Efficacy and safety of Puerarin injection on acute heart failure: A systematic review and meta-analysis.

Objective: This study aimed to assess the adjunctive efficacy and safety of Puerarin injection (PI) on acute heart failure (AHF) based on a systematic review and meta-analysis. Methods: Nine databases were searched from March 1990 to March 2022 to identify randomized controlled trials (RCTs) related to the adjunctive treatment of PI for AHF. The Cochrane collaboration tool was used to assess the risk of bias in the included studies. Meta-analysis and subgroup and sensitivity analyses were conducted by RevMan 5.3 software. The evidence's certainty was evaluated by grading recommendations assessment, development, and evaluation (GRADE) methods. Results: A total of 8 studies were included with a total of 614 patients with AHF. The meta-analysis demonstrated that adjunctive treatment with PI on AHF was superior to conventional medicine alone. It increased the total effective rate (RR = 1.38; 95% CI, 1.22-1.55; p < 0.001) and improved left ventricular ejection fraction [SMD = 0.85; 95% CI (0.62, 1.09); p < 0.001]. Regarding safety, a total of 11.9% (23/194) adverse reactions were observed in the PI group and 9.8% (19/194) adverse reactions in the control group, and there were no significant differences in the incident rate of adverse events between both groups [RR = 1.16; 95% CI (0.66-2.05); p = 0.061]. The outcomes' evidentiary quality was assessed as "moderate." Conclusion: PI had an adjunctive effect on AHF combined with conventional medicine, and it seemed to be safe and more effective than the conventional medical treatment alone for improving the total clinical effective rate and left ventricular ejection fraction. But further well-designed RCTs are required to confirm the efficacy and safety of XBP in treating AHF due to the poor methodological quality of the included RCTs. Systematic Review Registration: [https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=327636], identifier [CRD42022327636].

A Systematic Review and Meta-Analysis on the Efficacy of Puerarin Injection as Adjunctive Therapy for Unstable Angina Pectoris.

Background: As adjunctive therapy, puerarin injection has been widely applied for the treatment of unstable angina pectoris (UAP) in China during the past decades. However, the efficacy of puerarin injection as adjunctive therapy for UAP has not been well confirmed. The purpose of this meta-analysis was to summarize the available evidence to estimate the efficacy of puerarin injection in treating UAP. Objective: A systematic review and meta-analysis with subgroup analysis and sensitivity analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principle were carried out to evaluate the efficacy of puerarin injection as adjunctive therapy in treating UAP. Methods: To obtain the published randomized controlled trials (RCTs) on puerarin injection, databases, namely, China National Knowledge Infrastructure (CNKI), Wanfang Database, Chinese Biomedical Literature Database, Sino-Med, PubMed, China Science and Technology Journal Database (VIP), Medline, Google Scholar, Cochrane Library, Chinese Science Citation Database, and Embase were systematically searched until June 2021. In this meta-analysis, Review Manager version 5.3 software and Stata version 12.0 software were employed to analyze the collected data. Based on the methodological quality, years of publications, sample size and dosages, sensitivity analysis, and subgroup analysis were performed. The GRADE assessment was conducted by the software GRADEpro version 3.6 software. Results: A total of 17 RCTs involving 1,459 patients were included in this meta-analysis. Results indicated that puerarin injection as adjunctive therapy was more superior than conventional Western medicine alone in reducing angina symptoms [risk ratio (RR) = 1.22, 95% CI 1.16 to 1.28, Z = 8.11, p < 0.00001] and improving ECG (RR = 1.32, 95% CI 1.20 to 1.44, Z = 6.00, p < 0.00001), meanwhile reducing the frequency of angina attack [mean difference (MD) = -2.22, 95% CI -2.53 to -1.90, Z = 13.97, p < 0.00001] and the duration of angina attack (MD = -2.00, 95% CI -2.39 to -1.61, Z = 9.99, p < 0.00001) for the treatment of UAP. Results from the GRADE assessment suggested that the comprehensive quality of this evidence was low. Conclusion: This meta-analysis indicated that puerarin injection was more effective than using conventional Western medicine alone in the treatment of UAP. However, because of the low methodological quality of the included RCTs, more evidence was still needed to verify the efficacy of puerarin injection.

[Evaluation on safety of puerarin injection in clinical use].

Puerarin injection is commonly used in clinical treatment of coronary heart disease, angina pectoris, retinal artery, vein occlusion, sudden deafness and so on. This paper is aimed to evaluate the safety of puerarin injection in clinical use and explore the related factors that may cause its adverse reactions (ADRs), so as to find the warning signal of safety medication in time, put forward early warning, make early judgment and treatment, and ensure the safety of drug use. By strengthening surveillance, the best medication plan was established to prevent the occurrence of adverse reactions of puerarin injection and enhance people's awareness on the safety of puerarin injection. Database were searched to collect literature related to ADRs of puerarin injection. The data were extracted and analyzed by decision tree with treeage software and χ² test was used to verify the data. A total of 62 papers involving 129 cases were included. The results showed that ADRs occurred mostly in patients aged 50-79 years, with the immune system and blood system accounting for the majority (88.3%), and ADRs occurred mostly 48 h after drug administration (61.1%). The severity of ADRs was not related to the dosage of puerarin, but it was related to the choice of the infusion solvent. In puerarin injection, most of the ADRs were moderate or severe (64.3%), 13 out of 129 cases were of death. Therefore, the indications and methods of use should be strictly controlled, and the allergic history of patients should be carefully questioned before medication to strengthen the monitoring of drug use.

[Effects of chloride channels on hemolysis induced by puerarin injection].

OBJECTIVE: To observe the effects of blocking and activating chloride channels on hemolysis induced by puerarin injection in rabbits and to investigate the roles of chloride channels in hemolytic reaction induced by puerarin injection. METHODS: Rabbit erythrocyte suspension was incubated with different concentrations of puerarin injection(0.75, 1.5, 3, 6, 12 mg/ml) at 37oC for 6 hours. The cell imaging system was employed to observe whether puerarin injection induced hemolysis. The hemolysis rate was detected by microplate reader and flow cytometry. Effects of activating and closing chloride channels on the hemolysis induced by puerarin injection were explored. RESULTS: Puerarin injection could induce the hemolysis of rabbit erythrocytes in vitro. In the range of 1.5 mg/ml~12 mg/ml, puerarin injection could induce hemolysis in a concentration-dependent manner (n=3, P<0.01). The chloride channel blockers tamoxifen (20 µmol/L) and ATP (10 mmol/L) significantly inhibited the hemolysis induced by puerarin injection (n=3~5, P<0.01). Application of low concentration ATP (50 µmol/L) to activate the chloride channel significantly increased puerarin injection induced hemolysis (n=4, P<0.01). CONCLUSIONS: The hemolytic effect of puerarin injection is dose-dependent in vitro, and the activation of chloride channel is closely related to the hemolysis induced by puerarin injection.

Evaluation on safety of puerarin injection in clinical use / 中国中药杂志

Puerarin injection is commonly used in clinical treatment of coronary heart disease, angina pectoris, retinal artery, vein occlusion, sudden deafness and so on. This paper is aimed to evaluate the safety of puerarin injection in clinical use and explore the related factors that may cause its adverse reactions (ADRs), so as to find the warning signal of safety medication in time, put forward early warning, make early judgment and treatment, and ensure the safety of drug use. By strengthening surveillance, the best medication plan was established to prevent the occurrence of adverse reactions of puerarin injection and enhance people's awareness on the safety of puerarin injection. Database were searched to collect literature related to ADRs of puerarin injection. The data were extracted and analyzed by decision tree with treeage software and ² test was used to verify the data. A total of 62 papers involving 129 cases were included. The results showed that ADRs occurred mostly in patients aged 50-79 years, with the immune system and blood system accounting for the majority (88.3%), and ADRs occurred mostly 48 h after drug administration (61.1%). The severity of ADRs was not related to the dosage of puerarin, but it was related to the choice of the infusion solvent. In puerarin injection, most of the ADRs were moderate or severe (64.3%), 13 out of 129 cases were of death. Therefore, the indications and methods of use should be strictly controlled, and the allergic history of patients should be carefully questioned before medication to strengthen the monitoring of drug use.

Effects of chloride channels on hemolysis induced by puerarin injection / 中国应用生理学杂志

OBJECTIVE@#To observe the effects of blocking and activating chloride channels on hemolysis induced by puerarin injection in rabbits and to investigate the roles of chloride channels in hemolytic reaction induced by puerarin injection.@*METHODS@#Rabbit erythrocyte suspension was incubated with different concentrations of puerarin injection(0.75, 1.5, 3, 6, 12 mg/ml) at 37C for 6 hours. The cell imaging system was employed to observe whether puerarin injection induced hemolysis. The hemolysis rate was detected by microplate reader and flow cytometry. Effects of activating and closing chloride channels on the hemolysis induced by puerarin injection were explored.@*RESULTS@#Puerarin injection could induce the hemolysis of rabbit erythrocytes . In the range of 1.5 mg/ml~12 mg/ml, puerarin injection could induce hemolysis in a concentration-dependent manner (=3, <0.01). The chloride channel blockers tamoxifen (20 μmol/L) and ATP (10 mmol/L) significantly inhibited the hemolysis induced by puerarin injection (=3~5, <0.01). Application of low concentration ATP (50 μmol/L) to activate the chloride channel significantly increased puerarin injection induced hemolysis (=4, <0.01).@*CONCLUSIONS@#The hemolytic effect of puerarin injection is dose-dependent , and the activation of chloride channel is closely related to the hemolysis induced by puerarin injection.

Analysis of the Clinical Observation of Puerarin Injection for Elderly Female Patients with Osteoporosis and Unstable Angina Pectoris / 中国药房

OBJECTIVE:To explore therapeutic efficacy and safety of Puerarin injection for elderly female patients with osteo-porosis and unstable angina pectoris,and its effects on serum inflammatory factors. METHODS:Totally 107 elderly women with osteoporosis and unstable angina were analyzed retrospectively and divided into control group(53 cases)and observation group(54 cases) according to drug use. Control group was given routine treatment as Caltrate D,Alendronate sodium tablet,Glyceryl trini-trate tablet ,Metoprolol tartrate tablet,Atorvastatin calcium tablet,Trimetazidine hydrochloride tablet. On the basis of control group, observation group was additionally given Puerarin injection 4 mL added into 5% Glucose injection 500 mL intravenously,once a day. Treatment course of 2 groups lasted for 2 weeks. Therapeutic efficacies of 2 groups were observed as well as the levels of se-rum inflammatory factors(hs-CRP,TNF-α,MMP-9,sCD40L),and the occurrence of ADR. RESULTS:The total response rates of angina pectoris and osteoporosis pain in observation group were significantly higher than control group,with statistical signifi-cance (P0.05). After treatment,the levels of hs-CRP,TNF-α,MMP-9 and sCD40L in 2 groups were significantly lower than before,and the observation group was significantly lower than the control group,with statistical sig-nificance(P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:Based on routine treatment,Pu-erarin injection shows significant therapeutic efficacy for senile female osteoporosis patients with unstable angina and can significant-ly reduce the levels of serum inflammatory factors with good safety.

Puerarin injection for treatment of unstable angina pectoris: a meta-analysis and systematic review.

BACKGROUND: Puerarin is an effective ingredient isolated from Radix Puerariae, a leguminous plant. In China, a large number of early studies suggest that puerarin may be used in the treatment of coronary heart disease. In recent years, puerarin injection has been widely used to treat coronary heart disease and angina pectoris. OBJECTIVE: To systematically evaluate the clinical efficacy and safety of puerarin injection in the treatment of unstable angina pectoris (UAP). METHODS: Data were retrieved from digital databases, including PubMed, Excerpt Medica Database (EMBASE), China Biology Medicine (CBM), the Cochrane Library, and Chinese databases. RESULTS: Compared with patients who were treated with conventional Western medicines alone, the patients who were treated with conventional Western medicines in combination with puerarin injection exhibited significant improvements in the incidence of angina pectoris, electrocardiogram findings, nitroglycerin consumption and plasma endothelin levels. CONCLUSIONS: Strong evidence suggests that, the use of puerarin in combination with conventional Western medicines is a better treatment option for treating UAP, compared with the use of conventional Western medicines alone.

Chronopharmacokinetics of puerarin in diabetic rats.

Puerarin injection has been widely used for clinic treatment of diabetes recently. To assess the relationship between the administration time of puerarin and the blood concentration of puerarin as well as its pharmacokinetic parameters, the diabetic rat model was used in current study. The rats were randomly divided into morning and evening groups according to the administration time. After the puerarin injection, blood glucose was tested in order to know whether the efficiency of puerarin was influenced by its concentration and pharmacokinetic parameters. Our results show that the average concentration of puerarin in the evening group is significantly higher than that in the morning group. The numbers of t1/2α, t1/2ß, CL and AUC(0-∞) are significantly different between the morning and evening groups. The blood glucose level in the evening group was lower than that in the morning group. The speed of its onset is higher and the blood glucose level declines much more significantly in the evening group. These findings suggest that the concentration and pharmacokinetic parameters of puerarin affect its efficiency in diabetic rats. Therefore, it might be better to give puerarin in evening than in the morning for the mellitus treatment.

A clinical efficacy and safety study on coronary heart disease and angina treatment with Puerarin Injection / 中华流行病学杂志

Objective To observe the clinical efficacy and safety of Puerarin Injection treatment on angina pectoris.Methods 388 patients with angina pectoris,enrolled to Tianjin Fourth Central Hospital during January 2009 and February 2011 were selected and randomly divided into treatment or control groups with 194 patients of each.Based on the conventional therapy program,one group was given Puerarin Injection as treatment group while,the other was given with Danshen Injection as control group.Clinical efficacy,the attack rate of angina pectoris,oxygen consumption,iadices on electrocardiogram,haemorheology and other adverse reactions among the two groups were compared.Results The total efficacy of the treatment group (88.14％,171/194)was significantly higher than the control group (61.86％,120/194) and the difference was statistically significant (P＜0.05).During the treatment,no significant adverse events were noticed in both of the two groups of patients.Conclusion The Puerarin Injection treatment program on angina pectoris seemed effective and safe.

Clinical observation of acupuncture combined with puerarin injection in the treatment of patients with sudden deafness / 中国基层医药

Objective To explore therapeutic effects of acupuncture combined with puerarin injection in the treatment of patients with sudden deafness.Methods 83 patients with sudden deafnss were randomly divided into 2 groups.Control group(n =38) received puersrin injection.Treatment group ( n =45 ) received acupuncture received acupuncture combined with puerarin injection.The effect was compared between the two groups.Results The effective rate of treatment group was 86.7％,and was higher than that of control group(73.6％ ) ( P ＜0.05 ).The hearing function of treatment group was better than that of the control group after treatment ( t =6.21,P ＜ 0.01 ).Conclusion Acupuncture combined with puerarin injection in the treatment of patients with sudden deafness could obtain good curative effect,and it was worth to be spread and studied in the clinic.

To effects of Puerarin Injection associated with Irbesartan on Cardiac Insufficiency at Decompensated Stage of chronic corpulmonale heart failure / 国际中医中药杂志

ObjectiveTo explore the curative effects of Puerarin Injection associated with Irbesartan on decompensated chronic cor pulmonale heart failure. MethodsA total of 168 cases conforming to the diagnostic standards were randomized into control group (92 cases) and therapy group (76 cases). In the control group: Based on the results of sputum and X-ray, broad-spectrum antibiotics were firstly selected and used for 3 days after admission. Then sensitive antibiotics were selected according to the results of sputum culture and drug sensitivity test. Medicine for relieving cough and asthma, and apophlegmatisant were used routinely. Patients with heart failure were treated with Digoxin or diuresis. In addition to the above treatments, the therapeutic group were treated with Puerarin Injection 600mg and Irbesartan 75mg once a day. The two groups were both treated for 20 days. Results①The incipient slope, 0.8 slope, 0.5 slope and the minimal surplus were all significantly changed (P＜0.01) in therapeutic group after the treatment. There were significant difference in the incipient slope, 0.8 slope, 0.5 slope and the minimal surplus before and after treatment both in the control group and therapeutic group. ②The plasma viscosity and blood viscosity decreased observably (P＜0.01) after the treatment in the therapeutic group, and more obviously than that in the control group (P＜0.01). ③The arterial oxygen pressure (PaO2) and arterial oxygen saturation (SaO2) in the therapeutic group were enhanced more prominently than that of the control group (P＜0.01). ④The mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) decreased obviously in the therapeutic group after the treatment, and more observably than those in the control group (P＜0.01). ⑤The cardiac output and cardiac index were improved prominently in the therapeutic group after the treatment, and more obviously than that of the control group (P＜0.01). ⑥The heart functional capacity (NYHA) improved significantly after the treatment both in the control group and the therapeutic group (P＜0.05). ConclusionsPuerarin Injection and Irbesartan could remarkablely change the erytlu'ocyte deformabifity, improve the hemorheology, lower pulmonary hypertension, and improve the cardiac function and the clinical efficacy in decompensation stage.

Therapeutic Effect of Puerarin Intervention Combined with Acupuncture for Prolapse of Lumbar Intervertebral Disc with Blood Stasis / 广州中医药大学学报

[ Objective ] To observe the therapeutic effect of acupuncture on cleft acupoints combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis. [ Methods ] Sixty cases were divided into two groups by using random number: group A (n = 30) was treated by acupuncturing the Jiaji points from 4th lumbar vertebrae to 1st sacral vertebrae and specific points such as Waiqiu (GB36), Weizhong (BL40) and Xiaxi (GB43), and with intervention of puerarin Injection into the region of affected lumbar intervertebral foramen; group B (n = 30) was treated by acupuncturing the same acupoints as group A and with routine acupoint injection of puerarin Injection. After a 30-day treatment , the therapeutic effect in the two groups was evaluated by symptoms and signs scoring and pain visual stimulation scoring method. Peripheral blood interleukin 6 (IL-6) and blood rheology parameters before and after treatment were also observed to investigate the therapeutic mechanism. [Results] After one treatment course, the therapeutic effect in group A was better than that in group B (Z = 2.525, P = 0.012) and the mean treatment course was shorter (P 0.05). [Conclusion] The synergistic action of acupuncture combined with puerarin intervention for the treatment of prolapse of lumbar intervertebral disc with blood stasis is better than that of routine acupoint injection of puerarin Injection. The mechanism may be related to the fact that intervention treatment can introduce the drug to the affected area, which benefits the improvement of peripheral blood IL-6 and blood rheology parameters, and thus relieve radiculitis.

Puerarin Injection- induced Hemolytic Reactions:Literature Analysis of 44 Cases / 中国药房

OBJECTIVE:To probe into the regular pattern,related factors and prognosis of hemolytic reactions induced by Puerarin injection.METHODS:A total of 44 hemolytic cases induced by Puerarin injection reported in 26 papers of domestic journals published since 1994 were analyzed.RESULTS:Of the 44 cases collected,31 were males and 13 females,with a mean age of(67.5?9.6) years.The hemolytic reactions were induced either by Puerarin injection or Puerarin for injection with a mean dose of(445.2?123.8)mg and a mean concentration of puerarin(in infusion) of(1.55?0.52) mg?mL~(-1).The hemolytic reactions occurred chiefly after administration of puerarin for 7 consecutive days(7.96?3.84 days on average) and appeared as acute hemolytic anemia.The puerarin specific antibody was noted in immunological test.10 patients including 9 males and 1 male died at a mean age of(72.1?5.7) years.CONCLUSION:The occurrence and turnover of Puerarin Injection - induced hemolytic reactions are related to many factors,to which great attention should be paid.

Effect of Puerarin on Insulin Resistance in Gestational Diabetic Mellitus Rats / 中药新药与临床药理

Objective To observe the effect of puerarin injection (PI) on insulin resistance in gestational diabetic mellitus(GDM) rats. Methods Rats with gestation for 5 days received onedose injection of STZ 35 mg/kg into subaortic caudal vein. After injection for 72 hours, rats with blood sugar over 13.5 mmol/L indicated the modeling being successful. Then the model rats were divided into treatment group (TG, using Puerarin), westernmedicine control group(WCG, using rosiglitazone) and model group (MG, using 0.9 % NaCl), 10 rats in each group .Ten normal gestational rats were used as normal control group (NCG, using 0.9 % NaCl).Two weeks later, the changes of blood sugar, Creactive protein (CRP) and tumor necrosis factor- ? (TNF- ? ) were observed. Results Compared with MG, the above indexes were improved in TG and WCG after treatment( P

Experimental research of Puerarin Injection on blood-high-viscosity in rats of blood-stasis model / 中成药

AIM: To observe the ameliorative effect of Puerarin Injection on blood hyperviscosity in acute blood-stasis model rats. METHODS: The acute blood-stasis model rats were made by injected adrenaline repeatedly and soaked in ice water. The markers of whole blood viscosity and plasm viscosity in the rats were measured with Auto-Viscometer. RESULTS: The whole blood viscosity and plasm viscosity was significantly raised in the acute blood-stasis model rats and Puerarin Injection had ameliorative effects on them. CONCLUSION: Puerarin Injection can ameliorate the blood-high-viscosity in rats of blood-stasis model.

Investigation on Compatible Stability of Puerarin Injection With 10 Commonly-used Drugs / 中国药房

OBJECTIVE:To study the compatible stability of puerarin injection with 10 commonly-used drugs.METHODS:The changes in appearance,pH,particulate and puerarin content after mixing with 10 drugs were observed and assayed.RESU_LTS & CONCLUSION:Puerarin injection mixing with adenosine triphosphate,coenzyme A and ribavirin showed significant change in pH,which indicats that they are incompatable each other,however,when puerarin injection was mixed with vitamin B6,potassium chloride,etamsylate,cimetidine,gentamycin,amikacin and erythromycin,no significant changes in pH,particulate and puerarin content were found,which indicates their compatibility.