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Ugeskrift For Laeger Mar 2024Modern healthcare requires clinicians to navigate through complex drug treatments. This review offers an overview of sources of drug information which can be used for... (Review)
Review
Modern healthcare requires clinicians to navigate through complex drug treatments. This review offers an overview of sources of drug information which can be used for general medication prescription and for challenging patient populations. Key considerations for pregnant or breastfeeding patients, those with renal impairment, and those with liver dysfunction are discussed. We also touch on adverse drug reactions and drug interactions. Finally, information about services from independent regional drug information centers, that can be used by clinicians, are provided.
Topics: Female; Pregnancy; Humans; Breast Feeding; Drug-Related Side Effects and Adverse Reactions; Drug Interactions; Drug Prescriptions
PubMed: 38533858
DOI: 10.61409/V10230654 -
Metabolites Jul 2023Because of the high research and development cost of new drugs, the long development process of new drugs, and the high failure rate at later stages, combining past... (Review)
Review
Because of the high research and development cost of new drugs, the long development process of new drugs, and the high failure rate at later stages, combining past drugs has gradually become a more economical and attractive alternative. However, the ensuing problem of drug-drug interactions (DDIs) urgently need to be solved, and combination has attracted a lot of attention from pharmaceutical researchers. At present, DDI is often evaluated and investigated from two perspectives: pharmacodynamics and pharmacokinetics. However, in some special cases, DDI cannot be accurately evaluated from a single perspective. Therefore, this review describes and compares the current DDI evaluation methods based on two aspects: pharmacokinetic interaction and pharmacodynamic interaction. The methods summarized in this paper mainly include probe drug cocktail methods, liver microsome and hepatocyte models, static models, physiologically based pharmacokinetic models, machine learning models, in vivo comparative efficacy studies, and in vitro static and dynamic tests. This review aims to serve as a useful guide for interested researchers to promote more scientific accuracy and clinical practical use of DDI studies.
PubMed: 37623842
DOI: 10.3390/metabo13080897 -
European Journal of Drug Metabolism and... Jul 2023Ocedurenone (KBP-5074) is a novel nonsteroidal mineralocorticoid receptor antagonist that has demonstrated safety and efficacy in clinical trials in patients with...
BACKGROUND AND OBJECTIVES
Ocedurenone (KBP-5074) is a novel nonsteroidal mineralocorticoid receptor antagonist that has demonstrated safety and efficacy in clinical trials in patients with uncontrolled hypertension and stage 3b/4 chronic kidney disease. This study evaluated the involvement of cytochrome P450 (CYP) isozymes and drug transporters in the biotransformation of ocedurenone, and whether ocedurenone inhibited or induced CYP enzymes and transporters. Clinical pharmacokinetic drug-drug interaction (DDI) of ocedurenone with CYP3A inhibitor and inducer were investigated in healthy volunteers.
METHODS
In vitro tests were conducted to determine which CYP enzymes were involved in ocedurenone's metabolism and whether ocedurenone inhibited or induced these CYP enzymes; ocedurenone substrate characteristics for efflux and uptake transporters and its inhibitory potential on major drug transporters were also assessed. A clinical DDI study was conducted in healthy volunteers to evaluate the effects of a strong CYP3A inhibitor (itraconazole) and inducer (rifampin) on ocedurenone's pharmacokinetics.
RESULTS
The in vitro study showed that ocedurenone was primarily metabolized by CYP3A4 and that it did not inhibit CYP enzymes. Ocedurenone appeared to be a substrate of BCRP and P-gp efflux transporters and inhibited BCRP, BSEP, MDR1, MATE1 and 2-K, OATP1B1/3, and OCT1. The clinical DDI study showed that itraconazole reduced ocedurenone's oral clearance by 51% and increased area under the plasma concentration-time curve extrapolated to infinity (AUC) by 104%, while rifampin increased its oral clearance by 6.4-fold and decreased plasma AUC by 84%.
CONCLUSION
Ocedurenone was shown to be a CYP3A substrate, with no inhibition potential on major drug metabolizing CYP enzymes and transporters at clinical efficacious doses. Ocedurenone did not induce CYP1A2 and 3A4 activity in cultured human primary hepatocytes. Clinical DDI study indicated ocedurenone was well tolerated when administered as a single 0.5-mg dose both alone and with itraconazole or rifampin, and while itraconazole had a weak effect on ocedurenone's pharmacokinetics, rifampin had a significant effect reducing systemic exposures.
Topics: Humans; Rifampin; Cytochrome P-450 CYP3A Inhibitors; Itraconazole; Cytochrome P-450 CYP3A Inducers; ATP Binding Cassette Transporter, Subfamily G, Member 2; Area Under Curve; Neoplasm Proteins; Cytochrome P-450 Enzyme System; Drug Interactions; Cytochrome P-450 CYP3A
PubMed: 37357226
DOI: 10.1007/s13318-023-00837-5 -
Briefings in Bioinformatics Nov 2023In clinical treatment, two or more drugs (i.e. drug combination) are simultaneously or successively used for therapy with the purpose of primarily enhancing the... (Review)
Review
In clinical treatment, two or more drugs (i.e. drug combination) are simultaneously or successively used for therapy with the purpose of primarily enhancing the therapeutic efficacy or reducing drug side effects. However, inappropriate drug combination may not only fail to improve efficacy, but even lead to adverse reactions. Therefore, according to the basic principle of improving the efficacy and/or reducing adverse reactions, we should study drug-drug interactions (DDIs) comprehensively and thoroughly so as to reasonably use drug combination. In this review, we first introduced the basic conception and classification of DDIs. Further, some important publicly available databases and web servers about experimentally verified or predicted DDIs were briefly described. As an effective auxiliary tool, computational models for predicting DDIs can not only save the cost of biological experiments, but also provide relevant guidance for combination therapy to some extent. Therefore, we summarized three types of prediction models (including traditional machine learning-based models, deep learning-based models and score function-based models) proposed during recent years and discussed the advantages as well as limitations of them. Besides, we pointed out the problems that need to be solved in the future research of DDIs prediction and provided corresponding suggestions.
Topics: Humans; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Databases, Factual; Computer Simulation; Drug Combinations
PubMed: 38113076
DOI: 10.1093/bib/bbad445 -
Proceedings of the National Academy of... Jul 2023Development of a simple, label-free screening technique capable of precisely and directly sensing interaction-in-solution over a size range from small molecules to large...
Development of a simple, label-free screening technique capable of precisely and directly sensing interaction-in-solution over a size range from small molecules to large proteins such as antibodies could offer an important tool for researchers and pharmaceutical companies in the field of drug development. In this work, we present a thermostable Raman interaction profiling (TRIP) technique that facilitates low-concentration and low-dose screening of binding between protein and ligand in physiologically relevant conditions. TRIP was applied to eight protein-ligand systems, and produced reproducible high-resolution Raman measurements, which were analyzed by principal component analysis. TRIP was able to resolve time-depending binding between 2,4-dinitrophenol and transthyretin, and analyze biologically relevant SARS-CoV-2 spike-antibody interactions. Mixtures of the spike receptor-binding domain with neutralizing, nonbinding, or binding but nonneutralizing antibodies revealed distinct and reproducible Raman signals. TRIP holds promise for the future developments of high-throughput drug screening and real-time binding measurements between protein and drug.
Topics: Humans; Microscopy; SARS-CoV-2; COVID-19; Drug Evaluation, Preclinical; Ligands; Antibodies, Viral; Drug Interactions; Spike Glycoprotein, Coronavirus; Antibodies, Neutralizing
PubMed: 37463207
DOI: 10.1073/pnas.2218826120 -
Advances in Clinical and Experimental... Aug 2023The majority of Americans, accounting for 51% of the population, take 2 or more drugs daily. Unfortunately, nearly 100,000 people die annually as a result of adverse...
The majority of Americans, accounting for 51% of the population, take 2 or more drugs daily. Unfortunately, nearly 100,000 people die annually as a result of adverse drug reactions (ADRs), making it the 4th most common cause of mortality in the USA. Drug-drug interactions (DDls) and their impact on patients represent critical challenges for the healthcare system. To reduce the incidence of ADRs, this study focuses on identifying DDls using a machine-learning approach. Drug-related information was obtained from various free databases, including DrugBank, BioGRID and Comparative Toxicogenomics Database. Eight similarity matrices between drugs were created as covariates in the model in order to assess their infiuence on DDls. Three distinct machine learning algorithms were considered, namely, logistic regression (LR), extreme Gradient Boosting (XGBoost) and neural network (NN). Our study examined 22 notable drugs and their interactions with 841 other drugs from DrugBank. The accuracy of the machine learning approaches ranged from 68% to 78%, while the F1 scores ranged from 78% to 83%. Our study indicates that enzyme and target similarity are the most significant parameters in identifying DDls. Finally, our data-driven approach reveals that machine learning methods can accurately predict DDls and provide additional insights in a timely and cost-effective manner.
Topics: Humans; Drug Interactions; Drug-Related Side Effects and Adverse Reactions; Algorithms; Databases, Factual; Machine Learning
PubMed: 37589227
DOI: 10.17219/acem/169852 -
The Journal of Pharmacology and... Nov 2023Awareness of drug interactions involving opioids is critical for patient treatment as they are common therapeutics used in numerous care settings, including both chronic... (Review)
Review
Awareness of drug interactions involving opioids is critical for patient treatment as they are common therapeutics used in numerous care settings, including both chronic and disease-related pain. Not only do opioids have narrow therapeutic indexes and are extensively used, but they have the potential to cause severe toxicity. Opioids are the classical pain treatment for patients who suffer from moderate to severe pain. More importantly, opioids are often prescribed in combination with multiple other drugs, especially in patient populations who typically are prescribed a large drug regimen. This review focuses on the current knowledge of common opioid drug-drug interactions (DDIs), focusing specifically on hydrocodone, oxycodone, and morphine DDIs. The DDIs covered in this review include pharmacokinetic DDI arising from enzyme inhibition or induction, primarily due to inhibition of cytochrome p450 enzymes (CYPs). However, opioids such as morphine are metabolized by uridine-5'-diphosphoglucuronosyltransferases (UGTs), principally UGT2B7, and glucuronidation is another important pathway for opioid-drug interactions. This review also covers several pharmacodynamic DDI studies as well as the basics of CYP and UGT metabolism, including detailed opioid metabolism and the potential involvement of metabolizing enzyme gene variation in DDI. Based upon the current literature, further studies are needed to fully investigate and describe the DDI potential with opioids in pain and related disease settings to improve clinical outcomes for patients. SIGNIFICANCE STATEMENT: A review of the literature focusing on drug-drug interactions involving opioids is important because they can be toxic and potentially lethal, occurring through pharmacodynamic interactions as well as pharmacokinetic interactions occurring through inhibition or induction of drug metabolism.
Topics: Humans; Analgesics, Opioid; Oxycodone; Hydrocodone; Pain; Drug Interactions; Morphine; Cytochrome P-450 Enzyme System
PubMed: 37679047
DOI: 10.1124/jpet.123.001651 -
Arteriosclerosis, Thrombosis, and... May 2024Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in... (Review)
Review
Colchicine-an anti-inflammatory alkaloid-has assumed an important role in the management of cardiovascular inflammation ≈3500 years after its first medicinal use in ancient Egypt. Primarily used in high doses for the treatment of acute gout flares during the 20th century, research in the early 21st century demonstrated that low-dose colchicine effectively treats acute gout attacks, lowers the risk of recurrent pericarditis, and can add to secondary prevention of major adverse cardiovascular events. As the first Food and Drug Administration-approved targeted anti-inflammatory cardiovascular therapy, colchicine currently has a unique role in the management of atherosclerotic cardiovascular disease. The safe use of colchicine requires careful monitoring for drug-drug interactions, changes in kidney and liver function, and counseling regarding gastrointestinal upset. Future research should elucidate the mechanisms of anti-inflammatory effects of colchicine relevant to atherosclerosis, the potential role of colchicine in primary prevention, in other cardiometabolic conditions, colchicine's safety in cardiovascular patients, and opportunities for individualizing colchicine therapy using clinical and molecular diagnostics.
Topics: Humans; Anti-Inflammatory Agents; Cardiovascular Diseases; Colchicine; Drug Interactions; Gout Suppressants; Treatment Outcome
PubMed: 38511324
DOI: 10.1161/ATVBAHA.124.319851 -
GM Crops & Food Dec 2023Unintended effects of gene edit crops may pose safety issues. Omics is a useful tool for researchers to evaluate these unexpected effects. Transcriptome and proteomics...
Unintended effects of gene edit crops may pose safety issues. Omics is a useful tool for researchers to evaluate these unexpected effects. Transcriptome and proteomics analyses were performed for two gene editors, CRISPR-Cas9 and adenine base editor (ABE) gene edit rice, as well as corresponding wild-type plants (Nipponbare). Transcriptome revealed 520 and 566 rice differentially expressed genes (DEGs) in the Cas9/Nip and ABE/Nip comparisons, respectively. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that most DEGs participated in metabolism of terpenoids and polyketones, plant-pathogen interactions, and plant signal transduction. It mainly belongs to environmental adaptation. Proteomics revealed 298 and 54 rice differentially expressed proteins (DEPs) in the Cas9/Nip and ABE/Nip comparisons, respectively. KEGG pathway enrichment analysis showed that most DEPs participated in the biosynthesis of secondary metabolite and metabolic pathways.According to integrated transcriptomes and proteomics analysis, the results showed that no newly generated genes were identified as new transcripts of these differentially expressed genes, and gene edit tools had little effect on rice transcription levels and no new proteins were generated in the gene-edited rice.
Topics: Humans; Proteomics; Adenine; Crops, Agricultural; Herb-Drug Interactions; Occupational Therapy; Oryza
PubMed: 37387261
DOI: 10.1080/21645698.2023.2229927 -
British Journal of Clinical Pharmacology Jul 2023Midostaurin is often prescribed with azole antifungals in patients with leukaemia, either for aspergillosis prophylaxis or treatment. Midostaurin is extensively...
Midostaurin is often prescribed with azole antifungals in patients with leukaemia, either for aspergillosis prophylaxis or treatment. Midostaurin is extensively metabolized by cytochrome (CYP) 3A4. In addition, it inhibits and induces various CYPs at therapeutic concentrations. Thus, midostaurin is associated with a high potential for drug-drug interactions (DDIs), both as a substrate (victim) and as a perpetrator. However, data on midostaurin as a perpetrator of DDIs are scarce, as most pharmacokinetic studies have focused on midostaurin as a victim drug. We report a clinically relevant bidirectional DDI between midostaurin and voriconazole during induction treatment. A 49-year-old woman with acute myeloid leukaemia developed invasive pulmonary aspergillosis after induction chemotherapy. She was treated with voriconazole at standard dosage. Six days after starting midostaurin, she developed visual hallucinations with a concurrent sharp increase in voriconazole blood concentration (C 10.3 mg L , target C 1-5 mg L ). Neurotoxicity was considered to be related to voriconazole overexposure. The concentration of midostaurin was concomitantly six-fold above the average expected level, but without safety issues. Midostaurin was stopped and the dosage of voriconazole was adjusted with therapeutic drug monitoring. The evolution was favourable, with quick resolution and no recurrence of visual hallucinations. To our knowledge, this is the first case suggesting that midostaurin and voriconazole reciprocally inhibit each other's metabolism, leading to increased exposure of both. This case highlights the knowledge gap regarding drug-drug interactions between midostaurin and azole antifungals. Close clinical and therapeutic drug monitoring is advised in such cases.
Topics: Female; Humans; Middle Aged; Voriconazole; Antifungal Agents; Drug Interactions; Leukemia, Myeloid, Acute; Hallucinations
PubMed: 37050863
DOI: 10.1111/bcp.15743