Clinical pharmacokinetics of nebivolol: a systematic review.

Nebivolol is a beta-1 receptor blocker used to treat hypertension, heart failure, erectile dysfunction, vascular disease, and diabetes mellitus. This review investigated the data regarding pharmacokinetic (PK) parameters, drug-drug interactions, dextrorotatory (D), and levorotatory (L) stereoisomers of nebivolol. The articles related to the PK of nebivolol were retrieved by searching the five databases; Google Scholar, PubMed, Cochrane Library, ScienceDirect, and EBSCO. A total of 20 studies comprising plasma concentration-time profile data following the nebivolol's oral and intravenous (IV) administration were included. The area under the concentration-time curve from zero to infinity (AUC0-∞) was 15 times greater in poor metabolizers (PMs) than in extensive metabolizers (EMs). In hypertensive patients, L-nebivolol expressed a higher maximum plasma concentration (Cmax) than D-nebivolol, i.e. 2.5 ng/ml vs 1.2 ng/ml. The AUC0-∞ of nebivolol was 3-fold greater in chronic kidney disease (CKD). The clearance (CL) was increased in obese than in controls from 51.6 ± 11.6 L/h to 71.6 ± 17.4 L/h when 0.5 mg/ml IV solution was infused. Nebivolol showed higher Cmax, AUC0-∞ and half-life (t1/2) when co-administered with bupropion, duloxetine, fluvoxamine, paroxetine, lansoprazole, and fluoxetine. This concise review of nebivolol would be advantageous in assessing all PK parameters, which may be crucial for clinicians to avoid drug-drug interactions, prevent adverse drug events and optimize the dosage regimen in diseased patients diagnosed with hypertension and cardiovascular disorders.

Human exposure to trace metals and arsenic via consumption of fish from river Chenab, Pakistan and associated health risks.

This study provided the first hand data of trace elements into fish muscles (N = 65) collected from river Chenab in Pakistan during 2013, using inductively coupled plasma mass spectrometry (ICP-MS). We monitored the health risk associated with consumption of contaminated fish of river Chenab, by the local population. The mean concentrations (µg/g, wet weight), in descending order were: Zn (35.5-54.4), Cu (1.38-4.57), Mn (2.43-4.5), As (0.23-1.21), Cr (0.21-0.67), Ni (0.14-0.34), Pb (0.14-0.31), Co (0.09-0.12), Cd (0.07-0.12) with higher concentration to be observed in the herbivore fish species (i.e., Cirrhinus reba and Catla catla). The levels of trace elements in different fish species found in this study were compared with similar data worldwide, and with the international standards for consumption. The concentration (µg/g) of arsenic in many cases (>65%) exceeded the FAO/WHO expert committee on food additives permissible limits. From the human health point of view, this study highlights that the local inhabitants, (i.e., fisher folk communities and population frequently consuming fish at about 100 g/day) along the river Chenab are exposed chronically to arsenic pollution with carcinogenic (10-4 to 10-6) and non-carcinogenic (THQ>1) risks, especially from the intake of Cirrhinus reba.