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The Cochrane Database of Systematic... Jul 2005Miscarriage is the spontaneous loss of a pregnancy before the fetus is viable. Uterine muscle relaxant drugs have been used for women at risk of miscarriage in the... (Review)
Review
BACKGROUND
Miscarriage is the spontaneous loss of a pregnancy before the fetus is viable. Uterine muscle relaxant drugs have been used for women at risk of miscarriage in the belief they relax uterine muscle, and hence reduce the risk of miscarriage.
OBJECTIVES
To assess the effects for the woman and her baby of uterine muscle relaxant drugs when used for threatened miscarriage.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group Trials Register (4 May 2004), and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 2, 2004).
SELECTION CRITERIA
Randomised trials were included, and quasi-randomised trials were excluded. The participants were women with a pregnancy of less than 20 weeks' gestation having a threatened miscarriage. The interventions were any uterine muscle relaxing drugs (including tocolytic and antispasmodic agents) compared with either placebo or no drug. Primary outcomes for the review were miscarriage: defined as spontaneous pregnancy loss before fetal viability, baby death (stillbirth or neonatal death) and maternal death.
DATA COLLECTION AND ANALYSIS
Both review authors independently assessed studies for eligibility and trial quality, and extracted data.
MAIN RESULTS
One poor quality trial (170 women) was included. This compared a beta-agonist with placebo. There was a lower risk of intrauterine death associated with the use of a beta-agonist (relative risk (RR) 0.25, 95% confidence interval (CI) 0.12 to 0.51). Preterm birth was the only other outcome reported (RR 1.67, 95% CI 0.63 to 4.38).
AUTHORS' CONCLUSIONS
There is insufficient evidence to support the use of uterine muscle relaxant drugs for women with threatened miscarriage. Any such use should be restricted to the context of randomised trials.
Topics: Abortion, Threatened; Female; Humans; Parasympatholytics; Pregnancy; Tocolytic Agents
PubMed: 16034877
DOI: 10.1002/14651858.CD002857.pub2 -
American Family Physician Dec 2005Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel... (Review)
Review
Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms. Irritable bowel syndrome is more likely to affect women than men and is most common in patients 30 to 50 years of age. Symptoms are improved equally by diets supplemented with fiber or hydrolyzed guar gum, but more patients prefer hydrolyzed guar gum. Antispasmodic agents may be used as needed, but anticholinergic and other side effects limit their use in some patients. Loperamide is an option for treatment of moderately severe diarrhea. Antidepressants have been shown to relieve pain and may be effective in low doses. Trials using alosetron showed a clinically significant, although modest, gain over placebo, but it is indicated only for women with severe diarrhea-predominant symptoms or for those in whom conventional treatment has failed. Tegaserod has an advantage over placebo in constipation-predominant irritable bowel syndrome; it is indicated for up to 12 weeks of treatment in women. However, postmarketing reports of severe diarrhea and ischemic colitis further limit its use. Herbal therapies such as peppermint oil also may be effective in the treatment of irritable bowel syndrome. Therapies should focus on specific gastrointestinal dysfunctions (e.g., constipation, diarrhea, pain), and medications only should be used when nonprescription remedies do not work or when symptoms are severe.
Topics: Adult; Antidiarrheals; Diagnosis, Differential; Female; Humans; Irritable Bowel Syndrome; Loperamide; Male; Middle Aged; Parasympatholytics; Serotonin 5-HT3 Receptor Antagonists
PubMed: 16370407
DOI: No ID Found -
Journal of Rehabilitation Medicine Mar 2017Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in... (Review)
Review
Oral baclofen has long been a mainstay in the management of spasticity. This review looks at the clinical evidence for the efficacy and safety of oral baclofen in patients with spasticity of any origin or severity, to determine whether there is a rationale for the use of intrathecal baclofen. Results suggest that oral baclofen may be effective in many patients with spasticity, regardless of the underlying disease or severity, and that it is at least comparable with other antispasmodic agents. However, adverse effects, such as muscle weakness, nausea, somnolence and paraesthesia, are common with oral baclofen, affecting between 25% and 75% of patients, and limiting its usefulness. Intrathecal baclofen may be an effective alternative as the drug is delivered directly into the cerebrospinal fluid, thus bypassing the blood-brain barrier and thereby optimizing the efficacy of baclofen while minimizing drug-related side-effects. Intrathecal baclofen is a viable option in patients who experience intolerable side-effects or who fail to respond to the maximum recommended dose of oral baclofen.
Topics: Administration, Oral; Adult; Baclofen; Disorders of Excessive Somnolence; Dose-Response Relationship, Drug; Female; Humans; Injections, Spinal; Male; Muscle Relaxants, Central; Muscle Spasticity; Muscle Weakness; Nausea; Parasympatholytics
PubMed: 28233010
DOI: 10.2340/16501977-2211 -
European Neurology 2014New clinical experience with 9-delta-tetrahydocannabinol (THC) and cannabidiol (CBD) oromucosal spray (Sativex®) involving more than an additional 1,000 patients with... (Review)
Review
New clinical experience with 9-delta-tetrahydocannabinol (THC) and cannabidiol (CBD) oromucosal spray (Sativex®) involving more than an additional 1,000 patients with MS spasticity (approximately 150 in clinical studies and 900 in post-marketing surveillance studies) have become available in 2013 and are reviewed. A randomized, placebo controlled long-term follow-up clinical trial with THC:CBD spray versus placebo demonstrated that it was not associated with cognitive decline, depression or significant mood changes after 12 months of treatment. Furthermore, in a prospective observational pilot study involving 33 patients (60% female) aged 33-68 years and a mean disease duration of 6.6 years, THC:CBD oromucosal spray did not adversely influence standard driving ability in patients with moderate to severe MS spasticity. Other new long term observational data about the use of THC:CBD oromucosal spray in clinical practice are available from patient registries in the UK, Germany and Spain. Findings to date reinforce the efficacy and safety observed in Phase III clinical trials. It is of interest that in practice average dosages used by patients tended to be lower than those reported in clinical studies (5-6.4 vs. >8 sprays/day), and effectiveness was maintained in the majority of patients. Importantly, no additional safety concerns were identified in the registry studies which included findings from patients who have been treated for prolonged periods (in the German/UK registry 45% of patients had >2 years exposure). Thus, these new data support a positive benefit-risk relationship for THC:CBD oromucosal spray during longer-term use.
Topics: Affect; Automobile Driving; Cannabidiol; Clinical Trials as Topic; Cognition; Dronabinol; Drug Combinations; Humans; Multiple Sclerosis; Muscle Spasticity; Oral Sprays; Parasympatholytics; Plant Extracts; Product Surveillance, Postmarketing; Randomized Controlled Trials as Topic
PubMed: 24457846
DOI: 10.1159/000357742 -
World Journal of Gastroenterology May 2014Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is... (Review)
Review
Irritable bowel syndrome (IBS) is the commonest cause of recurrent abdominal pain (RAP) in children in both more developed and developing parts of the world. It is defined by the Rome III criteria for functional gastrointestinal disorders. It is characterized by abdominal pain that is improved by defecation and whose onset is associated with a change in stool form and or frequency and is not explained by structural or biochemical abnormalities. It is estimated that 10%-15% of older children and adolescents suffer from IBS. IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors. The diagnosis of IBS is made based on the Rome III criteria together with ruling out organic causes of RAP in children such as inflammatory bowel disease and celiac disease. Once the diagnosis of IBS is made, it is important to explain to the parents (and children) that there is no serious underlying disease. This reassurance may be effective treatment in a large number of cases. Lifestyle modifications, stress management, dietary interventions and probiotics may be beneficial in some cases. Although there is limited evidence for efficacy of pharmacological therapies such as antispasmodics and antidiarrheals; these have a role in severe cases. Biopsychosocial therapies have shown encouraging results in initial trials but are beset by limited availability. Further research is necessary to understand the pathophysiology and provide specific focused therapies.
Topics: Abdominal Pain; Adolescent; Antidiarrheals; Child; Drug Therapy; Evidence-Based Medicine; Female; Humans; Irritable Bowel Syndrome; Life Style; Male; Parasympatholytics; Parents; Probiotics; Psychotherapy; Recurrence; Severity of Illness Index; Stress, Psychological; Treatment Outcome
PubMed: 24876724
DOI: 10.3748/wjg.v20.i20.6013 -
BMC Complementary and Alternative... Jan 2017The present research was carried out to investigate pharmacological properties of Buxus papillosa C.K. Schneid. (Buxaceae).
BACKGROUND
The present research was carried out to investigate pharmacological properties of Buxus papillosa C.K. Schneid. (Buxaceae).
METHODS
Buxus papillosa extracts of leaves (BpL), stem (BpS), roots (BpR) and BpL fractions: hexane (BpL-H), aqueous (BpL-A) also plant constituent, cyclomicrobuxine effect were studied in jejunum, atria, aorta and tracheal preparations from rabbit and guine-peg.
RESULTS
Ca antagonistic effect of BpS, BpR, BpL-H, BpL-A and cyclomicrobuxine were conclusively suggested, when spontaneous contractions of rabbit jejunal preparation was relaxed along with subsequent relaxation of potassium chloride (80 mM) induced contractions. Ca antagonistic effect was further confirmed, when a prominent right shift like that of verapamil was observed in Ca concentration-response curves, drawn in a tissue pretreated with BpL (0.3-1.0 mg/mL). In rabbit tracheal tissues BpL, BpS, BpR, BpL-H and BpL-A produced a prominent relaxation in contractions induced by potassium chloride (80 mM) and carbachol (1 μm). When tested in rabbit aortic rings, BpL, BpS, BpR, BpL-H and BpL-A showed concentration-dependent (0.1-3.0 mg/mL) vasorelaxant effect against phenylephrine (1 μM) and high K-induced contractions. In isolated guinea-pig right atria, BpL, BpS, BpR, BpL-H and BpL-A suppressed atrial force of spontaneous contractions, with BpL-A being most potent.
CONCLUSIONS
Our results reveal that Buxus papillosa possesses gut, airways and cardiovascular inhibitory actions.
Topics: Animals; Aorta; Bronchodilator Agents; Buxus; Guinea Pigs; Jejunum; Molecular Structure; Myocardial Contraction; Parasympatholytics; Plant Extracts; Plant Leaves; Pregnanolone; Rabbits; Trachea; Vasodilator Agents
PubMed: 28100216
DOI: 10.1186/s12906-017-1558-x -
Pharmaceutical Biology Dec 2017Salsola imbricata Forssk. (Chenopodiaceae) has folkloric repute for the treatment of various gastrointestinal and respiratory ailments.
CONTEXT
Salsola imbricata Forssk. (Chenopodiaceae) has folkloric repute for the treatment of various gastrointestinal and respiratory ailments.
OBJECTIVE
The present study investigates spasmolytic and bronchorelaxant effects of S. imbricata.
MATERIALS AND METHODS
The crude aqueous-ethanol extract of the aerial parts of S. imbricata and its fractions, in cumulative concentrations (0.01-10 mg/mL), were tested on contractions of isolated rabbit jejunum and tracheal preparations. Furthermore, concentration response curves (CRCs) of Ca and carbachol were constructed in the absence and presence of the extract. Standard organ bath methods were used.
RESULTS
The crude extract relaxed spontaneous, K(80 mM) and carbachol (1 μM)-induced contractions in jejunum preparations with respective EC values of 0.40 (0.35-0.46), 0.69 (0.60-0.79) and 0.66 (0.57-0.75) mg/mL. It shifted Ca CRCs rightward in nonparallel manner. In isolated tracheal preparations, the crude extract caused relaxation of K(80 mM) and carbachol (1 μM)-induced contractions with EC values of 0.86 (0.75-0.98) and 0.74 (0.66-0.84) mg/mL, respectively. It displaced carbachol CRCs rightward with suppression of maximal response. In both tissues, pretreatment with propranolol (1 μM) caused rightward shift in inhibitory CRCs of the extract against carbachol-induced contractions. The ethyl acetate fraction was found more potent in relaxing smooth muscle contractions than the parent extract and its aqueous fraction.
DISCUSSION AND CONCLUSION
The results suggest that the spasmolytic and bronchorelaxant activities of S. imbricata are related to Ca antagonistic and β-adrenergic agonistic effects, thus justifying some of the traditional uses of the plant.
Topics: Adrenergic beta-Agonists; Adrenergic beta-Antagonists; Animals; Bronchodilator Agents; Calcium Channel Blockers; Calcium Signaling; Dose-Response Relationship, Drug; Ethanol; Female; In Vitro Techniques; Jejunum; Male; Muscle Relaxation; Muscle, Smooth; Parasympatholytics; Phytotherapy; Plant Components, Aerial; Plant Extracts; Plants, Medicinal; Rabbits; Salsola; Solvents; Trachea
PubMed: 28209080
DOI: 10.1080/13880209.2017.1291691 -
Frontiers in Bioscience (Landmark... Jan 2024Medicinal herbs are frequently used for the management of gastrointestinal disorders because they contain various compounds that can potentially amplify the intended...
BACKGROUND
Medicinal herbs are frequently used for the management of gastrointestinal disorders because they contain various compounds that can potentially amplify the intended therapeutic effects. Cuminaldehyde is a plant-based constituent found in oils derived from botanicals such as cumin, eucalyptus, myrrh, and cassia and is responsible for its health benefits. Despite the utilization of cuminaldehyde for several medicinal properties, there is currently insufficient scientific evidence to support its effectiveness in treating diarrhea. Hence, the present investigation was carried out to evaluate the antidiarrheal and antispasmodic efficacy of cuminaldehyde, with detailed pharmacodynamics explored.
METHODS
An antidiarrheal test was conducted in mice following the castor oil-induced diarrhea model, while an isolated small intestine obtained from rats was used to evaluate the detailed mechanism(s) of antispasmodic effects.
RESULTS
Cuminaldehyde, at 10 and 20 mg/kg, exhibited 60 and 80% protection in mice from episodic diarrhea compared to the saline control group, whereas this inhibitory effect was significantly reversed in the pretreated mice with glibenclamide, similar to cromakalim, an ATP-dependent K+ channel opener. In the experiments conducted in isolated rat tissues, cuminaldehyde reversed the glibenclamide-sensitive low K+ (25 mM)-mediated contractions at significantly higher potency compared to its inhibitory effect against high K+ (80 mM), thus showing predominant involvement of ATP-dependent K+ activation followed by Ca++ channel inhibition. Cromakalim, a standard drug, selectively suppressed the glibenclamide-sensitive low K+-induced contractions, whereas no relaxation was observed against high K+, as expected. Verapamil, a Ca++ channel inhibitor, effectively suppressed both low and high K+-induced contractions with similar potency, as anticipated. At higher concentrations, the inhibitory effect of cuminaldehyde against Ca++ channels was further confirmed when the preincubated ileum tissues with cuminaldehyde (3 and 10 mM) in Ca++ free medium shifted CaCl2-mediated concentration-response curves (CRCs) towards the right with suppression of the maximum peaks, similar to verapamil, a standard Ca++ ion inhibitor.
CONCLUSIONS
Present findings support the antidiarrheal and antispasmodic potential of cuminaldehyde, possibly by the predominant activation of ATP-dependent K+ channels followed by voltage-gated Ca++ inhibition. However, further in-depth assays are recommended to know the precise mechanism and to elucidate additional unexplored mechanism(s) if involved.
Topics: Rats; Mice; Animals; Antidiarrheals; Parasympatholytics; Cromakalim; Glyburide; Plant Extracts; Jejunum; Diarrhea; Verapamil; Adenosine Triphosphate; Cymenes; Benzaldehydes
PubMed: 38287835
DOI: 10.31083/j.fbl2901043 -
Journal of Smooth Muscle Research =... 2024Functional bowel disorders (FBD) have a major potential to degrade the standards of public life. Juniperus oxycedrus L. (J. oxycedrus) (Cupressaceae) has been described...
Functional bowel disorders (FBD) have a major potential to degrade the standards of public life. Juniperus oxycedrus L. (J. oxycedrus) (Cupressaceae) has been described as a plant used in traditional medicine as an antidiarrheal medication. The present study is the first to obtain information on the antispasmodic and antidiarrheic effects of J. oxycedrus aqueous extract through in vitro and in vivo studies. An aqueous extract of J. oxycedrus (AEJO) was extracted by decoctioning air-dried aerial sections of the plant. Antispasmodic activity was tested in an isolated jejunum segment of rats exposed to cumulative doses of drogue extract. The antidiarrheic activity was tested using diarrhea caused by castor oil, a transit study of the small intestine, and castor oil-induced enteropooling assays in mice. In the jejunum of rats, the AEJO (0.1, 0.3 and 1 mg/ml) diminished the maximum tone induced by low K (25 mM), while it exhibited a weak inhibitory effect on high K (75 mM) with an IC=0.49 ± 0.01 mg/ml and IC=2.65 ± 0.16 mg/ml, respectively. In the contractions induced by CCh (10 M), AEJO diminished the maximum tone, similar to that induced by low K (25 mM). with an IC=0.45 ± 0.02 mg/ml. The inhibitory effect of AEJO on low K induced contractions was significantly diminished in the presence of glibenclamide (GB) (0.3 µM) and 4-aminopyrimidine (4-AP) (100 µM), with IC values of 1.84 ± 0.09 mg/ml. and 1.63 ± 0.16 mg/ml, respectively). The demonstrated inhibitory effect was similar to that produced by a non-competitive antagonist acting on cholinergic receptors and calcium channels. In castor oil-induced diarrhea in mice, AEJO (100, 200, and 400 mg/kg) caused an extension of the latency time, a reduced defecation frequency, and a decrease in the amount of wet feces compared to the untreated group (distilled water). Moreover, it showed a significant anti-motility effect and reduced the amount of fluid accumulated in the intestinal lumen at all tested doses. These findings support the conventional use of Juniperus oxycedrus L. as a remedy for gastrointestinal diseases.
Topics: Animals; Jejunum; Antidiarrheals; Parasympatholytics; Plant Extracts; Juniperus; Mice; Rats; Diarrhea; Male; Castor Oil; Gastrointestinal Transit; Rats, Wistar; Gastrointestinal Motility; Muscle, Smooth; Muscle Contraction
PubMed: 38777767
DOI: 10.1540/jsmr.60.10 -
Journal of Zhejiang University....Traditional Chinese herbal drugs have been used for thousands of years in Chinese pharmacopoeia. The bark of Magnolia officinalis Rehder & E. Wilson, known under the... (Review)
Review
Traditional Chinese herbal drugs have been used for thousands of years in Chinese pharmacopoeia. The bark of Magnolia officinalis Rehder & E. Wilson, known under the pinyin name "Houpo", has been traditionally used in Chinese and Japanese medicines for the treatment of anxiety, asthma, depression, gastrointestinal disorders, headache, and more. Moreover, Magnolia bark extract is a major constituent of currently marketed dietary supplements and cosmetic products. Much pharmacological activity has been reported for this herb and its major compounds, notably antioxidant, anti-inflammatory, antibiotic and antispasmodic effects. However, the mechanisms underlying this have not been elucidated and only a very few clinical trials have been published. In vitro and in vivo toxicity studies have also been published and indicate some intriguing features. The present review aims to summarize the literature on M. officinalis bark composition, utilisation, pharmacology, and safety.
Topics: Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antioxidants; Anxiety; Asthma; Depression; Drugs, Chinese Herbal; Gastrointestinal Diseases; Headache; Humans; Magnolia; Parasympatholytics; Plant Bark; Plant Extracts
PubMed: 28271656
DOI: 10.1631/jzus.B1600299