Potential herb-drug interactions between anti-COVID-19 drugs and traditional Chinese medicine

Coronavirus disease 2019(COVID-19),caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has spread worldwide.Effective treatments against COVID-19 remain urgently in need although vaccination significantly reduces the incidence,hospitalization,and mortality.At present,antiviral drugs including Nirmatrelvir/Ritonavir(Paxlovid^(TM)),Remdesivir,and Molnupiravir have been authorized to treat COVID-19 and become more globally available.On the other hand,traditional Chinese medicine(TCM)has been used for the treatment of epidemic diseases for a long history.Currently,various TCM formulae against COVID-19 such as Qingfei Paidu decoction,Xuanfei Baidu granule,Huashi Baidu granule,Jinhua Qinggan granule,Lianhua Qingwen capsule,and Xuebijing injection have been widely used in clinical practice in China,which may cause potential herb-drug interactions(HDIs)in patients under treatment with antiviral drugs and affect the efficacy and safety of medicines.However,information on potential HDIs between the above anti-COVID-19 drugs and TCM formulae is lacking,and thus this work seeks to summarize and highlight potential HDIs between antiviral drugs and TCM formulae against COVID-19,and especially pharmacokinetic HDIs mediated by metabolizing enzymes and/or transporters.These well-characterized HDIs could provide useful information on clinical concomitant medicine use to maximize clinical outcomes and minimize adverse and toxic effects.

Understanding Interactions Between Chinese Medicines and Pharmaceutical Drugs in Integrative Healthcare

In the 21st century, the public are more informed, mainly via the Internet, about health and medical products and have become more knowledgeable about matters relating to their health conditions and well-being in curing and preventing illnesses. They often self-medicate themselves with various health products and over-the-counter （OTC） medicines apart from prescribed pharmaceutical drugs （PD）. Some of those non-prescribed products may have doubtful quality control and contain harmful additives or unchecked ingredients; thus their usefulness is in doubt. The increasing popularity world-wide of using Chinese medicines （CM） and related OTC functional products has raised concerns over their concomitant use with PD and the consequential adverse effects. In most cases the alleged causes of adverse effects are linked with herbal sources, although the authorised information on the interactions between CM-PD is not plentiful in the literature. There is an urgent need for such a data base. The future professionals in health and medical care should be knowledgeable or aware of what their patients have been taking or given. In actual practice the patients may receive both treatments intentionally or unintentionally, with or without the awareness of the practitioner. In these situations a reliable database for interactions between CM-PD will be extremely useful for consultation when treatment problems appear or during emergency situations. Their combining of medications may be involved with possible outcomes of adverse reactions or beneficial effects. Such a database will be welcomed by both practitioners of herbal medicines and orthodox medicine practitioners in the emerging trend of integrative medicine. The author has been involved in various research projects of basic and clinical aspects in mainly CM among other herbal and PD. Examples will be given largely on those related to these disciplines as illustrations in this overview.

前置处方审核中西药联用药物相互作用规则的建立及优化

目的 以建立医院前置处方审核中西药联用相互作用规则和管理制度为手段,提高中西药联合应用水平。方法 通过访谈法查找前置处方审核中西药联用存在的问题,通过文献及其他资料查阅建立中西药不合理联用数据库,以数据库为依据设置前置处方审核中西药联用规则。调取北京市西城区广外医院2022年1月至12月门急诊处方,采用PDCA循环法进行药物相互作用规则及管理制度优化,比较优化前后中西药联用的合理性水平。结果 建立了57类147种中药、61类148种西药不合理联用数据库。经过四轮PDCA循环管理建立前置审核中西药联用相互作用规则和管理制度后,中西药联用不合理处方占比由9.11%降至2.44%,干预处方医师修改率由82.93%升至95.45%、医师考核平均分数由79.30分升至94.25分。结论 通过前置处方审核中西药不合理联用处方规则的建立,能提高中西药不合理联用水平,降低因不合理联用带来的风险。

Quorum sensing-based interactions among drugs,microbes,and diseases

Many diseases and health conditions are closely related to various microbes,which participate in complex interactions with diverse drugs;nonetheless,the detailed targets of such drugs remain to be elucidated.Many existing studies have reported causal associations among drugs,gut microbes,or diseases,calling for a workflow to reveal their intricate interactions.In this study,we developed a systematic workflow comprising three modules to construct a Quorum Sensing-based Drug-Microbe-Disease(QSDMD)database(http://www.qsdmd.lbci.net/),which includes diverse interactions for more than 8,000 drugs,163 microbes,and 42 common diseases.Potential interactions between microbes and more than 8,000 drugs have been systematically studied by targeting microbial QS receptors combined with a docking-based virtual screening technique and in vitro experimental validations.Furthermore,we have constructed a QS-based drug-receptor interaction network,proposed a systematic framework including various drug-receptor-microbe-disease connections,and mapped a paradigmatic circular interaction network based on the QS-DMD,which can provide the underlying QS-based mechanisms for the reported causal associations.The QS-DMD will promote an understanding of personalized medicine and the development of potential therapies for diverse diseases.This work contributes to a paradigm for the construction of a molecule-receptor-microbe-disease interaction network for human health that may form one of the key knowledge maps of precision medicine in the future.

消癌平注射液对多西紫杉醇在大鼠体内的药代动力学及体外CYP450酶活性的影响研究

目的探讨消癌平注射液(XAP)对大鼠体内多西紫杉醇(DOC)药代动力学与体外细胞色素P450(CYP450)酶活性的影响。方法对24只SD雄性大鼠实施体内研究,随机分为A组(DOC对照组)、B组(XAP+DOC组)、C组[(咪达唑仑(MDZ)对照组)]、D组(XAP+MDZ组)共4组。借助超高效液相色谱串联质谱法检测给药后5、10、20、30 min和1、2、3、4、6、8、12、24 h大鼠血清中DOC/MDZ浓度,计算药代动力学参数。通过重组CYP450酶3A4(CYP3A4)的体外反应体系展开研究,制备人肝微粒体,以MDZ为底物探究XAP对CYP450酶活性的抑制作用,考察XAP对DOC代谢的影响。结果体内药代动力学结果显示,XAP可使DOC的C max和AUC 0→t分别增加150%(P<0.01)和60%(P<0.05);t 1/2和MRT分别为(4.24±1.78)h、(3.92±1.14)h,较DOC对照组显著延长;XAP可使MDZ的消除延长,半衰期t 1/2延长至(0.962±0.19)h,MRT延长至(1.008±0.13)h,药时曲线下面积(AUC 0→∞)为(1510.078±242.11)ng·h/ml,均显著高于MDZ对照组(P<0.05)。以MDZ为底物进行的体外抑制实验表明,XAP(10~100 mg/ml)和C 21总甾体提取物(10~50μg/ml)能明显抑制人肝微粒体CYP3A4活性。结论XAP与DOC联合使用后,DOC的血药浓度升高,DOC的多个药代动力学参数明显改变,XAP对DOC的消除有抑制效能,同时其作用机制可能与CYP3A4受抑制有关。

基于“五邪相干”理论探讨《辅行诀脏腑用药法要》小补汤、小泻汤组方规律

应用“五邪相干”理论阐释《辅行诀脏腑用药法要》五行互藏理论,并结合《辅行诀脏腑用药法要》所列五行五味互含的25味药物,对《辅行诀脏腑用药法要》小补汤、小泻汤类方的配伍组方选药进行分析,认为在“五邪相干”理论指导下的《辅行诀脏腑用药法要》配伍组方选药可为临床提供新的思路。

民族医学发展与中华民族共同体形成的互动与互构:基于内蒙古蒙医药发展的考察

民族医学在中华民族共同体形成发展过程中具有促进交融的媒介信物作用。蒙医药发展是内蒙古各族人民铸牢中华民族共同体意识中的具体实践。蒙医药的形成和发展承载了民族间交往、交流、交融的历史记忆,国家对蒙医药发展的支持,强化了蒙古族人民的国家认同和向心力,同时蒙医药对民众的健康保障也增强了民族间的互信与互通。以蒙医药文化、蒙医药产业、蒙医药服务的深度融合为切入点,进一步发展壮大蒙医药,为深化有行、有感、有效的中华民族共同体铸牢路径。

Antibacterial activity of Rosmarinus officinalis L.alone and in combination with cefuroxime against methicillin-resistant Staphylococcus aureus

Objective:To determine the antimicrobial activity of rosemary(Rosmarinus of ficinalis L.) and to investigate the synergistic effects of this extract combined with ceforuxime against methicillinresistant Staphylococcus aureus(MRSA).Methods:The inhibitory and bactericidal activities of rosemary ethanol extract,alone and in combination with cefuroxime,were studied.Results:The minimum inhibitory concentrations(MICs) of the ethanol extract of rosemary were in the range of 0.39-3.13 mg/mL.The minimum bactericidal concentrations(MBCs) were usually equal to or double that MICs.The antimicrobial activity of combinations of the ethanol extract of rosemary and cefuroxime indicated their synergistic effects against all MRSAs.Conclusions:The present work clearly demonstrates that rosemary has a key role in the elevation of susceptibility toβ-lactams.

Self-medication with nutritional supplements and herbal over-the-counter products

In recent years,the popularity increased for nutritional supplements and herbal products.Prescription drugs,but not herbal therapies are paid by health insurances.They are sold over-the-counter(OTC)on the patients’own expense.However,there are potential risks of self-medication,e.g.incorrect self-diagnosis,severe adverse reactions,dangerous drug interactions,risk of addiction etc.They are often used by patients at their own discretion without knowledge of and control by their physicians.Certain users are at risk of intoxication.Multiple medications taken by older patients increase the risk for adverse drug reactions,drug-drug interactions,and compliance problems for this age group(polypharmacy).Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants.Herbal preparations may also be carcinogenic or interfere with cancer treatments.Pregnant women use various OTC preparations.However,in many cases,it is unclear whether their use is safe for mother or baby.Self-medication with herbals is also largely distributed among anxious and depressive patients,and patients with other conditions and symptoms.The popularity of herbal products has also brought concerns on quality,efficacy and safety.Cases of botanical misidentification,contaminations with heavy metals,pesticides,radioactivity,organic solvents,microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards.Hepatotoxic effects have been reported for more than 300 plant species,and some commonly used herbs have been demonstrated to interact with Western medication.Health care professionals have a critical responsibility assessing the self-care ability of their patients.Databases are available for pharmacists with information on action,side effects and toxicities as well as herbdrug interactions.There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations(phytovigilance).Physicians,pharmacists,and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs.Information centers for consumers and general practitioners are needed,and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled,double blind and randomized clinical trials.

Potential Herb-Drug Interaction in the Prevention of Cardiovascular Diseases during Integrated Traditional and Western Medicine Treatment

The combination of herbs and drugs is one of the most important approaches in the prevention and treatment of diseases in the integrated traditional and Western medicine （ITWM）. While most medical practices have proved that the combination of herbs and drugs led to a clinical efficacy that was often superior to merely using only one of them; results from some studies have triggered adverse reactions to such an approach. Since few herb-drug interaction studies were carried out during treatments combining herbs and drugs, it really restricts the development of treatment and treatment theory of the combination of herbs and drugs. Given that herb-drug interactions may occur through the main pathway of cytochrome P450 enzymes and transporters; then to exhaustively study the role and impact of herbs in drug metabolism, as well as to establish a corresponding database, is of greatsignificance for guiding the rational combination of herbs and drugs. When the herb-drug interaction information platform is implemented, we would get at ease a reasonable herb-drug prescription to achieve a better outcome, reduce dosage of some expensive drugs preserving the same efficacy, or even reduce some side effects of particular drugs; which might also promote the dynamic combination of Chinese and Western medicine, and accelerate the theory development of ITWM.

网络药理学--中医药研究开发的新技术

目前单一靶点的药物难以对复杂疾病产生良好的疗效,而且中药的作用机制比较复杂,在临床上配伍使用时较难达到预期治疗效果。网络药理学为近年来发展的新兴学科,在系统生物学的基础上融合了多个学科的前沿技术和内容,揭示中药成分与相关靶点相互作用的机制,系统地、整体地揭示疾病与靶点蛋白、靶点蛋白与药物、药物与药物之间的关系,从网络层面的角度观察药物对疾病的影响,以不同以往的角度设计新的药物分子,研制新药。为了促进中医药的持续发展,网络药理学近年被广泛应用于中药领域,现综述网络药理学在中药领域的研究方法以及近几年的应用进展。

Inhibitory Effect of 5-Adenylic Acid on Bitter Taste of Antipsychotic Drugs

The purpose of the present study was to examine the effect of adenylic acid (adenosine 5-monophosphate;AMP), a known nutritional enhancer, on inhibiting the bitterness of antipsychotic medicines administered to patients with mental illnesses, including children. First, we chose four antipsychotic medicines, amitriptyline hydrochloride (AMT), chlorpromazine hydrochloride (CPZ), haloperidol (HPD) and risperidone (RIS) and evaluated the inhibition of their bitterness by AMP through taste sensor measurements. AMP showed a significant bitterness inhibition effect on all drugs. Second, MarvinSketch analysis revealed the potential formation of electrostatic interactions between ionic forms (IV) of AMP and ionic (cationic) forms of each drug, which resulted in bitterness suppression. Third, chemical shift perturbations in 1H-NMR studies suggested an interaction between the phosphate group of AMP and amino group of AMT, CPZ, HPD and RIS. Last, conventional elution experiments of up to 1 min simulating oral cavity conditions were performed for 1 whole AMT tablet, half AMT tablet, crushed half AMT tablet, and crushed AMT tablet containing AMP powder/solution (1, 3 mM potency). The taste sensor output values of the crushed AMT tablet containing AMP powder/solution (1, 3 mM potency) were significantly lower than those of the crushed tablet.

中药有效成分与提取物对CYP1-3家族肝药酶的影响

目的从抑制与诱导两方面综述中药有效成分、提取物及其制品与CYP1-3家族中CYP450酶相互作用的研究成果,以期为中药、草药药物相互作用研究与临床合理用药提供参考。方法以“中药”“肝药酶”“细胞色素P450”“药物相互作用”等为关键词,组合查询近10年来在中国知网、维普网、PubMed等数据库中的相关文献,归纳中药有效成分、中药提取物及其制品与CYP1-3家族中CYP450酶相互作用的研究成果。结果研究发现,Ⅰ相代谢反应中的杂原子氧化、还原、水解、脱甲基、脱氢、羟化等代谢途径绝大部分由CYP 3个基因家族CYP1、CYP2、CYP3的6种同工酶(CYP1A2、CYP2C9、CYP2C19、CYP2D6、CYP2E1、CYP3A4)主导,这6种酶分别约代谢4%、18%、5%、30%、2%、50%的临床药物。结论研究中药有效成分、提取物及其制品与CYP1-3家族中各亚型的相互作用,对于指导临床联合用药、提高临床用药的安全性有着重大意义。

中药新药的药代研究

开展中药药代研究是实现中药现代化的需要,国家药政管理部门积极鼓励在中药新药研发中开展药代研究,然而如何结合注册要求和中药特点开展中药新药的药代研究尚需在技术上进一步细化。本文从三个方面讨论中药新药的药代研究:(1)中药注册申报要求及药物研究技术指导原则涉及的中药药代研究;(2)中药药代动力学方法及研究实例;(3)对中药新药药代研究的思考。当前中药药代动力学在理论、方法、技术、应用上已取得长足发展,基本解决了对中药这类复杂混合物药物开展药代研究的技术难题,为开展中药新药(特别是含多种活性成分的复方中药新药)的药代研究打下基础。围绕中药新药研发需求,迫切需要加紧制定专门针对中药新药的药代动力学研究技术指导原则及药物相互作用研究技术指导原则,这将进一步提升我国中药新药研发的技术水平,并向人用药品注册技术要求国际协调会(ICH)贡献中国标准。

中药有效成分、中药制剂和食物对CYP2D6的抑制作用研究进展

人细胞色素P450(CYP)2D6酶是CYP450酶系中一种重要的氧化代谢酶,参与临床中抗心律失常药、抗高血压药、镇痛药、止咳药、抗精神病药等多种药物代谢。近年来,关于中药有效成分、中药制剂和食物对CYP2D6抑制作用的研究也日益增多。本文查阅、整理并归纳了近年来国内外文献报道的对人CYP2D6有抑制作用的中药有效成分、中药制剂和食物,通过预测潜在的药物相互作用,以避免因中药-药物相互作用和食物-药物相互作用而引发的不良反应,并为临床上中药和经CYP2D6代谢药物的联合应用提供参考依据。

中、西药药代动力学相互作用研究进展

中药治疗各种疾病历史悠久,一般认为天然药物比合成药物安全导致中药在世界范围内的应用急剧增长,但中药同样具有潜在的不良反应和药物相互作用。本文综述并讨论了近几年来关于中、西药药代动力学相互作用研究,以促进中药的合理、安全使用。

细胞色素P450与药物代谢的研究现状

细胞色素P450(CYP)在众多中西药物代谢中起着非常重要的作用。本文综述了与药物代谢相关的CYP亚型、CYP与药物相互作用的关系及中药对CYP的影响,旨在合理解释和预测临床上药物间相互作用和药物不良反应等。同时选择适当的药物作为探针来评价CYP的活性,为实现临床个体化给药提供科学依据。

中药与肝脏药物代谢酶之间的相互作用

肝脏药物代谢酶是决定中药复方体内过程的关键因素,复方中化学成分对药物代谢酶的抑制或诱导作用是中药复方在药动学层次上产生相互作用的主要机制.本文首先建立中药配伍与肝脏药物代谢酶的相互作用技术,在有效组分、有效部位和饮片三个层次发现中药与肝脏药物代谢酶之间的相互作用,筛选发现中药复方中对肝脏药物代谢酶的诱导或抑制成分,探索肝脏药物代谢酶对中药成分代谢作用的具体亚型,结合中药复方作用的体内过程,系统阐述中药成分与机体之间的相互作用,为中药配伍、药效和安全性评价提供理论依据,为建立基于肝脏代谢酶表达方剂整体性研究的新模式提供技术支撑.

消癌平注射液等4种抗肿瘤中药注射剂对人肝微粒体中CYP450酶7种亚型的体外抑制作用研究

目的:考察消癌平注射液等4种抗肿瘤中药注射剂对人肝微粒体CYP450酶7种亚型CYP1A2、CYP2B6、CYP2C8、CYP2C9、CYP2C19、CYP2D6和CYP3A4/5的体外抑制作用。方法:消癌平注射液等4种抗肿瘤中药注射剂分别与7种CYP450酶亚型对应的混合探针药物在人肝微粒体中共同孵育,采用液相色谱-串联质谱(LC-MS/MS)法同时测定这7种探针药物的代谢产物:对乙酰氨基酚、羟基安非他酮、去甲阿莫地喹、4-羟基双氯芬酸、4-羟基美芬妥英、右啡烷和1-羟基咪达唑仑的浓度,分别代表CYP1A2、CYP2B6、CYP2C8、CYP2C9、CYP2C19、CYP2D6和CYP3A4/5的活性,其对CYP450酶亚型的抑制程度以IC50值表示。结果:在体外人肝微粒体孵育体系中,消癌平注射液对CYP1A2、CYP2B6、CYP2C8、CYP2C9、CYP2C19和CYP3A4/5的IC50值分别为0.51%、1.34%、1.42%、0.93%、1.09%和0.75%,艾迪注射液对CYP2C8的IC50值为0.21%;消癌平注射液对CYP2D6的IC50值为2.58%,艾迪注射液对CYP2B6、CYP2C9、CYP2C19和CYP3A4/5的IC50值分别为13.24%、16.31%、4.27%和3.73%,华蟾素注射液对CYP1A2、CYP2B6、CYP2C8和CYP2D6的IC50值分别为3.50%、28.01%、20.32%和32.59%,康艾注射液对CYP1A2、CYP2B6、CYP2C8、CYP2D6和CYP3A4/5的IC50值分别为2.55%、15.32%、1.44%、1.72%和3.99%,均高于各自的日用药量浓度;在测定浓度范围内,艾迪注射液对CYP1A2和CYP2D6,华蟾素注射液对CYP2C9、CYP2C19和CYP3A4/5,康艾注射液对CYP2C9和CYP2C19的活性抑制率均小于50%。结论:在体外,正常剂量下,消癌平注射液对人CYP1A2、CYP2B6、CYP2C8、CYP2C9、CYP2C19和CYP3A4/5,艾迪注射液体对人CYP2C8均有明显抑制作用;消癌平注射液对CYP2D6,艾迪注射液对CYP2B6、CYP2C9、CYP2C19和CYP3A4/5,华蟾素注射液对CYP1A2、CYP2B6、CYP2C8和CYP2D6,康艾注射液对CYP1A2、CYP2B6、CYP2C8、CYP2D6和CYP3A4/5,均无明显抑制作用;艾迪注射液对CYP1A2和CYP2D6,华蟾素注射液对CYP2C9、CYP2C19和CYP3A4/5,康艾注射液对CYP2C9和CYP2C19,均无抑制作用。

中药对华法林作用的影响及机制概述

华法林是临床常用的一种香豆素类口服抗凝药,具有蛋白结合率高、依赖细胞色素P450酶代谢及治疗窗窄等特点,易与其他药物发生相互作用,造成患者出血风险增加或抗凝治疗不足等严重后果。中药在治疗心脑血管疾病等方面具有独特的优势,临床应用广泛,与华法林合用的机会较多。本文根据已有的实验研究和临床案例报道,分别对单味中药及中药复方制剂对华法林抗凝作用的影响及相关机制进行了综述和探讨,以期为临床合理用药和相关研究提供参考。