Herbal interactions with cardiovascular drugs.

The prevalence of herb-drug interactions has been exaggerated. Nonetheless, some herbs, including garlic, ginkgo, ginseng, and St John's wort, can have a significant influence on concurrently administered drugs. Herbal medicines may mimic, decrease, or increase the action of prescribed drugs. This can be especially important for drugs with narrow therapeutic windows and in sensitive patient populations such as older adults, the chronically ill, and those with compromised immune systems.

Potentiation of oral anticoagulation and hemarthrosis associated with nabumetone.

Concomitant therapy with warfarin and nonsteroidal antiinflammatory drugs (NSAIDs) is of concern due to the potential for increased bleeding. Nonsteroidal antiinflammatory drugs may alter patient response to warfarin by pharmacodynamic or pharmacokinetic interactions. A man receiving long-term, stable warfarin therapy experienced a significant increase in international normalized ratio 1 week after nabumetone was added to his regimen. Despite prompt reduction of the warfarin dosage, he experienced hemarthrosis of his right knee. Previous reports suggested lack of interaction between nabumetone and warfarin. Caution and close monitoring are advisable when the two agents are administered concomitantly.

The use of alternate-day lovastatin in hypercholesterolemic men.

OBJECTIVE: To quantitate the therapeutic effects of alternate-day lovastatin on serum lipoprotein values in a small group of men with primary hypercholesterolemia. DESIGN: Retrospective review of medical, pharmacy, and laboratory records. A paired Student's t-test was performed on absolute changes in lipoprotein values with an a priori p value less than or equal to 0.05 being statistically significant. SETTING: A lipid clinic within a tertiary care Department of Veterans Affairs Medical Center. PATIENTS: Twenty men (mean age 62.5 +/- 8.3 y) with mean +/- SD baseline low-density lipoprotein cholesterol (LDL-C) concentration of 161.3 +/- 21.9 mg/dL and triglyceride concentrations below 400 mg/dL. INTERVENTION: All patients had been prescribed lovastatin 20 mg every other day. MAIN OUTCOME MEASURES: The mean absolute and percent changes in lipoprotein values from baseline for patients receiving lovastatin 20 mg every other day and the percentage of patients attaining a target mean LDL-C concentration as defined by the National Cholesterol Education Panel Adult Treatment Panel II guidelines. RESULTS: Mean +/- SD total cholesterol and LDL-C were significantly reduced by 32.4 +/- 17.8 (14.0% +/- 7.8%) and 34.1 +/- 14.6 mg/dL (21.5% +/- 9.7%), respectively. No significant changes were seen in high- density lipoprotein cholesterol or triglycerides. Four of 20 patients (20%) attained a goal LDL-C concentration. CONCLUSIONS: Lovastatin 20 mg every other day may effectively lower LDL-C in some elderly men, and target LDL-C concentrations may be obtained in some patients.

Preparation and Immunological Properties of a Brilliant Blue-Protein Conjugate.

Brilliant Blue F.C.F. (BB), after purification to remove high molecular weight, blue-colored contaminants present in commercial preparations, was conjugated to bovine serum albumin (BSA). Phosphorus oxychloride was used to transform the sulfonate groups of BB to sulfonyl chloride groups; the product of this reaction was then allowed to react further with the protein. The conjugate thus prepared was purified by Sephadex G-25 column chromatography and found to contain 7 moles of BB per mole of BSA. Immunological studies in the rat indicated that neither IgE nor IgGa antibodies to BB could be detected in the sera of immunized animals. This would tend to suggest that BB possesses a low degree of allergenicity. However the possibility that some individuals under appropriate circumstances could respond with allergic manifestations to BB cannot be dismissed.