Current Drug Research Reviews - Volume 15, Issue 2, 2023

Personalized medicine (PM) is about developing an individualized approach to each patient's illness. Understanding how a patient's genomic portfolio renders them prone to various diseases may be enhanced by discovering genetic, epigenetic, and medical evidence. Medical therapy that is safe and effective for specific individuals may be predicted using the PM approach, which is a complete expansion of an older methodology (One-Size-Fits-All). Patient’s well-being and longevity may improve and costs are reduced if PM is used. Using existing biomarkers and early genome and epigenomic processes to better understand PM may lead to earlier diagnosis of the disease, including carcinogenesis. A key focus of the PM technique is preventative medicine, which emphasizes proactive actions rather than depending only on reactive ones. More intrusive procedures may be avoided or postponed using this technique, resulting in a higher quality of life and lower financial burdens for patients. End-of-life care costs are putting a strain on governmentfunded healthcare systems across the globe, notably in the United States. When used in conjunction with present treatments, PM may help them work better and lessen the disadvantages of just non-PM methods. Using genetic profiling, doctors may choose a drug based on a participant's genetic profile that minimizes unwanted side effects and ensures a better result while also being less costly than a 'trial-and-error' approach to sickness treatment. The less effective non- PM ('trial-and-error') strategy leads to drug toxicity, severe adverse effects, reactive treatment, and misdiagnosis. PM and proactive therapeutic regimens should be used more often to save costs and enhance overall well-being.

Piperine is a fascinating substance since it can be used as a biomarker in combination with other bioactive compounds or their analogues, as well as therapeutic molecules used for the healing of a variety of diseases. It displays a plentiful therapeutic potential and various health benefits when administered alone or in combination with several other drugs and/or phytochemicals. It has also been used to enhance the pharmacokinetic profile of many nutraceutical compounds like curcumin, resveratrol, quercetin, beta-carotene, barbiturates, propranolol, metformin, theophylline etc. The present review discloses the synergistic effect of piperine and its derivatives, clinical studies, and patent studies of piperine.

Background: Epidemiological studies have suggested that a regular intake of flavonoids is beneficial for cellular homeostasis and in the prevention of the transformation of normal cells into cancerous cells. Because of their multiple biological targets, flavonoids have been studied and investigated as phytoconstituents with potential anticancer properties. Flavonoids interfere in the development of cancerous cells by inhibition of topoisomerases, protein kinases, angiogenesis, induction of apoptosis, cell cycle arrest, modulation of multidrug resistance, and improvement in anti-oxidative activities. The current review summarizes the anticancer properties of flavonoids along with the key structural features and their mechanisms. The present study provides a detailed analysis of anticancer activities with previously published data on different flavonoids. The review highlighted the structural aspects and mechanism of action of flavonoids with their potential target sites. Flavonoids induce anticancer activity by protein kinases inhibition, P-gp modulation, antiangiogenesis, topoisomerases inhibition, etc. Open ring C, the double bond between C2-C3, the oxo group at C4, and the position of ring B are crucial determinants for their anticancer activity. Flavonoids act by multiple mechanisms but further studies on target selectivity and specificity of flavonoids are necessary to establish them as anticancer therapeutics. The presence of a C2-C3 double bond and oxo group at C4 (also known as an enone moiety) or -OH in the neighbour of a double bond that can transform easily into an enone are common features present in flavonoids. Thus, it can be concluded that enone moiety or its precursor groups are mainly responsible for the anticancer activities of flavonoids via different mechanisms of action.

Insomnia is one of the major challenges in medical science nowadays as it leads to the great socio-economic burden by impairing daytime function as well as the development of exhaustion, depression and memory disturbance in affected individuals. Several important classes of drugs have been tried including the BZDs and Non-BZD hypnotics. Available drugs to combat this disease have the limitations of abuse potential, tolerance and cognitive impairments. In some instances, withdrawal symptoms have been observed on abrupt cessation of those drugs. The Orexin system has been very recently targeted as a therapeutic option to overcome those limitations. Daridorexant as a Dual Orexin Receptor Antagonists (DORA) in the treatment of insomnia has been evaluated in several preclinical and clinical studies. Available information obtained from those studies has shown promising future for this drug in the management of insomnia. Beyond its effectiveness in insomnia, it has been successfully used in patients suffering from Obstructive sleep apnoea, Chronic Obstructive Airway Disease (COAD), Alzheimer’s Disease (AD), hypertension and cardiovascular disorders. Larger studies need to address the safety issues as well as obtain robust pharmacovigilance information to safeguard the risk-benefit aspect of this drug in insomniac adults.

Background: Individuals with severe mental illness are prone to severe COVID-19 infection with increased morbidity and mortality. Psychiatric patients are often concerned about the potential interactions between the newly approved COVID-19 vaccines in Malaysia and psychotropic drugs like antidepressants. To date, such data are unavailable. Objectives: This review aims to clear the polemics of COVID-19 vaccine-antidepressants interaction in these 3 aspects: (1) cytokines and cytochrome P450 pathway, (2) blood-brain barrier (BBB) involvement and (3) and its interaction with polyethylene glycol (PEG), the potential allergenic culprit following COVID-19 vaccination. Methods: A scoping approach was employed to search for peer-reviewed journal articles across four healthcare and scientific databases (PubMed, MEDLINE, PsycINFO and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Results: Antidepressants metabolism often involves the CYP450 enzymes. Vaccine-antidepressants interactions are probable, likely to be triggered by interactions of CYP450 enzymes and inflammatory cytokines, resulting in diminished drug metabolism and chemical detoxification. Aside, PEG, the excipient in mRNA-based COVID-19 vaccines and antidepressants, has been reported as an anaphylaxis causative allergen. However, whether it leads to synergistic, potentiation or antagonistic effects when used in combination remains to be elucidated. ; Conclusion: Psychotropic medications, including antidepressants, showed potentially relevant safety risks for COVID-19 patients. These vulnerable patient group must be prioritized for early access to safe and efficacious COVID-19 vaccines, as vaccination remains the most important public health intervention to tackle the ongoing COVID-19 pandemic.

Objective: Amoxicillin is among the most used antibiotics in the treatment of a wide spectrum of bacterial infections. Although amoxicillin is categorized as group B in pregnancy, the findings of studies regarding its effects on the fetus are controversial. The aim of this systematic review was to review the reported effects of amoxicillin administration in pregnancy on congenital anomalies. Methods: Published articles in PubMed, Scopus, SID, and Magiran databases, as well as Google Scholar were searched till May 2021 based on a search strategy. Case-control and cohort studies in Persian or English language were included. Four studies, including two case-control and two cohort studies, with an overall sample size of 260491 pregnant mothers, were included in the review. Results: A review of case-control studies revealed an increased risk for cleft palate in one study. Cohort studies did not reveal a significant relationship between amoxicillin use and major congenital anomalies. Conclusion: The findings of this systematic review showed that although no major congenital anomaly was reported for the administration of amoxicillin consumption with or without clavulanic acid, there is a possibility that amoxicillin administration in pregnancy might be related to some anomalies, including cleft palate. Amoxicillin should be administered with caution during pregnancy till more evidence is provided regarding its safety.

Introduction: Poly-drug use has increased in recent decades, especially in young drugusing groups. Classic epidemiological indicators of drug use, such as prevalence and incidence of users of specific substances, are not adequate as measures of the possible harms of poly-drug use. We applied poly-drug use indicators, based on substance-specific harm scores reported by van Amsterdam and Nutt in 2015, to data from high school student surveys, showing their usefulness in identifying high-risk drug consumption. Analysing the ‘correlation’ between high-risk drug use of high school students and school dropout allows the evaluation of adopted prevention policies and may suggest more suitable approaches. Methods: Each drug user is characterized by two specific scores: overall frequency of use of substances during the period of interest (FUS) and poly-drug use score (PDS). The poly-drug use score is a weighted average of the harm scores of the individual substances used multiplied by their respective frequencies of use. The PDS increases with the frequency of use, with the number of substances used, and with the specific harm scores of each substance. This indicator consists of two components, one representing the health harm score toward self and the other the social harm score toward others. Results: The indicators have been applied to sample data involving youth population, specifically the ESPAD®Italia survey data on high school students conducted annually in Italy. The trends of poly-drug use at different ages of students, 15-19 years, over time, and gender have been studied. The results have been linked to educational outcomes, early school leaving and social aspects, making it possible to assess present prevention interventions and suggest appropriate planning of future prevention interventions. Conclusion: Poly-drug use indicators allow a comprehensive quantitative evaluation of the risks of drug use. The analysis of the links between heavy use of drugs, school performance and dropout, and the social variables that influence them, shown in this work, suggests how best to plan secondary or indicated prevention interventions at school. The problem of including "new" NPS in analyses is also briefly discussed.

Background: Majoon-Najah is a composite Unani formulation that consists of multiple medicinal plants and is advised for neurological illnesses. Several studies were carried out on Majoon-Najah (MN) and its ingredients to evaluate the protective effect against seizure and antidepressant activity in animals using a classical form as well as extract. Terminalia bellerica and Emblica officinalis are the major constituents of MN. Scientifically documented literature summarises the hepatoprotective potential of these constituents. Aim: The current study aimed to evaluate the possible hepatoprotective, antioxidant and antiinflammatory perspective of traditional Indian Unani formulation MN and Majoon-Najah hydroalcoholic extract (MNHE) in a Guinea pig model. Methods: Thirty adult male albino guinea pigs were randomly assigned into five groups for this study. MN and MNHE were given intragastrically for 15 days, followed by intraperitoneal Cadmium chloride (CdCl2, 3 mg/kg/day) from days 8 to 15, as per the schedule. Blood samples were taken from the heart on the 16th day, and the liver was operated on for biochemical analysis and histopathology under complete anesthesia. Results: CdCl2 changed the levels of liver function markers, serum biochemical indicators like albumin, total protein, glucose, and cholesterol in the blood; lipid peroxidation (MDA), glutathione reductase (GSH), superoxide dismutase (SOD), and glutathione peroxidase (GPX) in hepatic tissue homogenate, pro-inflammatory cytokines level and liver cytoarchitecture. MN and MNHE were found to protect guinea pigs’ liver from CdCl2-induced injury by lowering raised parameters and increasing enzymatic antioxidants. MN and MNHE did not significantly heal injured liver tissues caused by CdCl2 in histopathological examinations. Conclusion: CdCl2 induces hepatotoxicity that is likely to worsen with increasing dosage and duration of exposure. MN and MNHE exert their hepatoprotective action by scavenging free radicals, decreasing malondialdehyde levels, activating antioxidant enzymes, and down-regulating proinflammatory indicators.