Case Report: Severe Hematological, Muscle and Liver Toxicity Caused by Drugs and Artichoke Infusion Interaction in an Elderly Polymedicated Patient.

BACKGROUND: Case report, in a patient with a history of diabetes and hypertension, treated with metformin, gliclazide, enalapril + hydrochlorothiazide, amlodipine, aspirin and diazepam, recently medicated for a gouty crisis with colchicine and clonixin without improvement. Believing it could help in the treatment of gouty crisis symptoms he took about 1.5 L of artichoke infusion (Cynara cardunculus). He felt better and did agriculture work but developed a distal muscle pain, severe anemia, standard biochemical liver cholestasis, increase of alkaline phosphatase and marked increase of inflammatory parameters (hyperleucocytosis) and enters in the emergency department at the hospital. OBJECTIVE: Evaluation of the cause of complaints and laboratory abnormalities and the involvement of artichoke infusion. RESULTS: The prominence of the inflammatory parameters was ruled out because of exhaustive autoimmune, infectious or para-neoplastic syndrome (blood cultures, serology, diagnostic imaging, bone marrow and bone biopsy, muscle biopsy and nerve, abdominal angiography) were carried out showing normal results. The evaluation pointed out that the concomitant intake of artichoke infusion may have been involved in the framework developed, since the drugs which were being administered to/by the patient have a metabolism mainly mediated by CYP450 3A4 and 2C9 that could be compromised when these isoenzymes are inhibited by phenolic and flavonoid compounds from plants. Colchicine was one of the last drugs took that have as side effects most of the symptoms felt by patient including diarrhea and anemia. CONCLUSION: The spontaneous and complete recovery of the patient and the negativity of research looking for other causes, conduce to a strong possibility of the interaction between artichoke and the drugs in the clinical presentation of this case.

Comparative evaluation of Melissa officinalis L., Tilia europaea L., Passiflora edulis Sims. and Hypericum perforatum L. in the elevated plus maze anxiety test.

There are numerous plants that have been used for their 'tranquillising' properties in Portuguese folk medicine. This report will describe a comparative analysis of the effects of Melissa officinalis L., Tilia europaea L., Passiflora edulis Sims. and Hypericum perforatum L. on the performance of mice in the elevated plus maze, open-field, and horizontal-wire tests. We have tested lyophilised aqueous extracts with doses ranging from 5-100 mg/kg prepared according to traditional folk medicine. The results indicate that Hypericum perforatum L. and Tilia europaea L. induced significant raise in immobility time, diminution of rearing and other parameters, suggesting a clear sedative effect at doses ranging from 10-100 mg/kg. Below these doses, Tilia europaea L. did not induce any significant change in the tests mentioned, while Hypericum perforatum L. (5 mg/kg) increased the time spent in the open areas of the elevated plus maze and the percentage of unprotected head-dips and stretch-approach postures, thus indicating an anxiolytic effect. For this dose, there were no significant changes in motor activity as measured by classical parameters for the tests used. As the infused H. perforatum L. tested was devoid of hyperforin, it can be stated that the observed effects cannot be attributed to this substance.

Galphimia glauca organic fraction antagonizes LTD(4)-induced contraction in guinea pig airways.

Galphimia glauca is used for the treatment of asthma and allergies in Latin American traditional medicine. The ethylacetate fraction from its aerial parts was assayed for bronchoconstriction induced by antigen and several agonists in guinea pig tracheae. The organic fraction significantly inhibited the contractile response to ovalbumin in tracheae from sensitized guinea pigs, and significantly and selectively inhibited the bronchoconstriction induced by leukotriene D(4) (LTD(4)). The relative potency of the ethylacetate fraction of G. glauca to produce a concentration-dependent rightward shift of LTD(4) concentration-response curve was similar to that reported for SK&F 104353, a well-known competitive LTD(4)-antagonist.

Xanthorrhizol induces endothelium-independent relaxation of rat thoracic aorta.

Xanthorrhizol, a bisabolene isolated from the medicinal plant Iostephane heterophylla, was assayed on rat thoracic aorta rings to elucidate its effect and likely mechanism of action, by measuring changes of isometric tension. Xanthorrhizol (1, 3, 10, 30 and 100 microg/mL) significantly inhibited precontractions induced by KCI-; (60mM), noradrenaline (10(-6) M) or CaCl2 (1.0 mM). Increasing concentrations of external calcium antagonized the inhibitory effect on KCl-induced contractions. The vasorelaxing effect of xanthorrhizol was not affected by indomethacin (10 microM) or L-NAME (100 microM) in intact rat thoracic aorta rings precontracted by noradrenaline, which suggested that the effect was not mediated through either endothelium-derived prostacyclin (PGI2) or nitric oxide release from endothelial cells. Endothelium removal did not affect the relaxation induced by xanthorrhizol on rat thoracic aorta rings, discarding the participation of any substance released by the endothelium. Xanthorrhizol inhibitory effect was greater on KCI- and CaCl2-induced contractions than on those induced by noradrenaline. Xanthorrhizol inhibitory effect in rat thoracic aorta is likely explained for interference with calcium availability by inhibiting calcium influx through both voltage- and receptor-operated channels.

Effect of xanthorrhizol, xanthorrhizol glycoside and trachylobanoic acid isolated from Cachani complex plants upon the contractile activity of uterine smooth muscle.

Xanthorrhizol, xanthorrhizol glycoside, and trachylobanoic acid, compounds isolated from medicinal plants that are grouped in the complex known as Cachani have been shown to inhibit the tonic contraction of rat uterus induced by: (a) depolarizing K+ solution (60 mM), (b) CaCl2 (1 mM), and (c) BAY K 8644 (0.3 microM) in a concentration-dependent manner (1-30 micrograms/mL). The inhibitory potency was displayed as follows: xanthorrhizol > xanthorrhizol glycoside > trachylobanoic acid. These results suggest that the assayed compounds might block voltage operated calcium influx in myometrial cells as they displayed a calcium-antagonistic activity. This effect is not due to peripheral receptor activation (beta 2-adrenergic, H2-histaminergic) as neither propranolol nor cimetidine modified the inhibitory effect of the compounds assayed. This is the first report showing that plants belonging to the Cachani complex may contain uterine smooth muscle bioactive substances.