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Seventy-nine injectable herb extractions have been approved by the Chinese Food and Drug Administration (CFDA) and are frequently administered intravenously for various diseases. Unfortunately, herb-drug interactions are under-investigated and sometimes overlooked in the clinic. In the present investigation the in vitro inhibition of 9 drug metabolizing enzymes including CYP1A, CYP2A6, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6, CYP2E1, and CYP3A was assessed using an appropriate probe substrate for each enzyme with human liver microsomes. Metabolite formation was quantified using a validated and sensitive high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay. The IC50 of each herb extract was estimated using a concentration range from 5% to 0.5%, and the time-dependent inhibition of the nine CYP450 isoenzymes was also determined. Of the 79 approved iv herb injectables, 37 inhibited CYP1A, 24 inhibited CYP2A6, 41 inhibited CYP2B6, 36 inhibited CYP2C8, 31 inhibited CYP2C9, 41 inhibited CYP2C19, 13 inhibited CYP2D6, 25 inhibited CYP2E1, and 42 inhibited CYP3A with 50% or greater inhibition at a test concentration of 5% (v/v). IC50 differences were noted between pre-incubation or co-incubation assays with HLM for 30 min, with the time-dependent inhibitory (TDI) effects were observed with 2 injectables on CYP1A, 5 injectables on CYP2A6, 5 injectables on CYP2B6, 6 injectables on CYP2C8, 1 injectable on CYP2D6 and 6 injectables on CYP3A. Collectively, the results demonstrate that potential herb-drug interactions (HDIs) can occur with the concomitant use of herb injectables and prescription drugs that are cleared by CYP450 enzymes, and further investigation is warrant for the clinical relevance of these interactions.
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Second-line injectable drugs (kanamycin, amikacin and capreomycin) have been an integral part of the multidrug-resistant tuberculosis (MDR-TB) treatment regimen for decades, despite their known association with renal failure and ototoxicity. Unfortunately, there are many countries that haven't included new or reused drugs in their treatment regimens for MDR-TB and still depend on second-line injectable drugs (SLIDs) in order to have a sufficient amount of effective drugs in their regimens. Our purpose is to show the frequency and severity of the ototoxicity associated with the use of SLIDs only detected initially by means of an audiometry. We conducted a retrospective analysis including all the patients who received treatment regimens with SLIDs from 2010 to 2017 in a tuberculosis clinic in Mexico. 47 patients who received SLIDs (amikacin, kanamycin, capreomycin) were included in the analysis. The mean age was 40.3 ± 16.4 years. Thirty one patients (63.3%) had previously received TB treatment in the past. The most commonly used SLID was amikacin in 33 cases (67.3%), followed by capreomycin in 14 cases (28.6%). Twenty seven patients (55.1%) developed significant hearing loss (> 40 dB), and 13 patients (26.5%) developed severe or profound hearing loss (> 70 dB). Severe hearing loss is a common, irreversible and now unnecessary complication of the MDR/RR-TB (multidrug- and rifampicin-resistant tuberculosis) treatment, since the SLIDs may and shall be substituted by new and reused, more effective and far less toxic drugs.
Subject(s)
Therapeutics , TuberculosisABSTRACT
Background: Prescribing drugs for any disease is not complete until it is rationally done. Irrational prescriptions often lead to treatment failure, toxicity or drug interactions which may prove detrimental to the patient. Antibiotics are very much prescribed in day to day practice but their rational use prevents treatment failure, resistance.Methods: A cross sectional study was conducted in a tertiary care hospital to see the antibiotic prescribing pattern. Prescriptions were screened one time from different OPDs with prior permission from the doctor attending the respective OPD.Results: A total of 200 prescriptions were assessed out of which 121 had monotherapies prescribed, 79 had FDCs. Antibiotics were the most commonly prescribed drugs. Prescriptions having drug combinations were assessed and pantoprazole domperidone was the most commonly prescribed (32.91%).Conclusions: Drugs should be prescribed rationally for proper therapeutic benefit. It encourages the patient to properly use the medicine and properly comply to it.
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The WHO has developed medication use indicators, including prescription indicators with an aim to evaluate the services provided to the population in regard to medications. With the help of these indicators, there will be constant watch on drug prescribing pattern in health care to avoid irrational prescribing.
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@#Schizophrenia is a chronic, debilitating illness affecting around 21 million people globally. It is a severe form of mental health problem, affecting more individuals aged 15-35 years (late adolescence to early adulthood) and commonly found among males 1 • It is thought to result from a combination of genetic, environmental and psychosocial factors. In the Philippines, schizophrenia is the leading cause for mental health consultation and treatment in hospitals2 • Based from the Philippine Health Information System on Mental Health data gathered from 2014 to 2015 in 14 health facilities, around 42% out of 2,562 patients on record were diagnosed with schizophrenia. From this data, it is estimated that 1 % or around 1 million of the country's total population are affected by this disorder. Poor adherence to medication is a major cause of poor outcomes in patients with schizophrenia, with non-adherence as high as 50-74% in the initial phase of treatment3 - 5 • Nonadherence is associated with relapse, re-hospitalization and poor quality of life among individuals with the illness3 • While remission and ultimately, recovery, is the goal, the foundation of successful treatment is appropriate medication prescription and good adherence. The use of new generation, long-acting injectable (LAI) antipsychotic medications is one of the ways to improve patient's adherence to treatment by reducing frequency of administration and improving the consistency of drug delivery as well as bioavailability in the circulation 6.On January 25, 2018, Johnson and Johnson Philippines organized a symposium on LAI treatment during the 2018 International Congress of the Asian Federation of Psychiatric Associations (AFPA) and 44th Philippine Psychiatric Association Annual Convention at the Philippine International Convention Center, Pasay City. The purpose of the symposium was to discuss the role of long-acting antipsychotic medications in a comprehensive treatment approach for schizophrenia. A total of almost 300 psychiatrists and psychologists attended the activity. The aim of this special report is to present the discussion of the guest speaker Dr. Allan Tasman, and weigh the pros and cons of using long-acting injectable (LAI) antipsychotics as part of treatment for Filipino patients with schizophrenia. Dr. Tasman is an internationally known psychiatrist and advocate of integrative biopsychosocial treatment model within a comprehensive, collaborative system of care and innovation for psychiatric education and clinical services. He is currently professor and emeritus chairman of the Department of Psychiatry and Behavioral Sciences at the University of Louisville, and Schwab Endowed Chair in Social and Community Psychiatry. The primary objectives of Dr. Tasman's presentation were to: (1) review comprehensive treatment approaches in schizophrenia, keeping in mind up-to-date medication management as the foundation of treatment; and (2) use evidence-based practice in maximizing the likelihood of recovery in patients with schizophrenia.
Subject(s)
SchizophreniaABSTRACT
OBJECTIVES: This study investigated whether long-acting injectable (LAI) paliperidone is different from its oral form in terms of the effect on cognitive function in schizophrenia spectrum and other psychotic disorders. METHODS: We reviewed the medical records of patients in Seoul National University Bundang Hospital who were diagnosed as having schizophrenia and/or other psychotic disorders based on DSM-5 from 2016 to 2017. Seven patients were treated with oral paliperidone and 11 were treated with paliperidone palmitate. All patients underwent clinical and neuropsychological assessment, including the Korean version of the MATRICS Consensus Cognitive Battery (MCCB) at their first visit or within one month of their initial treatment. MCCB was repeated within three to 12 months after the initial assessment. RESULTS: There was no significant difference between the two groups in most cognitive domains including speed of processing, attention and vigilance, working memory, verbal learning, visual learning and reasoning and problem solving domain. However, patients treated with paliperidone palmitate showed better improvement in social cognition domain than those taking oral paliperidone. The standardized values of social cognition domain scores had significantly improved over time in patients under paliperidone palmitate, demonstrating a significant time-by-group interaction. CONCLUSION: Our results show that long-acting injectable paliperidone could be helpful in some aspects of improving cognitive function in schizophrenia spectrum and other psychotic disorders. Further studies with other antipsychotics are necessary to generalize the results.
Subject(s)
Humans , Antipsychotic Agents , Cognition , Consensus , Learning , Medical Records , Memory, Short-Term , Paliperidone Palmitate , Pilot Projects , Problem Solving , Psychotic Disorders , Schizophrenia , Schizophrenia Spectrum and Other Psychotic Disorders , Seoul , Verbal LearningABSTRACT
PURPOSE: There have only been a few studies on optimal usage of injection material in the regional nerve block for lower extremity operations. The purpose of this study was to evaluate the efficacy of different concentrations of ropivacaine. MATERIALS AND METHODS: A total of 339 patients underwent lower extremity surgery under ultrasound-guided nerve block (combined femoral and sciatic nerve block) at a Chungnam National University Hospital between March 2016 and February 2017 and were randomly assigned to three groups: Group A (0.5%, 44 ml), group B (0.6%, 30 ml), and group C (0.75%, 30 ml). The interval between nerve block procedure and onset of the complete anesthetic effect (complete anesthetic time) was investigated. The degrees of intraoperative pain, and postoperative pain were evaluated using a visual analogue scale (VAS) score. Patient's satisfaction (0–10) was investigated. To evaluate the efficacy in accordance with the concentration under the same dose and same volume, group A and B were compared with group C respectively. RESULTS: There were 108, 118, and 113, in groups A, B, and C, respectively; and there were no significant differences with respect to the number, age, sex, and type of operation (p>0.05). The mean complete anesthetic times were 78.5, 76.4, and 58.6 minutes, respectively. The mean intraoperative VAS scores were 2.04, 0.62, and 0.24; and the mean postoperative VAS scores (6 hours/12 hours) were 2.41/4.08, 0.27/1.24, and 0.38/1.54. The mean patient's satisfactory scores were 8.53, 9.38, and 9.40, respectively. Compared with group C, group A showed significantly longer complete anesthetic time (p 0.05). Patient's satisfactory scores in both group A and B were similar to group C (p>0.05, p>0.05). There were no specific adverse reactions in all groups. CONCLUSION: Ropivacaine 0.6% as well as 0.75% are safe and effective anesthetics under the same volume (30 ml) for regional nerve block of the lower extremity. However, taking into account of the longer complete anesthetic time, the operation start time must be adjusted.
Subject(s)
Humans , Anesthetics , Femoral Nerve , Lower Extremity , Nerve Block , Pain, Postoperative , Prospective Studies , Sciatic Nerve , UltrasonographyABSTRACT
Ceftazidime is a broad spectrum antibiotic administered mainly by the parenteral route, and it is especially effective against Pseudomonas aeruginosa. The period of time in which serum levels exceed the Minimum Inhibitory Concentration (MIC) is an important pharmacodynamic parameter for its efficacy. One of the forms to extend this period is to administer the antibiotic by continuous infusion, after prior dilution in a Parenteral Solution (PS). The present work assessed the stability of ceftazidime in 5% glucose PS for 24 hours, combined or not with aminophylline, through High Performance Liquid Chromatography (HPLC). The physicochemical evaluation was accompanied by in vitro antimicrobial activity compared MIC test in the 24-hour period. Escherichia coli and Pseudomonas aeruginosa were the microorganisms chosen for the MIC comparison. The HPLC analysis confirmed ceftazidime and aminophylline individual stability on PS, while the MIC values were slightly higher than the mean described in the literature. When both drugs were associated in the same PS, the ceftazidime concentration by HPLC decreased 25% after 24 hours. Not only did the MIC values show high loss of antibiotic activity within the same period, but also altered MIC values immediately after the preparation, which was not detected by HPLC. Our results indicate that this drug combination is not compatible, even if used right away, and that PS might not be the best vehicle for ceftazidime, emphasizing the importance of the MIC evaluation for drug interactions.
Ceftazidima é um antimicrobiano administrado por via parenteral, que apresenta amplo espectro de ação, principalmente contra Pseudomonas aeruginosa. O tempo em que a concentração sérica de ceftazidima permanece acima da concentração mínima inibitória (MIC) é um importante parâmetro farmacodinâmico para a determinação da eficácia antimicrobiana e pode ser potencializado através da utilização de infusão contínua em soluções parenterais (PS). Este artigo visa a avaliar a estabilidade da ceftazidima em solução de glicose 5%, na presença e na ausência do fármaco aminofilina, através de cromatografia líquida de alta eficiência HPLC e MIC durante o período de 24 horas. Os microorganismos selecionados para a determinação do MIC foram Escherichia coli e Pseudomonas aeruginosa. Os ensaios em cromatógrafo líquido confirmaram a estabilidade dos fármacos ceftazidima e aminofilina quando são individualmente associados em PS, enquanto os valores de MIC ficaram maiores que os valores encontrados na literatura. Quando ambos os fármacos foram associados na mesma solução parenteral a concentração de ceftazidima obtida por HPLC diminuiu 25% depois de 24 horas. Os valores de MIC mostraram maior decaimento da atividade antimicrobiana neste mesmo período e também valores de MIC alterados nas soluções preparadas no tempo zero, decaimento este que não foi detectado em HPLC. Os resultados indicaram incompatibilidade na associação dos fármacos em PS, enfatizando a importância dos resultados de MIC para interações de fármacos.
Subject(s)
Ceftazidime/analysis , Aminophylline/analysis , Pharmaceutical Preparations/analysis , Microbial Sensitivity Tests , Chromatography, High Pressure Liquid , GlucoseABSTRACT
Introdução: A toxina botulínica é opção importante para o tratamento das rugas faciais dinâmicas. A toxina botulínica Lanzhou tipo A (LBTX-A) foi introduzida na China no início da década de 1990 e aprovada no Brasil em 2003. Objetivo: Avaliar a efi cácia e a tolerabilidade de LBTX-A para tratamento estético de rugas dinâmicas na parte superior da face. Materiais e Métodos: Em um estudo multicêntrico prospectivo com rótulo aberto, 110 indivíduos dos dois gêneros (idades de 25 a 65 anos) foram tratados com um total de 53 U de LBTX-A cada, distribuídos em 15 locais nos músculos frontal, corrugador, prócero e lateral ocular da órbita. Os pacientes foram revisados sete vezes no intervalo de 180 dias. A efi cácia foi avaliada por eletromiografi a, análise fotográfi ca e pelas opiniões do investigador e do paciente. A tolerabilidade foi avaliada pela incidência de eventos adversos. Resultados: Duas semanas depois das injeções, 94% dos pacientes tratados consideraram o resultado bom ou excelente. Na maioria dos casos, os resultados se prolongaram por 90 dias. Depois da injeção, quase todos os pacientes informaram dor leve ou ausência de dor e efeitos colaterais mínimos e reversíveis, como edema facial (seis pacientes), sensação de entumescimento facial (três pacientes) e ptose palpebral (dois pacientes). Conclusões: LBTX-A é efi ciente e bem tolerado para tratamento das linhas faciais dinâmicas.
Introduction: The botulinum toxin is a valuable option for the treatment of dynamic facial wrinkles. The Lanzhou botulinum toxin type A (LBTX-A) was introduced in China in the early 90's and approved in Brazil in 2003. Objective: Evaluate the effi cacy and tolerability of LBTX-A for the cosmetic treatment of dynamic wrinkles of the upper face. Material and Methods: In a prospective, open-label, multicenter study, 110 subjects of both sexes (aged from 25 to 65 years) were treated with a total of 53 U of LBTX-A each, distributed in fi fteen sites in the frontal, corrugator, procerus, orbicular ocular lateral muscles. The patients were reviewed 7 times within 180 days. Effi cacy was assessed by electromyography, photographic analysis and the investigator's and patient's opinions. Tolerability was assessed by the incidence of adverse events. Results: Two weeks post-injection, 94% of the treated patients considered the result as good or excellent. Results lasted 90 days in most cases. After injection, most patients reported mild or no pain, and minimal and reversible side effects as facial edema (6 patients), stuffi ness feeling (3 patients) and eyelid ptosis (2 patients). Conclusions: We conclude that LBTX-A is effi cient and well tolerated for the treatment of dynamic facial lines.
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This is a presentation of the management of the nasal deformity due to injectables based on some cases operated on. Out of 128 deformed cases seen in SAYOC EENT CLINIC, 89 were injected into the nose, 59 with paraffin and 30 with Sakurai fluid. The injections were mostly done by cosmetologists although there are few doctors and dentist. It is a sad fact that the procedures has been tolerated by the agencies and authorities concerned inspite of the reported dangers and complications. (Summary)