Pharmacokinetic Interactions between Cardiovascular Medicines and Plant Products

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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Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽

10.3390/medicines8080044 ◽

2021 ◽

Vol 8 (8) ◽

pp. 44

Author(s):

Mary Beth Babos ◽

Michelle Heinan ◽

Linda Redmond ◽

Fareeha Moiz ◽

Joao Victor Souza-Peres ◽

...

Keyword(s):

Drug Interaction ◽

Case Report ◽

Drug Interactions ◽

Clinical Studies ◽

Drug Information ◽

Case Reports ◽

Full Information ◽

Information Need ◽

Herbal Products ◽

Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

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An Introduction to Pharmacotherapy for Inborn Errors of Metabolism

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.6.432 ◽

2018 ◽

Vol 23 (6) ◽

pp. 432-446

Author(s):

Aaron A. Harthan

Keyword(s):

Adverse Effects ◽

Inborn Errors Of Metabolism ◽

Single Case ◽

Case Reports ◽

Review Article ◽

Metabolic Process ◽

Inborn Errors ◽

Herbal Products ◽

Disease States ◽

Treatment Plans

Inborn errors of metabolism comprise a wide array of diseases and complications in the pediatric patient. The rarity of these disorders limits the ability to conduct and review robust literature regarding the disease states, mechanisms of dysfunction, treatments, and outcomes. Often, treatment plans will be based on the pathophysiology associated with the disorder and theoretical agents that may be involved in the metabolic process. Medication therapies usually consist of natural or herbal products. Established efficacious pediatric doses for these products are difficult to find in tertiary resources, and adverse effects are routinely limited to single case reports. This review article attempts to summarize some of the more common inborn errors of metabolism in a manner that is applicable to pharmacists who will provide care for these patients.

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Abstract 145: Use of Bromocriptine in the Management of Peripartum Cardiomyopathy: A Systematic Review

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.145 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Garly Rushler Saint Croix ◽

Michel Ibrahim ◽

Sandra Chaparro

Keyword(s):

Clinical Outcomes ◽

Case Reports ◽

Thrombotic Event ◽

Case Control ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

The Other ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Multicenter Rct

Background: Prolactin metabolites have been shown to possibly be cardio-toxic in humans and play a role in the pathogenesis of Peripartum Cardiomyopathy (PPCM). Some studies have demonstrated medical treatment with bromocriptine, a dopamine agonist able to inhibit prolactin, associated with standard therapy to be beneficial not only in managing symptomatology but also in the reversal of disease process. The present study was performed to systematically review the PPCM literature and determine the therapeutic effect of bromocriptine on left ventricular function and clinical outcomes. Methods: We performed a literature review to identify randomized, nonrandomized clinical studies, case series and case reports that reported the use of bromocriptine in the management of PPCM. A total of 9 databases including MEDLINE, Embase, Cochrane, DARE and Scopus containing articles from January 1, 1945 to July 31, 2016 were analyzed. Results: We were able to identify and screen 410 potentially eligible publications through the databases. Based on our exclusion criterias, 8 studies were selected: one randomized control trial (RCT), two case control studies and five case reports. We found that Bromocriptine improved left ventricular ejection fraction (LVEF) and clinical outcomes in women with acute severe PPCM and no thrombotic event was reported. The RCT (n = 20) showed an improvement of composite end point of death, NYHA Class III/IV and LVEF < 35% (35 of 100) at 6 months. LVEF went from 27% (27 of 100) to 58% (58 of 100) in the group taking bromocriptine vs 36% (36 of 100) in the other group . One of the case controls (n = 51) showed LVEF improvement of 85% (43 of 51) and full recovery in 47% (24 of 51) after 6 months +/- 3 of treatment. The other case control study (n = 115) failed to suggest a beneficial effect of bromocriptine. However, all the five case reports (n = 7) showed LV improvement. Conclusion: Peripartum Cardiomyopathy is a rare but serious condition that affects childbearing women. Targeted therapies like bromocriptine have shown promising results but a large multicenter RCT is needed to evaluate furthermore the benefits and harms of bromocriptine before it can be adopted in routine clinical use.

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Abstract P101: Mechanical Thrombectomy in COVID-19 Positive Patients With Large Vessel Occlusion: Pooled Review of Individual Case Series

Stroke ◽

10.1161/str.52.suppl_1.p101 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Muhammad Z Memon ◽

Taha Nisar ◽

Amit Singla ◽

Anil Nanda ◽

Gaurav Gupta ◽

...

Keyword(s):

Clinical Outcomes ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Case Series ◽

Individual Case ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Historic Data ◽

Meta Analyses

Background: COVID-19 has been shown to induce a hypercoagulable state thereby increasing the risk of arterial thrombosis resulting in Large Vessel Occlusion Stroke (LVOs) Objective: We performed a systematic review of published reports to study the clinical characteristics, and outcomes of COVID-19 acute ischemic stroke (AIS) patients with LVO treated with mechanical thrombectomy (MT) and compared them with historical controls. Methods: We conducted a systematic literature search from December 2019 to July 2020 using multiple combinations of keywords from PubMed and Ovid databases according to the PRISMA meta-analyses and systemic reviews guidelines and then pooled data from individual case series. We included studies where COVID -19 associated LVO cases were treated with MT and their clinical outcomes were reported. We then compared these findings with the historic patient data from the five landmark randomized MT trials, the Hermes collaborators (HC). Results: An initial search generated 12 studies but after excluding case reports and multiple reports comprising of the same series of patients, a total of five reports consisting of 51 patients were analyzed. The mean age of patients was 59 years (IQR 36-75), and 40 (78 %) were men. Median NIHSS on presentation was 20 (IQR 10-29). AIS with LVO was the presenting manifestation of COVID-19 in 16 (20%) of patients. Intracranial ICA was the most common site of occlusion found in 27 (53%) of patients with multi-territory occlusion in 10 (20 %). Final recanalization TICI ≥ 2b was achieved in 33 (64%) of patients but reocclusion was noted in 7 (14 %). Modified Rankin score (mRS) 0-2 was reported in 12 (23 %) of patients with 40 % in-hospital mortality. When compared to historic data from HC, COVID -19 patients were younger (59 vs 69 years), presented with a higher median NIHSS score (20 vs 17), and had a higher prevalence of ICA terminus occlusion (53% vs 21% ). Similarly, patient outcomes were poor in the COVID -19 group with mRs 0-2 in (23 % versus 46 %) and mortality (40 % vs 15 %) compared to Hermes group. Conclusion: COVID -19 AIS patients with LVO who underwent MT were younger, had multiple territory occlusions with a propensity for ICA terminus location, and had poor angiographic and clinical outcomes as compared to historic data.

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Gelatinous Degeneration of the Bone Marrow: Two Case Reports Showing Different Hematological Features and Clinical Outcomes

Acta Haematologica ◽

10.1159/000108766 ◽

2007 ◽

Vol 118 (3) ◽

pp. 165-166 ◽

Cited By ~ 1

Author(s):

Pasquale Niscola ◽

Luca Maurillo ◽

Massimiliano Palombi ◽

Stefano Fratoni ◽

Alessio Pio Perrotti ◽

...

Keyword(s):

Bone Marrow ◽

Clinical Outcomes ◽

Case Reports

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Herbal products: active constituents, modes of action and quality control

Nutrition Research Reviews ◽

10.1079/095442200108729007 ◽

2000 ◽

Vol 13 (1) ◽

pp. 47-77 ◽

Cited By ~ 85

Author(s):

Ron B.H. Wills ◽

Kerry Bone ◽

Michelle Morgan

Keyword(s):

Quality Control ◽

Pharmacological Activity ◽

Medicinal Herbs ◽

Current Position ◽

Herbal Products ◽

Detailed Consideration ◽

Active Constituents ◽

Modes Of Action ◽

St John's Wort ◽

Manufactured Products

AbstractAn overview is given of the current position of medicinal herbs in general in relation to usage, market and production, types of pharmacological activity and how they differ from conventional drugs. The increasing importance of quality and manufactured products is also discussed. A more detailed consideration of these issues is given in relation to echinacea, valerian and St John's wort as these herbs are well studied, are market leaders and have widespread community usage.

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BK polyomavirus nephropathy in two kidney transplant patients with distinct diagnostic strategies for BK virus and similar clinical outcomes: two case reports

Journal of Medical Case Reports ◽

10.1186/s13256-017-1300-9 ◽

2017 ◽

Vol 11 (1) ◽

Cited By ~ 3

Author(s):

Ana Luisa Figueira Gouvêa ◽

Rachel Ingrid Juliboni Cosendey ◽

Ana Lucia Rosa Nascimento ◽

Fabiana Rabe Carvalho ◽

Andrea Alice Silva ◽

...

Keyword(s):

Clinical Outcomes ◽

Kidney Transplant ◽

Case Reports ◽

Bk Virus ◽

Diagnostic Strategies ◽

Transplant Patients ◽

Bk Polyomavirus ◽

Kidney Transplant Patients

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Pacemaker and Defibrillator Implantation and Programming in Patients with Deep Brain Stimulation

Arrhythmia & Electrophysiology Review ◽

10.15420/aer.2018.63.2 ◽

2019 ◽

Vol 8 (2) ◽

pp. 138-142 ◽

Cited By ~ 2

Author(s):

Mark Elliott ◽

Sheikh Momin ◽

Barnaby Fiddes ◽

Fahad Farooqi ◽

SM Afzal Sohaib

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Case Reports ◽

Cardiac Pacemaker ◽

Cardiac Device ◽

Deep Brain Stimulator ◽

Device Implantation ◽

Cardiac Devices ◽

Potential Interactions ◽

Deep Brain

The need for cardiac device implantation in patients receiving deep brain stimulation (DBS) is increasing. Despite the theoretical risk of the two systems interacting, there are no clear guidelines for cardiologists carrying out cardiac device implantation in this population. We performed a review of the literature and describe 13 case reports in which patients have both DBS and a cardiac pacemaker or ICD implanted. Except for one early study, in which an ICD shock reset the deep brain stimulator, no significant interactions have been reported. We discuss the potential interactions between DBS and cardiac devices, and provide practical advice for implanting cardiologists. We conclude that, provided that specific precautions are taken, cardiac device implantation is likely to be safe in patients with DBS.

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Impact of COVID-19 on the placental pathology of pregnant women and their infants: A systematic review protocol

10.31219/osf.io/3f8j7 ◽

2020 ◽

Author(s):

Irina Oltean ◽

Dina El Demellawy

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Clinical Outcomes ◽

Viral Infections ◽

Case Reports ◽

Case Series ◽

Cell Mediated Immunity ◽

Case Control Studies ◽

Antibody Testing ◽

Adverse Pregnancy

Pregnant women are susceptible to viral infections due to physiological changes such as cell-mediated immunity. No severe adverse pregnancy or neonatal outcomes have been consistently reported in COVID-19 positive pregnancy cases. There are controversies around the role of COVID-19 in pregnancy. A systematic review was conducted to examine clinical maternal and neonatal clinical outcomes. Studies were included if they reported COVID-19 infection among pregnant women and/or COVID-19 positive neonates as validated by positive antibody testing or viral testing using Polymerase Chain Reaction. Case series, case reports, case-control studies, and comparative studies were included. 837 records were identified, resulting in 525 records for level I screening. 41 were included after full-text review. Results suggest elevated rates of ICU admission, gestational diabetes, preeclampsia, C-sections, pre-term birth, and CRP in comparison to pregnant women without SARS-CoV-2. Careful monitoring of pregnancies with SARS-CoV-2 to minimize adverse clinical outcomes is recommended.

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