Fernando Antônio Frota Bezerra

Avaliação da segurança clínica de um fitoterápico contendo Mikania glomerata, Grindelia robusta, Copaifera officinalis, Myroxylon toluifera, Nasturtium officinale, própolis e mel em voluntários saudáveis

Calmatoss® is a phytomedicine used in several respiratory tract pathologies treatment composed of seven medicinal plants such as Mikania glomerata, Grindelia robusta, Copaifera officinalis, Myroxylon toluifera, Nasturtium officinale, as well as honey and propolis. The present study investigated the chronic administration of 15 mL Calmatoss® syroup four times a day during 21 days for any toxic effect on healthy volunteers. The clinical trial consisted of an open study with 24 volunteers included in the study only when considered healthy after clinical evaluation, physical examination and laboratory tests, which preceded the study. The laboratory tests included: heamatologic, biochemical and sorologic analysis. This evaluation was repeated after the first, second and third week of treatment and at post-study seven days after the last administration. Calmatoss® was well tolerated by the volunteers. Variations in the laboratory were observed and all of these laboratory changes returned to normal levels during or after the study. In spite of these variations none of the volunteers had their values out of the established normality limits for each parameter. In conclusion, clinical, electrocardiographic and laboratory tests did not show any evidence of toxic signals in the various organs and systems studied.

Vasorelaxant and antihypertensive effects of methanolic fraction of the essential oil of Alpinia zerumbet

Alpinia zerumbet is used in folk medicine in Brazil to treat hypertension. However, several pathways involved in the mechanism of vasorelaxation are still unclear. This study was designed to verify the antihypertensive effect of the methanolic fraction of the essential oil of A. zerumbet (MFEOAz) and to characterize its mechanism of action. The thoracic aortic rings from the Wistar rats were perfused in the organ chambers filled with Krebs solution, where the tension of each ring was measured. The antihypertensive effect of MFEOAz was assessed in rats submitted to chronic hypertension by inhibition of nitric oxide synthesis by indirect measurement of blood pressure with indirect tail cuff method. MFEOAz relaxed phenylephrine and KCl-induced contraction of either endothelium-intact or endothelium-denuded rat aortic rings in a concentration-dependent manner. Pre-incubation with MFEOAz (100 and 300 μg/mL) in Ca(2+)-free Krebs solution attenuated phenylephrine- or caffeine-induced contraction. Pre-incubation with L-NAME, ODQ, wortmannin, atropine, indomethacin, catalase, SOD, TEA, 4-aminopyridine, glibenclamide, apamin, charybdotoxin, or iberiotoxin did not affect MFEOAz-induced relaxation. The intragastric administration of MFEOAz induced an antihypertensive effect. MFEOAz it seems inhibited the calcium influx via voltage-operated calcium channels and receptor-operated calcium channels, as well as inhibition of calcium mobilization from intracellular stores.

Estudo de toxicologia clínica de um fitoterápico a base de associações de plantas, mel e própolis

The aim of this study is to evaluate the safety of the use of a phytomedicine syrup (Saratosse®) composed of several medicinal plants: Mikania glomerata, Mentha piperita, Eucalyptus globulus and Copaifera multijuga, along with honey and propolis to treat respiratory diseases. The clinical trial consisted of an open study with 26 adult volunteers of both sexes, who were given an oral dose of 15 mL of Saratosse® for 28 consecutive days, four times a day. Only volunteers who were found healthy after a clinical and physical examination were included. The laboratory tests included: hematological, biochemical and serological analysis. This evaluation was repeated after each week of treatment and seven days after the last administration. ANOVA analysis (Dunnetts test) showed a significant difference, albeit at low statistical level (p < 0.05). Significant differences to the pre-study were not shown by hemoglobin, SGOT, SGPT, creatinine and leukocytes analysis. Laboratorial tests results were within their maximum and minimum reference values. On the whole the medicine was well tolerated. Some side effects were related, which may or not be attributed to the phytomedicine. Clinical, electrocardiographic and laboratory tests did not show any evidence of toxic signs in the organs and systems studied.

Terbinafine quantification in human plasma by high-performance liquid chromatography coupled to electrospray tandem mass spectrometry: application to a bioequivalence study.

A method based on liquid chromatography with positive ion electrospray ionization and tandem mass spectrometry is described for the determination of terbinafine in human plasma using naftifine as internal standard. The method has a chromatographic run time of 5 minutes and was linear in the range 1.0 to 2000 ng/mL. The limit of quantification was 1.0 ng/mL; the intraday precision was 3.6%, 3.8%, 3.5%, and 4.1%; and the intraday accuracy was −2.7%, 7.7%, 4.8%, and −2.7% for 5.0, 80.0, 250.0, and 1500.0 ng/mL, respectively. The interday precision was 4.9%, 1.7%, 2.4%, and 4.6% and the interday accuracy was 0.3%, 5.8%, 6.5%, and −1.4% for the same concentrations. This method was used in a bioequivalence study of two tablet formulations of terbinafine. Twenty-four healthy volunteers (both sexes) received a single oral dose of terbinafine (250 mg) in an open, randomized, two-period crossover study. The 90% CI of geometric mean ratios between (Terbinafina®; Medley S/A Indústria Farmacêutica, Campinas, Brazil) and Lamisil® (Novartis Biociências S/A, São Paulo, Brazil) were 90.5% to 110.0% for C max , 92.2% to 108.1% for AUC last , and 91.3% to 107.5% for AUC 0–inf . Because the 90% CI for the above-mentioned parameters were included in the 80% to 125% interval proposed by the US FDA, the two formulations were considered bioequivalent in terms of rate and extent of absorption.

Evaluation of the therapeutic efficacy of Mentha crispa in the treatment of giardiasis

Its estimated that around 200 million people are annually infected with Giardia lamblia, making the disease a major cause of morbidity worldwide. The current treatment of giardiasis includes the use of several drugs, among them, herbal medicines formulated with Mentha crispa. Thus, the purpose of this study was to evaluate the therapeutic efficacy of M. crispa in the treatment of giardiasis. The research consisted initially of a cross-sectional study for the selection of subjects with giardiasis. After that, there was a randomized, open, in parallel with active control study, in order to verify the therapeutic efficacy of M. crispa in the treatment of giardiasis. Coprology samples were collected from 1622 patients between May 2005 and May 2007 for a series of parasitological examinations. Ninety-six patients with G. lamblia were selected, which were then distributed randomly into two groups: Secnidazole, consisting of 50 patients treated with 2g of Secnidazole and M. crispa, containing 46 patients treated with 2g of M. crispa. After 7 days, healing was evaluated by enzyme immunoassay in a fresh fecal sample. Additionally, the subjects were questioned about possible adverse effects and answered a questionnaire covering socioeconomic and hydrosanitary issues. The analysis of the clinical trial data showed that the cure rate for the Secnidazole group (84.0%) was significantly higher (P=0.0002) as that verified in the M. crispa group (47.83%). Therefore, the study concludes that, in the dose used in this trial, the effect of M. crispa in the treatment of giardisis is less effective than that of Secnidazole.

Efficacy of the tincture of jalapa in the treatment of functional constipation: A double-blind, randomized, placebo-controlled study

BACKGROUND Laxatives are much utilized, but few clinical trials assessed the efficacy of phytotherapics in the functional constipation. AIM The aim of this study was to evaluate the efficacy of the tincture of jalapa in the treatment of patients with functional constipation. METHODS Double-blind, randomized, placebo-controlled clinical trial was used in this study. Seventy-six patients were assigned to two treatment groups, jalapa or placebo. The study consisted of three phases: pre-treatment, treatment, and post-treatment, each phase lasting 7 days. The mean frequency of stools, the mean consistency of stools, and the presence of pain and effort to evacuate were assessed. We monitored adverse events before, during, and after the administration of 15 mL of tincture of jalapa or placebo. RESULTS After treatment, the mean frequency of stools of the jalapa group (0.58 ± 0.25 stools/day; P < 0.0001) was higher than in the placebo group (0.36 ± 0.20 stools/day). In the pre-treatment, stool consistency, according to the Bristol scale, ranged from types 1 to 3 for both groups. The jalapa group showed improved mean consistency of stools (P = 0.0102) after treatment, approximately ranging between types 2 and 4, while the placebo group did not show statistically significant differences (P = 0.1446). The reduction of pain (P = 0.0061) and effort (P = 0.0289) in the jalapa group were statistically significant. Both treatments were well tolerated by the patients. CONCLUSION The tincture of jalapa was shown to be effective in the acute treatment of functional constipation.

Estudo de toxicologia clínica de um fitoterápico contendo Passiflora incarnata L., Crataegus oxyacantha L., Salix alba L. em voluntários saudáveis

Pasalix® is an herbal medicine containing a combination of three medicinal plants: Passiflora incarnata, Salix alba and Crataegus oxyacantha. Its main indication is to treat anxiety and insomnia. The purpose of this study was to evaluate the clinical toxicology of that formulation in healthy volunteers. For this, a non-randomized open clinical trial was conducted with 24 healthy male volunteers, who received two (2) coated tablets of the herbal medicine twice a day for 28 uninterrupted days. The volunteers were included in the study only when considered healthy after clinical assessment, physical examination and laboratory tests which preceded the study. The laboratory tests included: hematological, biochemical and serological analysis. The clinical and laboratory evaluation was repeated after the 1st, 2nd, 3rd and 4th weeks of the treatment and 7 days after the last administration. Pasalix® was well tolerated by the 24 volunteers, and it has showed no serious adverse events. The clinical, laboratory, and electrocardiographic data assessed before, during and after the test showed no signals of toxicity in various organs and systems evaluated, confirming the safety of the preparation for use in trials of therapeutic efficacy.

Validation of a Reversed-Phase High-Performance Liquid Chromatography Method With Fluorescence Detection for the Bioequivalence Study of Norfloxacin in Plasma Samples

A robust method for the determination of norfloxacin in human plasma, using reversed-phase high-performance liquid chromatography (RP-HPLC) with fluorescence detection, has been developed. The method involves precipitation of plasma protein with acetonitrile and the use of ciprofloxacin as internal standard (IS). Chromatographic separations were performed on a Synergi MAX-RP 150 × 4.6-mm, 4-μ column with an elution system consisting of a mixture of phosphate buffer-acetonitrile (85:15, v/v). The calibration curve was linear, in the range of 30 to 3500 ng/mL. The recoveries at concentrations of 90, 1400, and 2800 ng/mL were 103.5%, 100.2%, and 100.2%, respectively. The quantification limit for norfloxacin was 30 ng/mL per 10-μL injection employing fluorescence detection with excitation and emission set at 300 and 450 nm, respectively. The method validation included examining the within-run and between-run precision and accuracy and ensuring that these were within accepted limits; in summary, the precision was <8.6% and accuracy ranged from 95.8% to 104.1% for concentration from 90 to 2800 ng/mL. The precision and accuracy for the lowest calibration standard (30 ng/mL) was well within accepted limits for lower limit of quantification. The method was then applied in a bioequivalence study in healthy volunteers given 400-mg doses of reference and test formulations of norfloxacin in random order and including a 7-day washout phase.

Determination of nimodipine in plasma by HPLC-MS/MS and pharmacokinetic application

To develop and validate a rapid, specific and highly sensitive method to quantify nimodipine in human plasma using dibucaine as the internal standard (IS). The analyte and IS were extracted from plasma samples by liquid-liquid extraction using hexane-ethyl acetate (1:1 v/v). The chromatographic separation was performed on a Varian® Polaris C18 analytical column (3 μm, 50 x 2.0 mm) and pre-column SecurityguardTM C18 (4.0 x 3.0 mm) with a mobile phase of Acetonitrile-Ammonium acetate 0.02 ml/L (80:20v/v). The method had a chromatographic run time of 4.5 min and linear calibration curve over the range of 0.1- 40 ng/mL (r > 0.9938). The limit of quantification was 100 pg/mL. Acceptable precision and accuracy were obtained for concentrations over the standard curve ranges. This validated method was successfully applied in determining the pharmacokinetic profile of nimodipine tablets of 30 mg administered to 24 healthy volunteers. The proposed method of analysis provided a sensitive and specific assay for nimodipine determination in human plasma. The time for the determination of one plasma sample was 4.5 min. This method is suitable for the analysis of nimodipine in human plasma samples collected for pharmacokinetic, bioavailability or bioequivalence studies in humans.

Safety and efficacy of phytomedicines

Abstract In this chapter the safety and efficacy of the phytomedicines around the globe have been discussed. Medicinal plants and herbal medicines are much more economic to use, than those of synthetic modern medicines. Due to this reason and also due to easy availability many poor patients of developing countries are attracted to these, even in developed countries like Germany, USA, etc., interests of people are growing. People believe that these herbal medicines are always safe, but unfortunately this is not the case. There are number of cases reported in the scientific reports around the globe, about the toxicities of the plants, plant products and herbal medicines. This chapter emphasizes and summarizes some of the important points on these safety and regulation issues.