Fitovigilância: avaliação das interações e reações adversas de fitoterápicos no mercado / Phytosurveillance: evaluation of interactions and adverse reactions of herbal medicines on the market

Introdução: O uso de plantas medicinais como insumos farmacêuticos ativos vegetais (IFAV), bem como o uso de fitoterápicos e suas associações com outros medicamentos fitoterápicos e os insumos farmacêuticos ativos (IFA) sintéticos, pode resultar em interações que afetem a eficácia e o uso seguro desses. O principal meio de notificações de reação adversa a medicamento (RAM) é a voluntária, o que dificulta a identificação e o monitoramento dessas RAM e retrata a importância da farmacovigilância em nosso país, realçando a necessidade de fortalecimento da cultura de notificação de eventos adversos a medicamentos (EAM). Objetivo: Analisar a ocorrência de RAM relacionada ao uso simultâneo de cinco fitoterápicos a outros sintéticos, descrevendo as possíveis interações IFAV-IFA sintéticos. Método: Foi realizada pesquisa bibliográfica sobre as interações IFAV-IFA sintéticos e suas notificações de RAM pelos principais sistemas de farmacovigilância do mundo. Resultados: Os principais mecanismos de interação entre IFAV-IFA sintéticos envolvem a metabolização pelas enzimas da família CYP450 ou a ação de transportadores de efluxo como a gp-P. Além disso, grande parte dos EAM fitoterápicos podem não estar sendo notificados, gerando possível subnotificação dessas informações no mundo. Conclusões: Sobre RAM contendo IFAV de Ginkgo biloba, Hypericum perforatum, Matricaria recutita, Allium sativum e Zingiber officinale, foram relatados 7.571 no mundo, classificados por continente, no período de 1971 a agosto de 2021, bem como lista de espécies vegetais da lista do Renisus que apresentam efeitos relatados nas enzimas CYP (1A2, 2C9, 2C19, 2D6 e 3A4), níveis de GSH, UGT e atividade da gp-P.

Introduction: The use of medicinal plants as active plant pharmaceutical ingredients (APPIs) as well as the use of herbal medicines and their associations with other herbal medicines and synthetic active pharmaceutical ingredients (API) can result in interactions that affect the efficacy and safe use of these. The main means of reporting adverse drug reactions (ADR) is voluntary, which makes the identification and monitoring of these ADRs difficult and portrays the importance of pharmacovigilance in our country, highlighting the need to strengthen the culture of reporting adverse drug events (ADE). Objective: To analyze the occurrence of ADR related to the simultaneous use of five herbal medicines with other synthetics, describing possible synthetic APPI-API interactions. Method: A literature search was carried out on synthetic APPI-API interactions and their notifications of ADR by the main pharmacovigilance systems in the world. Results: The main interaction mechanisms between synthetic APPI-API involve the metabolism by enzymes of the CYP450 family or the action of efflux transporters such as P-gp. In addition, a large part of phytotherapeutic AEM may not be being notified, generating possible underreporting of this information in the world. Conclusions: On ADR containing APPI from Ginkgo biloba, Hypericum perforatum, Matricaria recutita, Allium sativum and Zingiber officinale, 7,571 were reported worldwide, classified by continent, in the period 1971 to August 2021, as well as the list of plant species on the list of RENISUS that have reported effects on CYP enzymes (1A2, 2C9, 2C19, 2D6 and 3A4), levels of GSH, UGT and P-gp activity.

Isolation of mitraphylline from Uncaria tomentosa (Willd. ex Schult.) DC. barks and development of spectrophotometric method for total alkaloids determination in Cat's Claw samples.

INTRODUCTION: The usual quality control for Uncaria tomentosa (Willd. ex Schult.) DC. barks requires highly specific analytical standards and methods based on high-performance liquid chromatography (HPLC), which impacts the costs of the analytical process and the final products. OBJECTIVE: To obtain an analytical reference standard of mitraphylline by isolation from U. tomentosa barks and develop a spectrophotometric method for determination of total alkaloids in samples of U. tomentosa. METHODOLOGY: An alkaloid-enriched extract was obtained by acid-base partition and mitraphylline was selectively precipitated using an 80:20 v/v toluene/hexane solution. The compound was characterised by HPLC-UV/DAD (diode-array detector), mass spectrometry, UV-visible, infrared (IR) and 1 H- and 13 C-nuclear magnetic resonance (NMR) spectroscopy. Sample preparation for the spectrophotometric method consisted of an extraction with boiling methanol (3 × 10 mL, 15 min), followed by a strong cation exchange solid phase extraction (SCX-SPE) clean-up. RESULTS: Mitraphylline with a purity of 98% was isolated in 0.05% m/m yield. All characterisation results were in agreement with previous published data. The spectrophotometric method showed linear range between 0.40 and 20 µg/mL; limits of detection and quantification of 0.15 and 0.49 µg/mg, respectively; dispersion of results lower than 5% for repeatability and intermediate precision; statistically proven accuracy by comparison with reference values obtained by Soxhlet and an HPLC-UV/DAD method; and robustness in relation to sample mass extracted and extraction time. CONCLUSION: The methods developed to obtain mitraphylline analytical standard from U. tomentosa barks and to determine total alkaloids by spectrophotometry provided a cheaper and faster quality control alternative for U. tomentosa samples.

Decontamination of Mikania glomerata Leaves by Gamma Irradiation: Coumarin Determination by HPLC-DAD, Microbiological Control and Genotoxicological Studies.

Gamma irradiation as a decontaminating physical agent could be an important tool in the production chain of herbal medicines by improving the microbiological quality of raw materials and the safety of final products. This study was undertaken to investigate the genotoxic potential and eventual chemical modifications of a batch of Mikania glomerata raw material decontaminated by different doses of gamma irradiation (2.0, 3.5, and 5.0 kGy), using a cesium-137 source. DNA damage was assessed in vitro by agarose gel electrophoresis in regard to double-chain breaks of plasmid pUC 9.1 DNA and in vivo by micronucleus test in bone marrow cells of Wistar rats. Cytotoxicity in bone marrows was assessed by scoring polychromatic and normochromatic erythrocytes ratio. An HPLC-DAD method was adapted and validated for the enhancement of coumarin selectivity from the other matrix constituents. The microbial load was satisfactorily reduced, leading to sterilization at the highest dose. Genotoxic and cytotoxic effects were not increased in the in vitro and in vivo models. The concentration of coumarin and the chromatographic profiles of the hydroalcoholic plant extracts (ethanol 70% v/v) were not modified after such process. Therefore, this work suggests that gamma irradiation of M. glomerata raw material is suitable and safe for microbiological control purposes at the employed doses.

A concessão de patentes de medicamentos fitoterápicos no Brasil: uma análise do período 1997-2004 / The concession of patents of phytoterapeuticals medicines in brazil: analysis of the period 1997-2004

Este trabalho aborda o problema do consumo desenfreado de produtos naturais no Brasil, especificamente de medicamentos fitoterápicos, com suas conseqüências, à luz do Direito de Propriedade Industrial e do Direito Sanitário. Procura relacionar o papel e a esponsabilidade do INPI e a ANVISA, órgãos diretamente envolvidos, segundo a legislação mencionada, na melhoria da qualidade de produtos fitoterápicos registrados e lançados no mercado brasileiro. Mostra a necessidade de uma reavaliação dos critérios de concessão de patentes para a área analisada, por parte do INPI, bem como uma maior aproximação da ANVISA junto a esse órgão, de modo a harmonizar estratégias para que a população tenha acesso a medicamentos fitoterápicos seguros e eficazes. Explicita as estratégias da indústria nacional do setor em alavancar suas vendas no mercado, através de projetos de lei que não traduzem a realidade preconizada pela OMS, para o uso da Medicina Tradicional/Complementar, contrariando a legislação brasileira para o possível registro dos produtos patenteados. Conclui-se que interesses econômicos ligados à acirrada concorrência no mercado de fitoterápicos e suplementos nutricionais induzem a concessão de patentes para tais produtos, em detrimento das diretrizes existentes na Lei de Propriedade Industrial brasileira, em critérios de avaliação