Complementary and alternative medicines use in COVID-19: A global perspective on practice,policy and research

The COVID-19 pandemic has met international health systems with a low level of preparedness and emergency response. While the emergence of effective vaccines has offered the Governments, scientific communities, and members of the public a possible way out of the pandemic, effective pharmacotherapy, including immunotherapy for COVID-19 prevention and treatment, are yet to be established. Internationally, this has led to a surge in the demand and supply of many complementary and alternative medicines (CAM) and practices. Recent studies have shown increasing CAM information requests made to pharmacists and other healthcare staff from members of public and patients aimed at prevention, symptoms relief or treatment of COVID-19.In this context, it is imperative that healthcare professionals, including pharmacists, are acquainted with current practices, policies, and research in relation to CAM use in COVID-19. This narrative commentary will provide an update on global practices, policies and research in regards to CAM use in the context of COVID-19. Healthcare professionals’ understanding of popular CAMs and those tipped for potential benefits in COVID-19, patient and consumer behaviors in relation to CAM use; and healthcare professionals' awareness of cultural, religious, and self-care practices associated with CAM use are imperative to inform effective communication and counselling practices and promote evidence based self-care when patients present for advice. This narrative provides relevant discussions specific to different continents and regions historically linked to diverse CAM practices.     

Characterization of hallucinogenic phenethylamines using high‐resolution mass spectrometry for non‐targeted screening purposes

Hallucinogenic phenethylamines such as 2,5‐dimethoxyphenethylamines (2C–X) and their N ‐(2‐methoxybenzyl) derivatives (25X–NBOMe) have seen an increase in novel analogues in recent years. These rapidly changing analogues make it difficult for laboratories to rely on traditional targeted screening methods to detect unknown new psychoactive substances (NPS). In this study, twelve 2C–X, six 2,5‐dimethoxyamphetamines (DOX), and fourteen 25X–NBOMe derivatives, including two deuterated derivatives (2C–B‐d ₆ and 25I–NBOMe‐d ₉), were analyzed using ultra‐performance liquid chromatography coupled with quadrupole time‐of‐flight mass spectrometry (UPLC‐QTOF‐MS). Collision‐induced dissociation (CID) experiments were performed using collision energies set at 10, 20, and 40 eV. For 2C–X and DOX derivatives, common losses were observed including neutral and radical losses such as NH₃ (17.0265 Da), •CH₆N (32.0500 Da), C₂H₇N (45.0578 Da) and C₂H₉N (47.0735 Da). 2C–X derivatives displayed common product ions at m/z 164.0837 ([C₁₀H₁₂O₂]^+•), 149.0603 ([C₉H₉O₂]⁺), and 134.0732 ([C₉H₁₀O]^+•) while DOX derivatives had common product ions at m/z 178.0994 ([C₁₁H₁₄O₂]^+•), 163.0754 ([C₁₀H₁₁O₂]⁺), 147.0804 ([C₁₀H₁₁O]⁺), and 135.0810 ([C₉H₁₁O]⁺). 25X–NBOMe had characteristic product ions at m/z 121.0654 ([C₈H₉O]⁺) and 91.0548 ([C₇H₇]⁺) with minor common losses corresponding to 2‐methylanisole (C₈H₁₀O, 122.0732 Da), 2‐methoxybenzylamine (C₈H₁₁NO, 137.0847 Da), and •C₉H₁₄NO (152.1074 Da). Novel analogues of the selected classes can be detected by applying neutral loss filters (NLFs) and extracting the common product ions. Copyright © 2017 John Wiley & Sons, Ltd.     

An investigation of the 125I‐radioiodination of colchicine for medical purposes

A procedure for radioiodination of colchicine with iodine‐125 is carried out via an electrophilic substitution reaction. The reaction parameters studied were colchicine concentration, pH of the reaction mixture, reaction time, temperature, different oxidizing agents and different organic media to optimize the conditions for the labeling of colchicine and to obtain a high radiochemical yield of the ¹²⁵I‐colchicine (¹²⁵I‐Col). Using 3.7 MBq of Na¹²⁵I, 1.25 mM of colchicine as substrate, 1.1 mM of chloramine‐T (CAT) as oxidizing agent in ethanol at 60°C for 5 min, a maximum radiochemical yield of ¹²⁵I‐Col (60%) was obtained. The specific activity of ¹²⁵I‐Col obtained was 44.4 MBq/0.5 mmol, and the labeled compound was not completely separated and purified from Col by means of high‐pressure liquid chromatography (HPLC), so the uncertainty in the purity may affect the distribution and clearance routes due to the expected competition between ¹²⁵I‐Col and Col. The biological distribution in normal mice indicates the suitability of radioiodinated colchicine for imaging of muscles. Copyright © 2008 John Wiley & Sons, Ltd.     

Measuring the impact of long-term medicines use from the patient perspective

Polypharmacy is increasing, seemingly inexorably, and inevitably the associated difficulties for individual patients of coping with multiple medicines rise with it. Using medicines is one aspect of the burden associated with living with a chronic condition. It is becoming increasingly important to measure this burden particularly that relating to multiple long-term medicines. Pharmacists and other health professionals provide a myriad of services designed to optimise medicines use, ostensibly aiming to help and support patients, but in reality many such services focus on the medicines, and seek to improve adherence rather than reducing the burden for the patient. We believe that the patient perspective and experience of medicines use is fundamental to medicines optimisation and have developed an instrument which begins to quantify these experiences. The instrument, the Living with Medicines Questionnaire, was generated using qualitative findings with patients, to reflect their perspective. Further development is ongoing, involving researchers in multiple countries.     

Complementary and alternative medicines in the treatment of dementia: an evidence-based review

Alternative medicines may have potential beneficial results in treating certain forms of dementia and related symptoms, as well as slowing disease progression. Alternative medicines may ameliorate disturbances in cognition, mood, sleep and activities of daily living. Primary mechanisms of action include modifications in neurotransmitter synthesis, inhibition of neurotransmitter reuptake and enzyme-induced neurotransmitter breakdown, antioxidant and anti-platelet activity, enhanced blood flow and glucose metabolism. Adverse events can include cardiovascular, gastrointestinal, mood, autonomic and dermatologic effects. However, adverse events, when reported represent, a small percentage of treated groups and direct links between adverse events and alternative therapies are tenuous. Many studies of alternative medicines in dementia are inconclusive and characterised by methodological deficiencies such as small sample sizes and inadequate controls. If alternative medicines can be shown to be efficacious using more rigorous experimental designs, both consumers and clinicians could avail themselves of a wider range of pharmacological substances that may offer the advantage of being better tolerated and exhibiting safer therapeutic margins than some allopathic medicines. While a number of complementary interventions have shown both strengths and weaknesses, huperzine A, levacecarnine and EGB 761, based on the overall quality of the studies, identified mechanisms of activity and safety profiles merit further examination in controlled clinical outcome studies.