products was retrieved from MedlinePlus of the U.S. National Library of Medicine and the herbal monograph of the European Medicines Agency. The hepatotoxic potential of HDS was ascertained by considering published case reports. Other relevant data were collected from governmental documents, public databases, web sources, and the literature. We collected information for 296 unique HDS products. Evidence of hepatotoxicity was reported for 67, that is 1 in 5, of these HDS products. The database revealed an apparent gender preponderance with women representing 61% of HILI cases. Culprit hepatotoxic HDS were mostly used for weight control, followed by pain and inflammation, mental stress, and mood disorders. Commonly discussed mechanistic events associated with HILI are reactive metabolites and oxidative stress, mitochondrial injury, as well as inhibition of transporters. HDS⁻drug interactions, causing both synergistic and antagonizing effects of drugs, were also reported for certain HDS. The database contains information for nearly 300 commonly used HDS products to provide a single-entry point for better comprehension of their impact on public health.
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Affiliation(s)
- Jieqiang Zhu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Ji-Eun Seo
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Sanlong Wang
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
- National Center for Safety Evaluation of Drugs, National Institutes for Food and Drug Control, China's State Food and Drug Administration, Beijing 100176, China.
| | - Kristin Ashby
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Rodney Ballard
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Dianke Yu
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Baitang Ning
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Rajiv Agarwal
- Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Jürgen Borlak
- Center of Pharmacology and Toxicology, Hannover Medical School, 30625 Hannover, Germany.
| | - Weida Tong
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
| | - Minjun Chen
- Division of Bioinformatics and Biostatistics, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, AR 72079, USA.
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Roe AL, McMillan DA, Mahony C. A Tiered Approach for the Evaluation of the Safety of Botanicals Used as Dietary Supplements: An Industry Strategy. Clin Pharmacol Ther 2018; 104:446-457. [PMID: 29882956 PMCID: PMC6175063 DOI: 10.1002/cpt.1132] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 05/23/2018] [Indexed: 12/20/2022]
Abstract
Exposure to botanicals in dietary supplements is increasing across many geographies; with increased expectations from consumers, regulators, and industry stewards centered on quality and safety of these products. We present a tiered approach to assess the safety of botanicals, and an in silico decision tree to address toxicity data gaps. Tier 1 describes a Threshold of Toxicologic Concern (TTC) approach that can be used to assess the safety of conceptual levels of botanicals. Tier 2 is an approach to document a history of safe human use for botanical exposures higher than the TTC. An assessment of botanical-drug interaction (BDI) may also be necessary at this stage. Tier 3 involves botanical chemical constituent identification and safety assessment and the in silico approach as needed. Our novel approaches to identify potential hazards and establish safe human use levels for botanicals is cost and time efficient and minimizes reliance on animal testing.
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Affiliation(s)
- Amy L. Roe
- The Procter and Gamble CompanyMason Business CenterCincinnatiOhioUSA
| | - Donna A. McMillan
- The Procter and Gamble CompanyMason Business CenterCincinnatiOhioUSA
| | - Catherine Mahony
- Procter and Gamble Technical Centres LtdGreater London Innovation CentreEghamUK
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