[Potential interactions between drugs and dietary supplements]. / Potenciální interakce mezi lécivy a doplnky stravy rostlinného puvodu*

Purified active plant constituents were isolated and assessed for their pharmacological activities that constitute a basis of modern drug development. The situation with herbal supplements is different because the extract or dried herb or mixture of herbs contains several substances beside the beneficial one(s) that might produce drug interaction with the conventional medicine(s). Most patients are misinformed and believe that anything "natural" must be safe. This article is focusing on plant-based substances referred as dietary supplements (DS). Examples of reported drug interactions and contraindications associated with DS with two case studies are presented. As supplements are typically not prescribed, many doctors seem to have no interest in drug-DS interactions since a typical medical history of the patients does not include any questions about self-prescribed remedies of this nature. Rather, patients are left alone when they are tempted to try this or that DS and tend to rely on advice from friends, or on material they read on internet. A better quality control, compliance, public awareness and healthcare professionals vigilance for potential interactions are needed. It is of utmost importance to appreciate the impact of supplements on different stages of pharmacokinetics, especially on drug absorption and metabolism.

Beta-3 agonist-induced lipolysis and nitric oxide production: relationship to PPARgamma agonist/antagonist and AMP kinase modulation.

PPARgamma receptor agonist -troglitazone increases insulin sensitivity in visceral adipocytes and also increases fat mass. Beta-3 adrenergic receptor agonists mediate lipolysis and NO production (iNOS transcription) in visceral adipocytes. Troglitazone could possibly interfere with Beta-3-triggered lipolysis. We tested the crosstalk between PPARgamma agonist and Beta-3 agonist pathways on lipolysis and NO production in first 24 hours of treatment. Isolated epididymal rat adipocytes were cultivated in DMEM for 24 hours with treatment with Beta-3 agonist - BRL-37344, PPARgamma agonist - troglitazone, PPARgamma antagonist - SR-202 and AMPK blocker - compound C alone as well as in combinations. After 24 hours, lipolysis was measured by free glycerol, NO production by Griess reagent and iNOS mRNA by qRT-PCR. BRL-37344 increased lipolysis and NO production with iNOS transcription. Troglitazone increased all the three parameters as well but less than BRL-37344. Combination of troglitazone or SR-202 with BRL-37344 decreased NO production, iNOS transcription and lipolysis triggered before adding of BRL-37344. Compound C completely blocked the effect of troglitazone (and SR-202 as well) on BRL-37344. PPARgamma agonist/antagonist interferes with Beta-3 agonist activity in 24 hours. Troglitazone/SR-202 effect on Beta-3 triggered lipolysis and iNOS mRNA production is probably not PPAR gamma- but rather AMPK-dependent in first 24 hours (AMPK blocker - compound C blocked the effect).