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Frontiers in Pharmacology 2023We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in...
We aimed to systematically evaluate the prevalence and clinical characteristics of adverse events associated with the adaptogens and antidepressant drug interactions in a retrospective chart review. A total of 1,816 reports of adverse events were evaluated. Cases were included in the analysis if the pharmacoepidemiological analysis showed the presence of a high probability of a causal relationship between an adaptogen and antidepressant interaction and the occurrence of adverse events. The following data were extracted from the reports: age, sex, antidepressant, plant products containing adaptogens, other concomitant medications, and clinical consequences of the interactions and their possible mechanisms. Adaptogens were involved in 9% of adverse events associated with the concomitant use of antidepressants and other preparations. We identified 30 reports in which side effects presented a causal relationship with the use of antidepressants and adaptogens. Here, we present the list of adaptogens with the corresponding antidepressants and the side effects caused by their interactions: : reboxetine (testicle pain and ejaculatory dysfunctions), sertraline (severe diarrhea), escitalopram (myalgia, epigastric pain, nausea, vomiting, restless legs syndrome, and severe cough), and paroxetine (generalized myalgia, ophthalmalgia, and ocular hypertension); : duloxetine (upper gastrointestinal bleeding), paroxetine (epistaxis), sertraline (vaginal hemorrhage), and agomelatine (irritability, agitation, headache, and dizziness); : bupropion (arthralgia and thrombocytopenia), amitriptyline (delirium), and fluoxetine (dysuria); : citalopram (generalized pruritus), escitalopram (galactorrhea), and trazodone (psoriasis relapse); : mianserin (arrhythmias), mirtazapine (edema of lower limbs and myalgia), and fluoxetine (gynecomastia); : mianserin (restless legs syndrome), paroxetine (gynecomastia and mastalgia), and venlafaxine (hyponatremia); : agomelatine (back pain and hyperhidrosis) and moclobemide (myocardial infarction); : duloxetine (back pain); : sertraline (upper gastrointestinal bleeding); : mianserin (restless legs syndrome); and : bupropion (seizures). Clinicians should monitor the adverse events associated with the concomitant use of adaptogens and antidepressant drugs in patients with mental disorders. Aggregation of side effects and pharmacokinetic interactions (inhibition of CYP and p-glycoprotein) between those medicines may result in clinically significant adverse events.
PubMed: 37829299
DOI: 10.3389/fphar.2023.1271776 -
The Science of the Total Environment Dec 2023In this study, the presence of 23 pharmaceutically active compounds (PhACs) including antibiotics, analgesics, anti-inflammatories, psychiatric and cardiovascular drugs,...
In this study, the presence of 23 pharmaceutically active compounds (PhACs) including antibiotics, analgesics, anti-inflammatories, psychiatric and cardiovascular drugs, antifungals and metabolites was investigated in surface waters. A total of 89 samples were collected during 3 years (2020, 2021 and 2022) from a European representative river basin (Tagus, Spain). To elucidate PhAC potential sources, sampling points located in areas with low, median and high anthropogenic influence were selected. The analytical method based on solid phase extraction (SPE) followed by UHPLC-MS/MS analysis was validated meeting SANTE/2020/12830 and SANTE/12682/2019 performance criteria. PhACs were quantified above limits of quantification (LOQs) in 96 % of water samples, being the antihypertensives valsartan (648 ng/L, 87 % quantification frequency) and irbesartan (390 ng/L, 75 %) and the antidepressant o-desmethylvenlafaxine (495 ng/L, 76 %) the predominant pollutants. The rest of the target PhACs showed median concentrations between 4 and 172 ng/L with quantification frequencies ranging from 35 to 75 %. ∑PhAC concentrations did not show temporal or seasonal trends. However, valsartan and naproxen presented lower levels in drier (spring and summer) compared to the wetter. Source identification revealed a clear anthropogenic origin since concentrations obtained in highly populated areas were statistically higher (p < 0.01) than those quantified in sparsely populated ones. This finding was also confirmed by calculating PhACs mass flow rates, which ranged between 1.4 and 235 kg/y. Finally, data generated were used to estimate the potential risk to the aquatic ecosystem for three trophic levels (phototrophic, invertebrate and vertebrate organisms). Risk quotient ratios (RQs) were calculated for all PhACs at the median (P50) and worst-case (max) scenarios. Up to 7 PhACs (acetaminophen, carbamazepine, gemfibrozil, ibuprofen, irbesartan, ketoprofen and venlafaxine) showed high risk for the highest trophic level (fish) in >45 % of investigated locations.
Topics: Animals; Water; Tandem Mass Spectrometry; Water Pollutants, Chemical; Ecosystem; Rivers; Spain; Irbesartan; Risk Assessment; Valsartan; Pharmaceutical Preparations; Environmental Monitoring
PubMed: 37774880
DOI: 10.1016/j.scitotenv.2023.167422 -
The Science of the Total Environment Jan 2024Reducing the risk posed by mixtures of pharmaceuticals is a goal of current initiatives such as the European Green Deal to reduce anthropological environmental impacts....
Reducing the risk posed by mixtures of pharmaceuticals is a goal of current initiatives such as the European Green Deal to reduce anthropological environmental impacts. Wastewater effluent typically contains large numbers of active pharmaceutical ingredients (APIs). For some APIs, existing technology such as conventional activated sludge (CAS) wastewater treatment plants (WWTPs) have removal rates below 20 %, thus the WWTP discharges are adding to the toxic burden of receiving waters. We present an environmental risk assessment of mixtures of 35 APIs in effluent samples from 82 Northern European WWTPs using the concentration addition model, and identify the respective risk-driving APIs. This is then compared to a corresponding mixture risk assessment of effluent samples from the Danish Hillerød WWTP subjected to post-treatment with varying specific ozone doses (0.15-1.05 mgO/mgDOC) and/or granulated activated carbon (GAC). All 82 WWTP effluent samples exceeded risk thresholds by at least a factor of 30, with a median RQ of 92.9, highlighting the need for effluent post-treatment and/or a substantial dilution in the recipient waters. Antibiotics, analgesics and anti-depressants were among the top risk drivers with 99 % of the average mixture risk attributable to azithromycin, diclofenac, venlafaxine, clarithromycin and mycophenolic acid. Effluent mixture risk was reduced by ozonation in a concentration-dependent manner, decreasing below threshold levels to a median RQ of 0.83 following treatment with 0.65 mgO/mg DOC. Fresh GAC was also effective at reducing the mixture risk both alone and with ozone treatment, with median RQ of 0.04 and 0.07 respectively. To our knowledge, this is the first study to present a risk assessment of pharmaceutical mixtures in effluent comparing "conventional" WWTP processes with additional post-treatment with ozone and/or GAC for reducing the joint risks of pharmaceutical mixtures for recipient waters. We demonstrate the need for additional WWTP treatment technologies, and the efficacy of GAC and ozonation in decreasing the risk to the aquatic environment from pharmaceutical mixtures to below acceptable threshold limits.
Topics: Wastewater; Charcoal; Ozone; Magnesium Oxide; Water Pollutants, Chemical; Risk Assessment; Pharmaceutical Preparations; Waste Disposal, Fluid
PubMed: 37774874
DOI: 10.1016/j.scitotenv.2023.167440 -
Tijdschrift Voor Psychiatrie 2023We describe a 71-year-old woman who developed interstitial pneumonia within a complex somatic state. Diagnostic clearance suggested venlafaxine-induced interstitial...
We describe a 71-year-old woman who developed interstitial pneumonia within a complex somatic state. Diagnostic clearance suggested venlafaxine-induced interstitial pneumonia. In the literature, we found 13 cases of venlafaxine-induced interstitial pneumonia. Case reports were also described for other antidepressants. Based on these case reports, there is consensus in the literature that antidepressants may in rare cases give rise to (sub)acute or chronic interstitial pneumonia. Although a rare side effect, it seems important to be aware of this as a psychiatrist.
PubMed: 37756030
DOI: No ID Found -
European Journal of Pharmaceutical... Dec 2023Intrinsic membrane permeability is one of several factors that critically determine the intestinal absorption of a chemical. The intrinsic membrane permeability of a...
Intrinsic membrane permeability is one of several factors that critically determine the intestinal absorption of a chemical. The intrinsic membrane permeability of a chemical is usually extracted from transwell experiments with Caco-2 or MDCK cells, preferably by the pK-Flux method, which is considered the method of choice when aqueous boundary layer effects need to be excluded. The pK-Flux method has two variants, the iso-pH method, where apical and basolateral pH are equal, and the gradient-pH method, where apical and basolateral pH are different. The most commonly used method is the gradient-pH method, as it is intended to reflect the pH-conditions in the gastrointestinal tract. However, concentration-shift effects caused by the applied pH-difference between apical and basolateral compartment in the gradient-pH method have not been considered in the evaluation of the experimental data in the past. Consequently, incorrect intrinsic membrane permeabilities have been determined. In this work, we present a revised method for extracting the intrinsic membrane permeability from gradient-pH data that considers concentration-shift effects in the basolateral aqueous boundary layer and filter as well as in the cytosol. Furthermore, we propose the use of the iso-pH method, where only concentration-shift effects in the cytosol need to be considered, as an alternative to the gradient-pH method. We use the five lipophilic bases amantadine, chloroquine, propranolol, venlafaxine and verapamil as examples to compare gradient-pH method and iso-pH method with regard to the extractability of the intrinsic membrane permeability. For lipophilic bases, the iso-pH method proves to be advantageous. All intrinsic membrane permeabilities determined in this work were substantially higher than the intrinsic membrane permeabilities reported in literature.
Topics: Humans; Caco-2 Cells; Cell Membrane Permeability; Propranolol; Intestinal Absorption; Permeability; Hydrogen-Ion Concentration
PubMed: 37751809
DOI: 10.1016/j.ejps.2023.106592 -
Indian Journal of Psychiatry Aug 2023Vortioxetine and venlafaxine are antidepressants which have shown established efficacy to treat major depressive disorder (MDD). There are no studies that compared them...
BACKGROUND
Vortioxetine and venlafaxine are antidepressants which have shown established efficacy to treat major depressive disorder (MDD). There are no studies that compared them for their efficacy in cognitive symptoms of depression. The study aimed to compare the effect of vortioxetine and venlafaxine on the change in cognitive scores in adults with MDD.
METHODS
The present study was an open-label, active-controlled parallel design randomized clinical trial. After randomization, baseline clinical evaluations by Montgomery-Asberg Depression Rating Scale (MADRS) and Social and Occupational Functioning Assessment Scale (SOFAS) were done and coding (subset of WAIS-IV), WCST, TMT, Stroop test, PGI memory were used to assess cognition in 100 unmedicated MDD patients. They were reassessed after eight weeks of monotherapy with vortioxetine or venlafaxine.
RESULTS
Primary cognitive measure (coding score) was found to be significantly higher (Mean Difference = 0.680; 95% CI:.202 to 1.158; = 0.006) in vortioxetine in comparison with venlafaxine. Stroop test scores (word score, color score, color-word score) were also found to be significantly higher with vortioxetine. In other cognitive measures (WCST scores: total trials, total errors score, total perseverative responses score, total perseverative errors scores; TMT-A and B scores), a significant decrease in scores with vortioxetine in comparison with venlafaxine were observed. A significant decrease in MADRS and increase in SOFAS scores were observed with vortioxetine in comparison with venlafaxine. Both the drugs alleviated the symptoms of depression but vortioxetine was better tolerated.
CONCLUSION
Our study findings suggest that improvement in cognitive scores is significantly higher with vortioxetine than venlafaxine over the eight weeks of monotherapy.
CLINICAL TRIAL REGISTRATION NUMBER
CTRI/2020/07/026819 (Registered with Clinical Trials Registry- India).
PubMed: 37736222
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_160_23 -
Cureus Sep 2023It is known that in the digital age we live in, people try to get information on many medical issues through Internet searches. Especially as a result of the COVID-19...
OBJECTIVE
It is known that in the digital age we live in, people try to get information on many medical issues through Internet searches. Especially as a result of the COVID-19 pandemic triggering mental problems and health professionals' stay-at-home warnings, it has become difficult for individuals to receive psychiatric help, and this has encouraged accessing information about mental problems and their treatments through Internet searches. In this context, infodemiologic research, especially with Google Trends (GT; Google LLC, Mountain View, California, United States), has become very popular in recent years. In our study, it was aimed to examine the interest in frequently used antidepressants and the effect of the COVID-19 pandemic on Internet searches.
METHODS
Search densities for five antidepressant drugs (sertraline, fluoxetine, citalopram, venlafaxine, duloxetine) that are frequently used around the world were examined on GT on 24/07/2023, and these searches were compared. Searches made within the last five years (24/07/2018-24/07/2023) were included in this study. Images were obtained using GT and Microsoft Excel 2019 (Microsoft Corporation, Redmond, Washington), and appropriate statistical analyses were performed with the SPSS Statistics version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.).
RESULTS
Sertraline was the most sought-after antidepressant before, during, and after the COVID-19 pandemic in the world. The searches related to sertraline increased gradually during the pandemic period, and this increase continued in the post-pandemic period. Other antidepressants whose search for it increased with the pandemic are fluoxetine, duloxetine, and venlafaxine. Searches for citalopram decreased during the pandemic process compared to the pre-pandemic period.
CONCLUSION
According to worldwide Internet searches, the prominence of some antidepressant group drugs during the pandemic period may be a reflection of the effects of the COVID-19 pandemic on mental health. Additionally, GT can provide psychiatrists with valuable insights into which depression medications are gaining popularity with the general public over time.
PubMed: 37731683
DOI: 10.7759/cureus.45558 -
Current Therapeutic Research, Clinical... 2023Intranasal administration is among the most effective alternatives to deliver drugs directly to the brain and prevent first-pass metabolism. Venlafaxine-loaded liposomes...
BACKGROUND
Intranasal administration is among the most effective alternatives to deliver drugs directly to the brain and prevent first-pass metabolism. Venlafaxine-loaded liposomes are biocompatible carriers that enhance transport qualities over the nasal mucosa.
OBJECTIVE
This research aimed to develop, formulate, characterize, and observe the prepared formulation.
METHODS
The formulation was developed using the thin-film hydration technique. The response surface plot interrelationship between three independent variables are lipid, cholesterol and polymer and four dependent variables such as particle size, percentage entrapment efficiency, and percentage drug release were ascertained using the Box-Behnken design.
RESULTS
The drug-release chitosan-coated liposomes were reported to have a particle size distribution, entanglement efficiency, and 84%, respectively, of 191 ± 34.71 nm, 94 ± 2.71% and 94 ± 2.71%. According to investigations, liposomes as a delivery system for the nasal route provided a more sustained drug release than the oral dosing form.
CONCLUSIONS
The intranasal administration of venlafaxine liposomal vesicles effectively enhanced the absolute bioavailability, retention time, and brain delivery of venlafaxine.
PubMed: 37727460
DOI: 10.1016/j.curtheres.2023.100714 -
Genetics and Molecular Biology 2023The toxic effects of venlafaxine (VLX) on aquatic organisms have already been verified and therefore are a proven matter of concern. Herein, we evaluated zebrafish...
The toxic effects of venlafaxine (VLX) on aquatic organisms have already been verified and therefore are a proven matter of concern. Herein, we evaluated zebrafish embryos/adults after acute exposure to VLX. Embryos/larvae were exposed to different concentrations of VLX (100-1000 mg/L; 1.33 as a dilution factor), to evaluate mortality/developmental changos and to analyze biomarkers (0.002-100 mg/L). For adults, mortality, genotoxicity, and biomarkers were assessed in five different concentrations of VLX (1-100 mg/L). The median lethal concentration (LC50-168h) was 274.1 mg/L for embryos/larvae, and >100 mg/L for adults (LC50-96h). VLX decreased the heart rate frequency and caused premature hatching and lack of equilibrium in embryos/larvae exposed to different concentrations ranging from 100 to 562.5 mg/L. The activity of acetylcholinesterase (AChE) was inhibited in larvae exposed to 1, 25 and 100 mg/L. Glutathione-S-transferase (GST) activity was reduced in both larvae and adults after exposure to different concentrations, mainly at 25 mg/L. For both larvae and adults, lactate dehydrogenase (LDH) activity increased after 100 mg/L of VLX exposure. No DNA damage was observed in peripheral erythrocytes. Exposure to VLX may cause adverse effects on zebrafish in their early and adult life stages, interfering with embryo-larval development, and can induce physiological disturbances in adults.
PubMed: 37695571
DOI: 10.1590/1678-4685-GMB-2022-0377 -
American Journal of Translational... 2023To determine the efficacy of venlafaxine combined with agomelatine in elderly patients with depression and observe the changes in S-100 calcium binding protein B...
OBJECTIVE
To determine the efficacy of venlafaxine combined with agomelatine in elderly patients with depression and observe the changes in S-100 calcium binding protein B (S-100B) and glial fibrillary acidic protein (GFAP) before and after treatment.
METHODS
The data of 142 elderly patients with depression treated in Affiliated Hospital of Gansu Medical College between January 2020 and January 2022 were retrospectively studied. Among the patients, 62 treated with venlafaxine were assigned to a control group, and 80 treated with agomelatine combined with venlafaxine were assigned to an observation group. In addition, 50 patients with suspected meningitis who were treated in Affiliated Hospital of Gansu Medical College over the same time span were enrolled into a normal group. The two groups of patients were compared in terms of clinical efficacy after treatment and the changes in S100B and GFAP before and after treatment. The diagnostic value of S100B and GFAP in patients with depression was explored. Additionally, the changes in Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) score before and after treatment were compared between the two groups, and the adverse drug reaction rate was also compared.
RESULTS
The patient group showed higher cerebrospinal fluid (CSF) levels of S100B and GFAP than the control group (P < 0.001). The areas under the curve (AUC) of CSF S100B and GFAP for diagnosing depression were 0.833 and 0.925, respectively, and the AUC of the combination of the two was 0.967, which was larger than that of CSF S100B or GFAP alone (P < 0.001). Additionally, the control group showed lower clinical efficacy than the observation group (P < 0.001). After treatment, the observation group exhibited lower CSF levels of S100B and GFAP than the control group (P < 0.001), and demonstrated higher RBANS score than the control group (P < 0.001). The difference in adverse drug reaction rate was not significant between the control group and the observation group (P > 0.05).
CONCLUSION
S100B and GFAP can be used as diagnostic indicators of depression. Agomelatine plus venlafaxine are superior to venlafaxine alone in the treatment of depression. The combination can contribute to better S100B and GFAP levels, and take a more obvious role in alleviating disease symptoms, thereby improving the cognitive function and overall well-being of patients.
PubMed: 37692959
DOI: No ID Found