Indian Journal of Pharmacology最新文献

Cardiovascular disease (CVD) poses a significant risk for individuals with type 2 diabetes mellitus (T2DM), and statins are integral in preventing such complications. However, global statin prescription practices often diverge from clinical guidelines, which can lead to suboptimal cardiovascular outcomes. This review examines global trends in statin prescription patterns in T2DM management, focusing on adherence to clinical guidelines, gaps in statin utilization, and the impact on cardiovascular health. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses-2 guidelines, this systematic review analyzed eight studies on statin prescription trends, guideline adherence, and therapy intensity, revealing significant global variations in prescription practices. Notably, higher prescription rates were found in Asia compared to Africa and certain developed nations. Despite recommendations, high-intensity statins were underutilized globally, with many patients receiving moderate- or low-intensity therapy. Inappropriate statin use was also observed in low-risk T2DM patients, raising concerns about unnecessary exposure to potential adverse effects. The findings underscore the urgent need for improved adherence to clinical guidelines, particularly for high-risk T2DM patients, and highlight the importance of addressing these barriers. To optimize cardiovascular outcomes, the review emphasizes enhanced physician education, better implementation of guidelines, and targeted strategies to optimize statin therapy. Addressing these gaps could lead to a reduction in CVD risk and improved outcomes for patients with T2DM globally.

Background: There have been concerns over the rationality of prescribing practices of fixed-dose combinations (FDCs) available in India. The FDC of domperidone and pantoprazole recently emerged as a top-selling product at Janaushadhi Kendras in India.

Methods: This cross-sectional study is a part of the prescription research which was conducted under the Indian Council of Medical Research (ICMR) Task Force Project on Rational Use of Drugs at 13 tertiary healthcare centers across the countries that were part of the ICMR-Rational Use of Medicine Centres Network. An assessment of rationality for prescribing practices of FDC of domperidone and proton-pump inhibitors (PPIs) was done based on the available guidelines and evidence from the literature.

Results: In this study, 8839 outpatient prescriptions were analyzed in which FDCs with domperidone and PPI were prescribed in 481 (5.44%) cases. The FDC containing domperidone + PPI was prescribed for nausea and vomiting in 10.81% of cases. The dose was not mentioned in 55% of prescriptions; the dose of domperidone up to 30 mg/day was mentioned in 42.41% of prescriptions and more than 30 mg/day in 2.28% of prescriptions. In 89.18% of cases, it was prescribed to patients under 60 years of age.

Conclusions: This study has shown a lack of rationality in the prescribing practices in FDC containing domperidone and PPI in terms of indications, dose, frequency, duration, and administration instructions.

Introduction: Alopecia, a common condition causing hair loss, leads to decreased self-esteem worldwide. Natural extracts such as rosemary (Rosmarinus officinalis L.) and capsicum (Capsicum annuum L.), traditionally used for various medicinal purposes in Egypt, are widely utilized in treatments for androgenetic alopecia and hair care products. However, these extracts lack market standardization and clear specifications, leading to inconsistent and unpredictable effects.

Objectives: This study aims to investigate the effects of standardized rosemary and capsicum extracts on testosterone-induced androgenetic alopecia in rats to ensure consistent quality and safety in marketed hair care products.

Materials and methods: The study involved preparing standardized rosemary and capsicum extracts and developing simple, accurate, sensitive, rapid, and reproducible methods for both. The extracts were tested on adult male Wistar rats with testosterone-induced alopecia, using a 2% finasteride solution as a reference standard. Visual and microscopic evaluations were conducted to measure three hair follicle parameters: diameter, length, and density.

Results: This study demonstrated the potent effects of standardized rosemary and capsicum extracts on hair growth parameters over 21 days; the application of 0.075% of standardized capsicum extract significantly improved hair growth parameters, including follicle density, length, and diameter. Furthermore, standardized rosemary extracts at 3% and 5% concentrations showed significant improvements across all measured parameters, particularly in hair follicle density.

Conclusions: This study highlights the potential of standardized rosemary and capsicum extracts in promoting hair growth parameters, including hair follicle density, length, and diameter. It will pave the way for more effective natural-based androgenetic alopecia treatment.

Background: Approximately 40%-75% of elderly individuals suffering from chronic diseases are nonadherent to medications. Manual pill organizers (MPO) and pill reminder apps (PRAs) are simple interventions that can improve medication adherence. This was a mixed-methods study to understand the feasibility and acceptability of MPO and a locally developed PRA amongst elderly individuals from rural Maharashtra.

Materials and methods: Sixty elderly individuals aged 60-80 years taking three or more oral medications with access to a smartphone were randomized to receive MPO, PRA, or MPO + PRA for 3 months (n = 30). The outcome measures included acceptability and feasibility using qualitative methods, and usability was measured using a system usability scale.

Results: Both MPO and PRA demonstrated good system usability and ease of independent use. The findings of the qualitative study highlighted reduced dependency on caregivers, reduced chance of missing a pill, and ease of carrying medicines during travel as benefits of MPO. User-friendliness, ability to take medication on time, and caregivers' satisfaction were reported benefits with PRA. Reported challenges included initial hesitancy, the additional workload of filling the MPO, alarm malfunctions, and dependency on family members for using PRA. Medication nonadherence due to forgetfulness significantly improved from 52% to 65% at baseline to 90%-100% at the end as reported using Medication Adherence Rating System-5. Participants in the combined group did not report any difficulty using the two interventions together.

Conclusion: The study demonstrates good feasibility and acceptability of MPOs and indigenously developed PRA either alone or in combination among the Indian rural elderly population. CTRI registration: CTRI/2024/01/061975 (Registered on- January 29, 2024).

Monocyte and muscle cells are considered Zn reservoirs and sensitive to Zn fluctuations, especially in terms of viability. The current study aimed to understand the effect of Zn sufficiency and deficiency on THP-1 monocyte and rhabdomyosarcoma (RD) muscle cell lines. Zinc sufficiency was maintained by supplementing 25 µM of Zn, whereas varying degrees of deficiency were created with intracellular Zn chelator-TPEN in serum-free medium. Cell viability was assessed by MTT assay and the Zn deficiency effect on cell cycle stage was determined through flow cytometry analysis. Zn sufficiency has no-observable effect on cell viability, however, Zn deficiency has a significant positive (P < 0.05) effect on cell death. Cell-cycle analysis has shown a significant higher percentage of THP-1, and RD cells were arrested at Sub-G1 stage in zinc deficiency. Results suggest that cells have the tendency of adaptation to sub-optimal zinc depletion. Further, subnormal level of zinc affected THP-1 and RD cell viability by increasing the cell death at the Sub-G1 stage.

A 49-year-old male presented with the complaints of sudden-onset redness and watering of both the eyes following the intake of fixed drug combination of ofloxacin-ornidazole for diarrhea. Following this, he developed redness of both the lips and blisters in the upper lip. He also developed erythematous macules in the medial aspects of the right lower thigh and ventral aspects of the right leg. Ocular examination showed conjunctival redness with diffuse corneal punctate epithelial erosions in both the eyes. The patient had a similar history affecting the same region 1 year back following the intake of the same combination medicine. To find out the specific inciting agent and owing to unavailability of Finn chamber, we developed a new modified skin patch test using empty tablet cover with three chambers, incorporated with ornidazole, Vaseline (petroleum jelly), and ofloxacin, respectively, and applied on the healed affected lesions. Modified patch test was positive for ornidazole at 48 h. Ornidazole-induced fixed drug eruption (FDE) affecting cornea is a rare and unique in our case report. The patient was then educated about the offending medication and advised to avoid in the future. We also conducted a systematic review of FDEs associated with ornidazole exposure. We searched PubMed and Google Scholar with specific keywords to finally retrieve 14 case reports of ofloxacin induced FDEs, which were further reviewed.

Introduction: Chronic sympathetic stress contributes significantly to the cardiac hypertrophy (CH) development. Currently, several pharmacological agents and surgical options are available for the treatment of CH. However, available treatment options are associated with side effects and surgical complications. The published reports indicated the PKM2 substantial role in numerous illnesses. Furthermore, the effect of shikonin (SK), a nonselective PKM2 inhibitor, on PKM2/c-Myc/PTBP1/HIF-1α signaling in the CH model has never been explored. Thus, in this study, we explore the effect of SK on the PKM2-mediated c-Myc/PTBP1/HIF-1α signaling pathway in isoproterenol (ISO)-induced CH.

Materials and methods: The preclinical rat model of pathological CH was developed by subcutaneous (s.c.) administration of ISO (5 mg/kg/day) over 14 days. ISO-treated rats were orally received SK (2 and 4 mg/kg/day) for a period of 14 days. After all treatment completion, animals were anesthetized for electrocardiogram (ECG), blood pressure, and ventricular function recording. Afterward, animal blood samples were isolated, and then animals were sacrificed for further molecular and histopathology studies.

Results: Fourteen days treatment of SK showed significant improvement in ECG, fibrosis, inflammation, and cardiac function. Moreover, PKM2, PTBP1, c-Myc, and HIF-1α expressions were upregulated, while PKM1 expression was downregulated in ISO-treated rats, which was reversed by SK treatment in ISO-induced CH rats.

Conclusion: Thus, our results demonstrated that SK modulates the PKM2/c-Myc/PTBP1/HIF-1α pathway mediated by PKM2 inhibition, which might be responsible for SK-mediated cardioprotection in ISO-induced CH.

Methotrexate (MTX) is a versatile drug used in various fields, including oncology and rheumatology, acting by inhibitory effects on DNA synthesis and cellular replication. While low-dose MTX is a first-line treatment for rheumatoid arthritis and psoriasis, overdose or incorrect dosing can lead to severe toxicity. We present three cases of accidental MTX poisoning, highlighting the diverse clinical manifestations and challenges in management. Patients presented with fever, weakness, mucocutaneous lesions, and pancytopenia, necessitating intensive care and supportive treatment. These cases underscore the importance of proper dosing, patient education, and pharmacist vigilance to prevent medication errors. Heightened awareness among clinicians is crucial to promptly recognize and manage MTX toxicity, ensuring the safe and effective use of this valuable therapeutic agent. Further research is needed to optimize dosing strategies and enhance safety measures for MTX administration.

Introduction: Deferasirox is a newer oral iron chelator which needs to be given for at least 1 year to see a significant decrease in serum ferritin level in thalassemia patients with chronic iron overload. This study aimed to assess the safety profile of branded generic deferasirox in pediatric thalassemia cases, as it has not been studied in eastern India, especially in real-world settings.

Subjects and methods: It was an observational hospital-based study in a government tertiary care teaching hospital where branded generic deferasirox is distributed free of cost to patients. One hundred and seventy-four patients were included. Safety assessment was done through active questioning about the symptoms starting after deferasirox therapy and through laboratory parameters and clinical examination.

Results: Sixty percent of patients developed adverse drug reactions (ADRs) with deferasirox during the 1-year follow-up. ADRs were more common in males than females. The highest number of ADRs was related to the gastrointestinal and hepatobiliary system. The ADRs were either mild or moderate. Compliance and number of ADRs were found to be inversely correlated.

Conclusion: ADRs of deferasirox are acceptable looking at the benefits. Regular monitoring and management of ADRs will facilitate patient compliance. However, healthcare professionals need to be alert while prescribing this drug and report any ADR, even if it is not labeled. This study found increased serum lipase and mouth ulcer as adverse effects, which are not yet labeled. These can be signals for further analysis by regulatory authorities.