No changes of cholesterol levels with a commercially available glucosamine product in patients treated with lipid lowering drugs: a controlled, randomised, open cross-over trial.

BACKGROUND: The widespread use of natural health products is also a problem, as they could interact with prescribed drugs in patients. One commonly used product is glucosamine for osteoarthritis and some reports have found increased values of cholesterol and other lipids in patients treated with simvastatin for hypercholesterolemia. The aim of this trial was to investigate the effects of glucosamine on s-cholesterol levels (total s-cholesterol, s-HDL, s-LDL) in primary care patients on treatment with simvastatin or atorvastatin. METHODS: Controlled, randomized, open, crossover pharmacodynamic study in two primary health care centres. Patients were treated with Artrox(®) (glucosamine) 625 mg twice daily and control (a commercially available multivitamin tablet Vitamineral(®)). The study started with a run-in period of four weeks followed by control or active treatment with randomization of sealed envelopes. Each treatment period was four weeks and the treatment with simvastatin or atorvastatin was unchanged during the study (12 weeks). 34 patients were treated with a stable dose of simvastatin (n=21) or atorvastatin (n=13) for at least three months. Assessments of total s-cholesterol, s-HDL, S-LDL and s-triglycerides were performed in the morning with the patients in a fasting condition. T-tests for paired samples were used for statistical analyses and a p-value <0.05 was considered significant. Endpoints were the differences in lipid values at week 8 and week 12. RESULTS: All patients completed the study. No significant changes were seen on any of lipid levels in the simvastatin group. CONCLUSION: The actual glucosamine product did not change lipid levels of patients treated with simvastatin. Atorvastatin group was too small for safe calculations but was also without changes. TRIAL REGISTRATION: EUDRACT2006-001458-28.

Effects of treatment with a commercially available St John's Wort product (Movina) on cholesterol levels in patients with hypercholesterolemia treated with simvastatin.

OBJECTIVE: To assess the effect of treatment with a St John's Wort product (Movina) on cholesterol levels (total cholesterol, LDL-cholesterol, and HDL-cholesterol) in patients with hypercholesterolemia on treatment with a stable dose of simvastatin. DESIGN: Controlled, randomized, open, crossover pharmacodynamic study. SETTING: Two primary healthcare centres. Intervention. Patients were treated with Movina one tablet (containing 300 mg of Hypericum perforatum) twice daily and control (a commercially available multivitamin tablet, Vitamineral). The trial started with a run-in period of 4 weeks. Then the treatment order between control and active treatment was decided (randomization using sealed envelopes). The duration of each treatment period was 4 weeks and simvastatin treatment was kept unchanged during the whole study period (12 weeks). SUBJECTS: Twenty-four patients with hypercholesterolemia treated with a stable dose of simvastatin (10-40 mg daily) for at least three months. MAIN OUTCOME MEASURES: Assessments of total cholesterol, HDL- cholesterol, LDL-cholesterol, and triglycerides were performed in the morning with the patients in a fasting condition. RESULTS: All patients completed the study. LDL-cholesterol was significantly increased during active treatment compared with control. Thus, the mean LDL-cholesterol after 4 weeks' active treatment was 2.72 mmol/L compared with 2.30 mmol/L after treatment with control (p <0.0001). An increase in total-cholesterol was also observed (5.08 mmol/L compared with 4.56 mmol/L, p <0.0001). CONCLUSION: Products containing St John's Wort should not be given to patients with hypercholesterolemia who are on treatment with simvastatin.

[Iron deficiency is a common cause of bad response to epoetin treatment. It's important to follow iron status--not only the Hb value]. / Järnbrist vanlig orsak till dålig effekt av epoetinbehandling. Viktigt att följa järnstatus--inte bara Hb-värde.

Anaemia in patients with chronic kidney disease can be treated with epoetin. An adequate iron status is necessary for an optimal epoetin treatment effect. Guidelines from the Swedish Association of Nephrology recommend that haemoglobin (Hb) and iron status should be investigated every 3 - 6 months. Recommended target values are 110-130 g/l (Hb), >20% (transferrin saturation) and >100 microg/l (S-ferritin). A cross-sectional study was performed in 173 pre-dialysis patients (GFR <20 ml/minx1.73 m2 BSA), 35% of whom received epoetin. In epoetin-treated patients, laboratory investigations as recommended in the guidelines were present for 100% (Hb), 67% (transferrin saturation) and 62% (S-ferritin) of the patients. In these patients, target values were reached for 57% (Hb), 66% (transferrin saturation) and 58% (S-ferritin). Forty percent of the epoetin-treated patients had absolute iron deficiency, 60% of whom received iron therapy. In conclusion, adherence to guidelines concerning epoetin and iron therapy in patients with chronic kidney disease could probably be improved.