An in vitro assessment of pharmacodynamic interactions between selected herbal extracts and anticancer chemotherapeutic agents
- Hwehwe, Nyashadzashe, Swanepoel, Bresler
- Authors: Hwehwe, Nyashadzashe , Swanepoel, Bresler
- Date: 2024-04
- Subjects: Chemotherapy , Herbs -- Therapeutic use , Antineoplastic agents
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10948/63506 , vital:73383
- Description: Cancer is a disease caused by uncontrolled growth and spreading of abnormal cells to distant body parts. Approximately 19.3 million and 10 million new cancer cases and cancer deaths, respectively were recorded in 2020. Despite advancements in prevention and therapeutic strategies, cancer remains a global health problem. Cancer patients are increasingly seeking complementary and alternative medicines, of which herbal medicines are the most common form of CAM used by patients. Numerous in vitro and in vivo studies of herbal medicines in cancer have shown that they have antioxidant and anticancer (antitumor and anti-proliferative) properties. While concurrent use with conventional cancer treatments may improve treatment efficacy, alleviate chemotherapy-related side effects, boost the immune system, or impede drug resistance, it can also prompt drug-herbal interactions, and this may affect the pharmacodynamics and pharmacokinetics of the chemotherapeutic drug. This study aimed to determine relevant pharmacodynamic interactions with chemotherapeutic drugs and investigate such interactions' mechanisms. The objectives of the study were to screen the cytotoxicity effects of drug compounds, herbal extracts, and drug-herb combinations, to determine the ability of treatments to induce apoptosis, and to determine the most beneficial treatment. The cytotoxic effects of cisplatin in HeLa cells, tamoxifen in MCF7 cells, 5-fluorouracil in Caco-2 cells, and grapeseed, green tea, fermented rooibos, and green rooibos in all the listed cell lines were evaluated individually and in combination using the bis-Benzamide H 33342 trihydrochloride/propidium iodide (Hoechst 33342/PI) dual staining method. CompuSyn 1.0 Software was used to quantify synergism and antagonism. The mechanism of apoptosis induction of the different synergetic combinations, drug compounds, and herbal extracts was illustrated by quantitative fluorescence image analysis, specifically cell cycle analysis, phosphatidylserine translocation, mitochondrial membrane potential analysis, caspase 3 activation, and reactive oxygen species production using the relevant contrast dyes. Grapeseed displayed cytotoxicity towards MCF7 and HeLa cells (IC50 57.98 and 83.28 μg/mL, respectively). Green tea was only cytotoxic against HeLa cells at an IC50 of 91,92 μg/mL. None of the extracts displayed cytotoxicity against Caco-2 cells (IC50 values > 200μg/mL). If the herbal extracts had inconclusive IC50 values in the three cell lines subsequent experiments were conducted using 100 μg/mL. The results showed that most of the combinations were antagonistic but, some combinations had synergistic or enhancement effects(1:3 for cisplatin with grape seed or green tea and tamoxifen with grapeseed or green tea, and 3:1 for cisplatin with green tea as well as for tamoxifen with fermented rooibos or green rooibos, and all the 1:1 combinations of 5- fluorouracil with all herbal extracts) with a combination index (CI) < 1. Grape seed and green tea were found to induce apoptosis in the three cell lines. Assays that were conducted to detect apoptosis induction showed positive staining for phosphatidylserine (PS), activated caspase 3, and reactive oxygen species (ROS), mitochondrial membrane depolarization. Analysis of the cell cycle showed two things; 1) that grape seed and green tea were apoptotic in HeLa and MCF7 cells only, and 2) the extracts of green tea and green rooibos, and the combinations of grape seed with all drug compounds arrested the cell in more than one phase of the cell cycle. The combinations of grapeseed and green tea potentially induced apoptosis in various manners but those with both rooibos extracts were unclear in all the cell lines. The results for combinations with grapeseed and green tea are promising and provide a basis for further research as combinations of chemotherapeutic drugs and herbal extracts may be effective therapeutic strategies. , Thesis (MPharm) -- Faculty of Health Sciences, School of Clinical Care & Medicinal Sciences, 2024
- Full Text:
- Date Issued: 2024-04
- Authors: Hwehwe, Nyashadzashe , Swanepoel, Bresler
- Date: 2024-04
- Subjects: Chemotherapy , Herbs -- Therapeutic use , Antineoplastic agents
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10948/63506 , vital:73383
- Description: Cancer is a disease caused by uncontrolled growth and spreading of abnormal cells to distant body parts. Approximately 19.3 million and 10 million new cancer cases and cancer deaths, respectively were recorded in 2020. Despite advancements in prevention and therapeutic strategies, cancer remains a global health problem. Cancer patients are increasingly seeking complementary and alternative medicines, of which herbal medicines are the most common form of CAM used by patients. Numerous in vitro and in vivo studies of herbal medicines in cancer have shown that they have antioxidant and anticancer (antitumor and anti-proliferative) properties. While concurrent use with conventional cancer treatments may improve treatment efficacy, alleviate chemotherapy-related side effects, boost the immune system, or impede drug resistance, it can also prompt drug-herbal interactions, and this may affect the pharmacodynamics and pharmacokinetics of the chemotherapeutic drug. This study aimed to determine relevant pharmacodynamic interactions with chemotherapeutic drugs and investigate such interactions' mechanisms. The objectives of the study were to screen the cytotoxicity effects of drug compounds, herbal extracts, and drug-herb combinations, to determine the ability of treatments to induce apoptosis, and to determine the most beneficial treatment. The cytotoxic effects of cisplatin in HeLa cells, tamoxifen in MCF7 cells, 5-fluorouracil in Caco-2 cells, and grapeseed, green tea, fermented rooibos, and green rooibos in all the listed cell lines were evaluated individually and in combination using the bis-Benzamide H 33342 trihydrochloride/propidium iodide (Hoechst 33342/PI) dual staining method. CompuSyn 1.0 Software was used to quantify synergism and antagonism. The mechanism of apoptosis induction of the different synergetic combinations, drug compounds, and herbal extracts was illustrated by quantitative fluorescence image analysis, specifically cell cycle analysis, phosphatidylserine translocation, mitochondrial membrane potential analysis, caspase 3 activation, and reactive oxygen species production using the relevant contrast dyes. Grapeseed displayed cytotoxicity towards MCF7 and HeLa cells (IC50 57.98 and 83.28 μg/mL, respectively). Green tea was only cytotoxic against HeLa cells at an IC50 of 91,92 μg/mL. None of the extracts displayed cytotoxicity against Caco-2 cells (IC50 values > 200μg/mL). If the herbal extracts had inconclusive IC50 values in the three cell lines subsequent experiments were conducted using 100 μg/mL. The results showed that most of the combinations were antagonistic but, some combinations had synergistic or enhancement effects(1:3 for cisplatin with grape seed or green tea and tamoxifen with grapeseed or green tea, and 3:1 for cisplatin with green tea as well as for tamoxifen with fermented rooibos or green rooibos, and all the 1:1 combinations of 5- fluorouracil with all herbal extracts) with a combination index (CI) < 1. Grape seed and green tea were found to induce apoptosis in the three cell lines. Assays that were conducted to detect apoptosis induction showed positive staining for phosphatidylserine (PS), activated caspase 3, and reactive oxygen species (ROS), mitochondrial membrane depolarization. Analysis of the cell cycle showed two things; 1) that grape seed and green tea were apoptotic in HeLa and MCF7 cells only, and 2) the extracts of green tea and green rooibos, and the combinations of grape seed with all drug compounds arrested the cell in more than one phase of the cell cycle. The combinations of grapeseed and green tea potentially induced apoptosis in various manners but those with both rooibos extracts were unclear in all the cell lines. The results for combinations with grapeseed and green tea are promising and provide a basis for further research as combinations of chemotherapeutic drugs and herbal extracts may be effective therapeutic strategies. , Thesis (MPharm) -- Faculty of Health Sciences, School of Clinical Care & Medicinal Sciences, 2024
- Full Text:
- Date Issued: 2024-04
Effects of selected natural flavonoids on an optimized insulin resistance induction model on myotubes and hepatocytes in vitro
- Authors: Van de Venter, Ruben
- Date: 2023-12
- Subjects: Flavonoid , Insulin resistance , Myotubes and hepatocytes
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10948/63049 , vital:73085
- Description: Introduction: As the third largest life-threatening non-communicable disease, further research to improve T2DM treatment remains pivotal. The approved insulin sensitizing agents, metformin and thiazolidinediones, although effective, have an array of adverse effects. This leads to the growing need for safer insulin sensitizing agents. Aims: To induce insulin resistance, an insulin resistance induction (IRI) model consisting of palmitic acid (PA), fructose, and dexamethasone (DEX), was optimized. The model was utilized to compare the insulin sensitizing efficacy of chrysin, apigenin, luteolin, and quercetin. The most effective flavonoid was extrapolated based on the hydroxylation hypothesis and relevant SAR. The flavonoid was combined with metformin to evaluate potential insulin sensitizing synergism. Methods: C3A hepatocytes and L6 myotubes were exposed to the IRI models: IR1, IR2, and OIR, for 24 and 48h. Morphological features indicative of insulin resistance were monitored through high-content analysis (HCA). Thereafter, cells were exposed to OIR and concurrently treated with the selected flavonoids. Cytotoxicity, oxidative stress (OS), mitochondrial content, mitochondrial membrane potential (MMP), and lipid accumulation, were once again evaluated through HCA. Subsequently, quercetin was combined with metformin (QM); insulin resistant conditions established through OIR exposure, and QM administered as prophylaxis. The efficacy of QM was determined through changes in phosphorylated-Akt, glucose uptake, and gluconeogenesis. Results: IR1 and IR2 demonstrated excessive potency, whereas OIR consistently generated insulin resistant C3A/L6 cells by increasing OS (↑14%/20%), lipid accumulation (0.7-fold/1.5-fold), and decreasing MMP (↓4%/6%). Of the selected flavonoids, quercetin was most effective at ameliorating each of these parameters. Furthermore, QM demonstrated potential insulin sensitizing synergism, as it improved Akt phosphorylation (Thr308: ↑31%/↑17%; Ser473: ↑29%), glucose uptake (↑10%/ 5%), and suppressed hepatic gluconeogenesis (15↓%) more effectively compared to monotherapy. Conclusions: OIR is an effective model for the induction of complete early-stage insulin resistance in myotubes and hepatocytes. Quercetin demonstrates exceptional antidiabetic activity due its unique expression of hydroxyl groups. Lastly, QM, comparative to monotherapy, improves insulin sensitivity with enhanced efficacy. , Thesis (Ma) -- Faculty of Health Science, 2023
- Full Text:
- Date Issued: 2023-12
- Authors: Van de Venter, Ruben
- Date: 2023-12
- Subjects: Flavonoid , Insulin resistance , Myotubes and hepatocytes
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10948/63049 , vital:73085
- Description: Introduction: As the third largest life-threatening non-communicable disease, further research to improve T2DM treatment remains pivotal. The approved insulin sensitizing agents, metformin and thiazolidinediones, although effective, have an array of adverse effects. This leads to the growing need for safer insulin sensitizing agents. Aims: To induce insulin resistance, an insulin resistance induction (IRI) model consisting of palmitic acid (PA), fructose, and dexamethasone (DEX), was optimized. The model was utilized to compare the insulin sensitizing efficacy of chrysin, apigenin, luteolin, and quercetin. The most effective flavonoid was extrapolated based on the hydroxylation hypothesis and relevant SAR. The flavonoid was combined with metformin to evaluate potential insulin sensitizing synergism. Methods: C3A hepatocytes and L6 myotubes were exposed to the IRI models: IR1, IR2, and OIR, for 24 and 48h. Morphological features indicative of insulin resistance were monitored through high-content analysis (HCA). Thereafter, cells were exposed to OIR and concurrently treated with the selected flavonoids. Cytotoxicity, oxidative stress (OS), mitochondrial content, mitochondrial membrane potential (MMP), and lipid accumulation, were once again evaluated through HCA. Subsequently, quercetin was combined with metformin (QM); insulin resistant conditions established through OIR exposure, and QM administered as prophylaxis. The efficacy of QM was determined through changes in phosphorylated-Akt, glucose uptake, and gluconeogenesis. Results: IR1 and IR2 demonstrated excessive potency, whereas OIR consistently generated insulin resistant C3A/L6 cells by increasing OS (↑14%/20%), lipid accumulation (0.7-fold/1.5-fold), and decreasing MMP (↓4%/6%). Of the selected flavonoids, quercetin was most effective at ameliorating each of these parameters. Furthermore, QM demonstrated potential insulin sensitizing synergism, as it improved Akt phosphorylation (Thr308: ↑31%/↑17%; Ser473: ↑29%), glucose uptake (↑10%/ 5%), and suppressed hepatic gluconeogenesis (15↓%) more effectively compared to monotherapy. Conclusions: OIR is an effective model for the induction of complete early-stage insulin resistance in myotubes and hepatocytes. Quercetin demonstrates exceptional antidiabetic activity due its unique expression of hydroxyl groups. Lastly, QM, comparative to monotherapy, improves insulin sensitivity with enhanced efficacy. , Thesis (Ma) -- Faculty of Health Science, 2023
- Full Text:
- Date Issued: 2023-12
A drug utilisation review of lithium at a public sector psychiatric hospital
- Authors: Mapfumo, Charlotte
- Date: 2020-04
- Subjects: Lithium -- Therapeutic use , Psychiatric hospitals -- South Africa -- Grahamstown , Drug utilization , Psychiatric hospital care , Manic-depressive illness , Lithium -- Toxicology , Drug monitoring
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/150541 , vital:38983
- Description: Bipolar disorder (BD) is a common mental condition that affects about 60 million people globally. Lithium is among the drugs of choice used to treat BD and other affective disorders such as schizoaffective disorder (SD). Lithium is a mood stabiliser with antimanic, antidepressant and anti-suicidal properties. Lithium has complex mechanisms of action and a narrow therapeutic index (NTI). Therapeutic drug monitoring (TDM) is a vital component of lithium therapy due to its NTI. Lithium toxicity can occur at therapeutic levels and is characterised by symptoms such as blurred vision and convulsions. Lithium interacts with a number of drugs resulting in lithium toxicity or diminished effects of lithium. Symptoms of lithium toxicity range from abdominal pain, convulsions and death. Lithium use is associated with serious adverse effects on renal and thyroid function. Other adverse effects include tremor and weight gain. Monitoring of lithium serum levels, renal and thyroid function are therefore recommended for patients on lithium therapy. Monitoring of these parameters assists in the early detection of any problems associated with lithium use. The metabolic monitoring of lithium is vital due to the adverse effect profile of lithium and the current South African Standard Treatment Guidelines Hospital level: Adults, do not have any recommendations for the monitoring of metabolic parameters. The National Institute for Health and Care Excellence (NICE) may be used and adapted for the South African setting. Aim and Objectives: The general aim of the study was to conduct a drug utilisation review (DUR) on lithium through investigating its prescribing and monitoring patterns in both inpatients and outpatients at Fort England Hospital. Methodology: The study was in the form of a retrospective DUR. Data was collected from 40 files (n=40) of patients who were on treatment with lithium between 1 January 2017-31 December 2017 at Fort England Hospital. The data was collected retrospectively for both in- and outpatients. Compliance of the monitoring requirements with both South African and international guidelines was analysed. Results and Discussion: In 87.50% (n=37) of the cases, patients had been on lithium therapy before 2017 with most patients (n=13; 37.50%) being maintained on 500 mg of lithium. Non-compliance with the South African and NICE guidelines for renal baseline monitoring was 65.00% (n=26) in both guidelines. Non-compliance for baseline thyroid monitoring was 70.00% (n=28) for both guidelines. There was non-compliance in 45.00% (n=18) of the cases for lithium serum level monitoring for both guidelines. Non-compliance with follow-up renal monitoring was 47.50% (n=19) for both guidelines. Compliance with the NICE guidelines for follow-up metabolic monitoring was 67.50% (n=27). Conclusion: There was non-compliance in most cases leaving room for clinical improvement in the monitoring of lithium. Healthcare professionals should be educated on the recommended monitoring guidelines to promote the rational use of lithium in South Africa. Pharmacists should be more involved in the TDM of lithium to promote its safe and effective use.
- Full Text:
- Date Issued: 2020-04
- Authors: Mapfumo, Charlotte
- Date: 2020-04
- Subjects: Lithium -- Therapeutic use , Psychiatric hospitals -- South Africa -- Grahamstown , Drug utilization , Psychiatric hospital care , Manic-depressive illness , Lithium -- Toxicology , Drug monitoring
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/150541 , vital:38983
- Description: Bipolar disorder (BD) is a common mental condition that affects about 60 million people globally. Lithium is among the drugs of choice used to treat BD and other affective disorders such as schizoaffective disorder (SD). Lithium is a mood stabiliser with antimanic, antidepressant and anti-suicidal properties. Lithium has complex mechanisms of action and a narrow therapeutic index (NTI). Therapeutic drug monitoring (TDM) is a vital component of lithium therapy due to its NTI. Lithium toxicity can occur at therapeutic levels and is characterised by symptoms such as blurred vision and convulsions. Lithium interacts with a number of drugs resulting in lithium toxicity or diminished effects of lithium. Symptoms of lithium toxicity range from abdominal pain, convulsions and death. Lithium use is associated with serious adverse effects on renal and thyroid function. Other adverse effects include tremor and weight gain. Monitoring of lithium serum levels, renal and thyroid function are therefore recommended for patients on lithium therapy. Monitoring of these parameters assists in the early detection of any problems associated with lithium use. The metabolic monitoring of lithium is vital due to the adverse effect profile of lithium and the current South African Standard Treatment Guidelines Hospital level: Adults, do not have any recommendations for the monitoring of metabolic parameters. The National Institute for Health and Care Excellence (NICE) may be used and adapted for the South African setting. Aim and Objectives: The general aim of the study was to conduct a drug utilisation review (DUR) on lithium through investigating its prescribing and monitoring patterns in both inpatients and outpatients at Fort England Hospital. Methodology: The study was in the form of a retrospective DUR. Data was collected from 40 files (n=40) of patients who were on treatment with lithium between 1 January 2017-31 December 2017 at Fort England Hospital. The data was collected retrospectively for both in- and outpatients. Compliance of the monitoring requirements with both South African and international guidelines was analysed. Results and Discussion: In 87.50% (n=37) of the cases, patients had been on lithium therapy before 2017 with most patients (n=13; 37.50%) being maintained on 500 mg of lithium. Non-compliance with the South African and NICE guidelines for renal baseline monitoring was 65.00% (n=26) in both guidelines. Non-compliance for baseline thyroid monitoring was 70.00% (n=28) for both guidelines. There was non-compliance in 45.00% (n=18) of the cases for lithium serum level monitoring for both guidelines. Non-compliance with follow-up renal monitoring was 47.50% (n=19) for both guidelines. Compliance with the NICE guidelines for follow-up metabolic monitoring was 67.50% (n=27). Conclusion: There was non-compliance in most cases leaving room for clinical improvement in the monitoring of lithium. Healthcare professionals should be educated on the recommended monitoring guidelines to promote the rational use of lithium in South Africa. Pharmacists should be more involved in the TDM of lithium to promote its safe and effective use.
- Full Text:
- Date Issued: 2020-04
Evaluating the prescribing and management practices of clozapine at a public sector psychiatric hospital
- Authors: Mukoko, Vimbisai Millicent
- Date: 2020-04
- Subjects: Clozapine , Schizophrenia -- Chemotherapy , Schizophrenia -- South Africa -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123266 , vital:35422
- Description: Approximately one percent (1%) of the South African population suffers from schizophrenia. Clozapine has proven to be more effective than conventional antipsychotics in the treatment of schizophrenia, particularly in alleviating positive symptoms. Clozapine is primarily indicated for treatment-resistant schizophrenia due to its severe adverse effect profile. The prescribing guidelines recommend a trial of at least two different antipsychotic drugs before the initiation of clozapine. At least one should be a non-clozapine second generation antipsychotic. Compared to other atypical antipsychotics, clozapine poses the greatest risk of causing a haematological event, such as neutropenia and agranulocytosis. Agranulocytosis (estimated prevalence of 1.3%) is a life-threatening adverse effect. Common adverse effects include weight gain and metabolic syndrome, hypersalivation and constipation. These can also predispose the patient to co-morbid diseases which further complicate their current diagnosis. Haematological and metabolic monitoring is paramount throughout the duration of clozapine therapy. International (NICE guidelines, Clozapine REMS, and Maudsley prescribing guidelines) and national (South African STGs, SASOP treatment guidelines and the SAMF) guidelines recommend these monitoring patterns to assist with the prevention and management of the adverse effects of clozapine.
- Full Text:
- Date Issued: 2020-04
- Authors: Mukoko, Vimbisai Millicent
- Date: 2020-04
- Subjects: Clozapine , Schizophrenia -- Chemotherapy , Schizophrenia -- South Africa -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123266 , vital:35422
- Description: Approximately one percent (1%) of the South African population suffers from schizophrenia. Clozapine has proven to be more effective than conventional antipsychotics in the treatment of schizophrenia, particularly in alleviating positive symptoms. Clozapine is primarily indicated for treatment-resistant schizophrenia due to its severe adverse effect profile. The prescribing guidelines recommend a trial of at least two different antipsychotic drugs before the initiation of clozapine. At least one should be a non-clozapine second generation antipsychotic. Compared to other atypical antipsychotics, clozapine poses the greatest risk of causing a haematological event, such as neutropenia and agranulocytosis. Agranulocytosis (estimated prevalence of 1.3%) is a life-threatening adverse effect. Common adverse effects include weight gain and metabolic syndrome, hypersalivation and constipation. These can also predispose the patient to co-morbid diseases which further complicate their current diagnosis. Haematological and metabolic monitoring is paramount throughout the duration of clozapine therapy. International (NICE guidelines, Clozapine REMS, and Maudsley prescribing guidelines) and national (South African STGs, SASOP treatment guidelines and the SAMF) guidelines recommend these monitoring patterns to assist with the prevention and management of the adverse effects of clozapine.
- Full Text:
- Date Issued: 2020-04
Evaluating the prescribing and management practices of venlafaxine at a public sector psychiatric hospital
- Authors: Naidu, Bavika
- Date: 2020-04
- Subjects: Venlafaxine , Anxiety disorcers -- Treatment , Depression, Mental -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123200 , vital:35414
- Description: Neuropsychiatric conditions have been ranked third in South Africa according to some of the most recent reviews of disease burden, following human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases (Bateman, 2012:70; South African Depression and Anxiety Group, 2018). For depressive disorders, the conventional selective serotonin reuptake inhibitors (e.g. fluoxetine), are common first-step treatments due to their relatively low toxicity and high tolerability (Rush et al., 2006:1231). The class of selective noradrenaline reuptake inhibitors (e.g. venlafaxine) is relatively new on the market. The first SNRI to be marketed in the United States was venlafaxine immediate-release (IR). It was approved by the United States FDA in 1993 (Sansone and Sansone, 2014:37) and was soon followed by the introduction of a micro-encapsulated extended-release (XR) formulation in 1997. Currently there is no published or readily available information concerning the prescribing and management patterns of venlafaxine as well as the incidence and types of adverse effects experienced by patients in the public health sector of South Africa besides the established increased in blood pressure.
- Full Text:
- Date Issued: 2020-04
- Authors: Naidu, Bavika
- Date: 2020-04
- Subjects: Venlafaxine , Anxiety disorcers -- Treatment , Depression, Mental -- Treatment
- Language: English
- Type: text , Thesis , Masters , M.Pharm
- Identifier: http://hdl.handle.net/10962/123200 , vital:35414
- Description: Neuropsychiatric conditions have been ranked third in South Africa according to some of the most recent reviews of disease burden, following human immunodeficiency virus/acquired immune deficiency syndrome and other infectious diseases (Bateman, 2012:70; South African Depression and Anxiety Group, 2018). For depressive disorders, the conventional selective serotonin reuptake inhibitors (e.g. fluoxetine), are common first-step treatments due to their relatively low toxicity and high tolerability (Rush et al., 2006:1231). The class of selective noradrenaline reuptake inhibitors (e.g. venlafaxine) is relatively new on the market. The first SNRI to be marketed in the United States was venlafaxine immediate-release (IR). It was approved by the United States FDA in 1993 (Sansone and Sansone, 2014:37) and was soon followed by the introduction of a micro-encapsulated extended-release (XR) formulation in 1997. Currently there is no published or readily available information concerning the prescribing and management patterns of venlafaxine as well as the incidence and types of adverse effects experienced by patients in the public health sector of South Africa besides the established increased in blood pressure.
- Full Text:
- Date Issued: 2020-04
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