An assessment of the impact of herb-drug combinations used by cancer patients

Background Herb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety. Method Three hundred seventy-five cancer patients attending oncology departments and centres of palliative care at the Oxford University Hospitals Trust (OUH), Duchess of Kent House, Sobell House, and Nettlebed Hospice participated in a self-administered questionnaire survey about their HDS use with their prescribed medicines. The classification system of Stockley’s Herbal Medicine’s Interactions was adopted to assess the potential risk of herb-drug interactions for these patients. Results 127/375 (34 %; 95 % CI 29, 39) consumed HDS, amounting to 101 different products. Most combinations were assessed as ‘no interaction’, 22 combinations were categorised as ‘doubt about outcomes of use’, 6 combinations as ‘Potentially hazardous outcome’, one combination as an interaction with ‘Significant hazard’, and one combination as an interaction of “Life-threatening outcome”. Most patients did not report any adverse events. Conclusion Most of the patients sampled were not exposed to any significant risk of harm from interactions with conventional medicines, but it is not possible as yet to conclude that risks in general are over-estimated. The incidence of HDS use was also less than anticipated, and significantly less than reported in other areas, illustrating the problems when extrapolating results from one region (the UK), in one setting (NHS oncology) in where patterns of supplement use may be very different to those elsewhere

Uncaria tomentosa extract: evaluation of effects on the in vitro and in vivo labeling of blood constituents with technetium-99m

The influence (in vivo and in vitro) of an Uncaria tomentosa extract (Cats claw) on the labeling of red blood cells (RBCs) and plasma and cellular proteins with technetium-99m (Tc-99m) was evaluated. For the in vivo treatment, animals were treated with Cats claw. For the in vitro treatment, heparinized blood was incubated with Cats claw before the addition of stannous chloride (SnCl2) and Tc-99m. Samples of plasma (P) and RBCs were separated and also precipitated with trichloroacetic acid. The soluble and insoluble fractions of P and RBCs were isolated. The analysis of the results of the in vivo study, indicates that there is no significant alteration on the uptake of Tc-99m by the blood constituents, but it significantly decrease (p<0.05) the labeling of blood constituents by in vitro methods. These effects could be due to chelation of stannous and /or pertechnetate ions and blockage of the Tc-99m bindings sites.<br>O objetivo do presente estudo foi avaliar a influência (in vivo e in vitro) de um extrato de Uncaria tomentosa (unha de gato) na marcação de hemácias e proteínas plasmáticas e celulares com tecnécio-99m (Tc-99m). Para o estudo in vivo, animais foram tratados com um extrato de unha de gato. Para o estudo in vitro, sangue heparinizado foi incubado com o extrato de unha de gato antes da adição de cloreto estanoso (SnCl2) e Tc-99m. Amostras de plasma e células foram separadas e também precipitadas com ácido tricloracético. As frações solúveis e insolúveis foram isoladas. A análise dos resultados do estudo in vivo, indica que não houve alteração significante na captação de Tc-99m pelos constituintes sanguíneos, entretanto, no tratamento in vitro, ocorreu redução significante da marcação de constituintes sanguíneos. Esses efeitos poderiam ser justificados por quelação dos íons estanoso e pertecnetato e bloqueio dos sítios de ligação do Tc-99m

Treatment of Giardiasis

Giardia lamblia is both the most common intestinal parasite in the United States and a frequent cause of diarrheal illness throughout the world. In spite of its recognition as an important human pathogen, there have been relatively few agents used in therapy. This paper discusses each class of drugs used in treatment, along with their mechanism of action, in vitro and clinical efficacy, and side effects and contraindications. Recommendations are made for the preferred treatment in different clinical situations. The greatest clinical experience is with the nitroimidazole drugs, i.e., metronidazole, tinidazole, and ornidazole, which are highly effective. A 5- to 7-day course of metronidazole can be expected to cure over 90% of individuals, and a single dose of tinidazole or ornidazole will cure a similar number. Quinacrine, which is no longer produced in the United States, has excellent efficacy but may be poorly tolerated, especially in children. Furazolidone is an effective alternative but must be administered four times a day for 7 to 10 days. Paromomycin may be used during early pregnancy, because it is not systematically absorbed, but it is not always effective. Patients who have resistant infection can usually be cured by a prolonged course of treatment with a combination of a nitroimidazole with quinacrine